Prevalence of Acute Neurologic Insults : A Case for Going Global *

Pediatric Critical Care Medicine www.pccmjournal. org 383 based on common definitions of pulmonary and extrapulmonary organ dysfunction and failure, consistent with the original trial protocol. The investigators used multivariate logistic regression to identify risk factors for MODS, and logistic or proportional hazards regression to compare clinical outcomes of individual patients from each PICU as a cluster variable. They found that 73% of the 2,449 children enrolled in RESTORE trial exhibited extrapulmonary organ dysfunction, with 1,547 (63%) showing concurrent MODS on day 0/1 and 244 (10%) showing newly occurred MODS on day 2 and beyond. Most patients (93%) with secondary (indirect) lung injury following sepsis presented signs of MODS, whereas those with primary (direct) lung injury could have both concurrent (56%) and new (12%) MODS. They also compared the risk factors for concurrent and new MODS, which were associated with 90-day in-hospital mortality after adjusting for sepsis, moderate/severe lung injury, and other baseline characteristics. They concluded that extrapulmonary organ dysfunction which occurred concurrently with respiratory dysfunction, especially in sepsis patients, was a major risk factor for mortality in pediatric acute respiratory failure. These findings confirmed our already known knowledge that sepsis is associated with a high mortality in pediatric acute hypoxemic respiratory failure. The original RESTORE study was a well-conducted randomized, controlled trial in PICU settings with advanced nursing care-based sedation protocols for patients from 2 weeks to 17 years old. The sample size, underlying morbidities, and investigation methodologies represented the contemporary standard of care. The diagnostic tools on study enrollment were adequately employed, and the trial showed good quality control although it was prematurely terminated when 50% of cases were enrolled. The original trial did not find the sedation protocol, when compared with usual and the Difficult Airway Society. Part 2: Intensive care and emergency departments. Br J Anaesth 2011; 106:632–642 4. Wang HE, Mann NC, Mears G, et al: Out-of-hospital airway management in the United States. Resuscitation 2011; 82:378–385 5. Sagarin MJ, Barton ED, Chng Y-M, et al: Airway Management by US and Canadian Emergency Medicine residents: A multicenter analysis of more than 6000 endotracheal intubation attempts. Ann Emerg Med 2005; 46:328–336 6. Walls RM, Brown CA 3rd, Bair AE, et al; NEAR II Investigators: Emergency airway management: A multi-center report of 8937 emergency department intubations. J Emerg Med 2011; 41:347–354 7. Nishisaki A, Ferry S, Colborn S, et al; National Emergency Airway Registry (NEAR); National Emergency Airway Registry for kids (NEAR4KIDS) Investigators: Characterization of tracheal intubation process of care and safety outcomes in a tertiary pediatric intensive care unit. Pediatr Crit Care Med 2012; 13:e5–e10 8. Nishisaki A, Turner DA, Brown CA 3rd, et al; National Emergency Airway Registry for Children (NEAR4KIDS); Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: A National Emergency Airway Registry for children: Landscape of tracheal intubation in 15 PICUs. Crit Care Med 2013; 41:874–885 9. Sanders RC Jr, Giuliano JS Jr, Sullivan JE, et al; National Emergency Airway Registry for Children Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network: Level of trainee and tracheal intubation outcomes. Pediatrics 2013; 131:e821–e828 10. Parker MM, Nuthall G, Brown C, et al; for the National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes. Pediatr Crit Care Med 2017; 18:310–318 11. Miguel-Montanes R, Hajage D, Messika J, et al: Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med 2015; 43:574–583 12. Janz DR, Semler MW, Lentz RJ, et al; Facilitating EndotracheaL intubation by Laryngoscopy technique and apneic Oxygenation Within the ICU Investigators and the Pragmatic Critical Care Research Group: Randomized trial of video laryngoscopy for endotracheal intubation of critically ill adults. Crit Care Med 2016; 44:1980–1987