Editor’s Choice Articles for November

November 2022 from Pediatric Critical Care Medicine (PCCM): Start by reading my three Editor’s Choice articles (1−3) along with their accompanying editorials (4−6). Next, read about emergency medical care as this month’s educational theme highlighted in the section called PCCM Connections for Readers. Finally, before you move on to the other content in PCCM, read this month’s PCCM Narrative essay. WHAT CAN WE LEARN ABOUT INDIVIDUAL AND ORGANIZATIONAL WORK-LIFE FACTORS AND MORAL DISTRESS IN PICU PRACTITIONERS? Lamiani G, Barlascini L, Borghi L, et al; Open Doors in INtensive care (ODIN) Study group 2: Moral Distress in the Italian PICUs: The Role of Individual and Organizational Factors (1). My first Editor’s Choice article comes from the Open Doors in Intensive Care (ODIN) study group comprising 23 PICUs in Italy. The ODIN group surveyed 635 of 874 eligible clinicians (75%) with the purpose of exploring the interplay between individual factors (i.e., sex, profession, years of experience, spiritual/religious belief, and resilience) and organizational factors (i.e., number of admissions, mortality rate, nurse-to-patient ratio, and parent presence) on staff moral distress (1). The accompanying editorial is thoughtful and informative (4). WHAT ARE THE OUTCOMES OF EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) IN CHILDREN WITH PRE-EXISTING DEFICITS IN NEUROLOGY OR DISABILITY? Dante AS, Carroll MK, Ng DK, et al; Pediatric ECMO (PediECMO) subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Extracorporeal Life Support Organization (ELSO): Extracorporeal Membrane Oxygenation Outcomes in Children With Preexisting Neurologic Disorders or Neurofunctional Disability (2). My next Editor’s Choice article comes from the eight U.S. hospitals reporting to the Pediatric ECMO Outcomes Registry (PEDECOR) over a period of almost 8 years. The authors aimed to determine the prevalence and nature of pre-ECMO neurologic disorders or disability, and to investigate any association between such disorders with subsequent unfavorable outcomes (2). The accompanying editorial comes from experienced PCCM authors at centers in Boston, Sydney, and Toronto (5). Please read their insightful analysis of the PEDECOR report along with the article, and refer to recent PCCM articles on communication around the time of ECMO (7−9). WHAT ABOUT STANDARDIZING OUTCOME MEASURES FOR SURVIVORS OF PEDIATRIC CRITICAL ILLNESS? Pinto NP, Maddux AB, Dervan LA, et al; POST-PICU Investigators of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN): A Core Outcome Measurement Set for Pediatric Critical Care (3). My third Editor’s Choice article is a multi-author, international Delphi consensus from the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Pediatric Outcomes Studies after PICU (POST-PICU) investigators and the U.S. Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN). In this article, 35 expert investigators delineate measures to evaluate each of the domains in the PICU Core Outcome Sets (COS) (3). Our editorialists provide important discussion, and the hope is that by using the PALISI/CPCCRN POST-PICU consensus on COS, investigators will enable comparability across future research studies (6). PCCM CONNECTIONS FOR READERS The connections material this month focuses on the educational theme of delivering the best in emergency medical care. Each article comes with an editorial. First, there are two articles about cardiopulmonary resuscitation (CPR) (10−13). One is about calcium administration for in-hospital cardiac arrest (IHCA) in children with heart disease from the American Heart Association’s Get With The Guidelines-Resuscitation registry (10), and the other is from the ICU-RESUScitation Project dataset. This work looks at the timing of the COVID-19 pandemic, which resulted in adaptations in our system of care for performing CPR, and temporal associations with CPR quality and outcomes after IHCA (12). Second in the theme of emergency care is an article about burns and mechanical ventilation (14,15). Third, we have an article about high-dose midazolam for refractory status epilepticus (16,17). Having read this materials on emergency care in our specialty (10−17), take the time to appreciate the report from Australia and New Zealand (18), with an editorial discussant from South Africa (19), describing national organization and the delivery of centralized PICU practice. Finally, before moving on to the other content that interests you, read the Narrative Essay called “Waves” (20); a reflection about new starts, stress, burnout, and the need to support each other.

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