Beyond the brain: General intensive care considerations in pediatric neurocritical care.

Managing children with critical neurological conditions requires a comprehensive understanding of several principles of critical care. Providing a holistic approach that addresses not only the acute interactions between the brain and different organ systems, but also critical illness-associated complications and recovery is essential for improving outcomes in these patients. The brain reacts to an insult with autonomic responses designed to optimize cardiac output and perfusion, which can paradoxically be detrimental. Managing neuro-cardiac interactions therefore requires balancing adequate cerebral perfusion and minimizing complications. The need for intubation and airway protection in patients with acute encephalopathy should be individualized following careful risk/benefit deliberations. Ventilatory strategies can have profound impact on cerebral perfusion. Therefore, understanding neuro-pulmonary interactions is vital to optimize ventilation and oxygenation to support a healing brain. Gastrointestinal dysfunction is common and often complicates the care of patients with critical neurological conditions. Kidney function, along with fluid status and electrolyte derangements, should also be carefully managed in the acutely injured brain. While in the pediatric intensive care unit, prevention of critical illness-associated complications such as healthcare-associated infections and deep vein thrombosis is vital in improving outcomes. As the brain emerges from the acute injury, rehabilitation and management of delirium and paroxysmal sympathetic hyperactivity is paramount for optimal recovery. All these considerations provide a foundation for the care of pediatric patients with critical neurological conditions in the intensive care unit.

Attitudes on Artificial Intelligence use in Pediatric Care From Parents of Hospitalized Children.

INTRODUCTION: Artificial intelligence (AI) may benefit pediatric healthcare, but it also raises ethical and pragmatic questions. Parental support is important for the advancement of AI in pediatric medicine. However, there is little literature describing parental attitudes toward AI in pediatric healthcare, and existing studies do not represent parents of hospitalized children well. METHODS: We administered the Attitudes toward Artificial Intelligence in Pediatric Healthcare, a validated survey, to parents of hospitalized children in a single tertiary children's hospital. Surveys were administered by trained study personnel (11/2/2021-5/1/2022). Demographic data were collected. An Attitudes toward Artificial Intelligence in Pediatric Healthcare score, assessing openness toward AI-assisted medicine, was calculated for seven areas of concern. Subgroup analyses were conducted using Mann-Whitney U tests to assess the effect of race, gender, education, insurance, length of stay, and intensive care unit (ICU) admission on AI use. RESULTS: We approached 90 parents and conducted 76 surveys for a response rate of 84%. Overall, parents were open to the use of AI in pediatric medicine. Social justice, convenience, privacy, and shared decision-making were important concerns. Parents of children admitted to an ICU expressed the most significantly different attitudes compared to parents of children not admitted to an ICU. CONCLUSIONS: Parents were overall supportive of AI-assisted healthcare decision-making. In particular, parents of children admitted to ICU have significantly different attitudes, and further study is needed to characterize these differences. Parents value transparency and disclosure pathways should be developed to support this expectation.

Clonidine for the Treatment of Agitation After Dexmedetomidine Discontinuation in Pediatric Patients: A Retrospective Cohort Study.

OBJECTIVE: Dexmedetomidine has become a widely used drug in PICUs for sedation. We aim to determine the effects of clonidine on pediatric patients after dexmedetomidine use. METHODS: This was a retrospective cohort study that evaluated all pediatric patients admitted to a tertiary PICU who received dexmedetomidine infusion for >48 hours. Outcomes in patients exposed to clonidine (CLON) were compared with those of patients who were not exposed (NoCLON). RESULTS: A total of 216 patients were included in this study (43 CLON and 173 NoCLON). The primary outcome, agitation, was less in the CLON cohort (9.3%) than in the NoCLON cohort (9.3% versus 29.5%, respectively; p < 0.01). Hospital LOS was longer in the CLON group (59 versus 20 days, p < 0.01), as was PICU LOS (37.4 versus 11.1 days, p < 0.01). There was no significant difference in the occurrence of increased heart rate or blood pressure between the 2 cohorts. Patients exposed to concurrent midazolam and opioid infusions had higher incidence of agitation when they did not receive clonidine (CLON 8% versus NoCLON 37%, OR 0.15; 95% CI, 0.05-0.51; p < 0.01). In contrast, there was no difference in the incidence of agitation for the CLON group versus the NoCLON group when dexmedetomidine was administered alone (25% versus 19%, OR 1.4; p = 0.99). CONCLUSIONS: Our study confirms the importance and effectiveness of clonidine to treat agitation after dexmedetomidine discontinuation. A validated withdrawal scoring tool can help better define dexmedetomidine withdrawal in pediatric patients.

Detection of suspected carcinogen azo dyes in textiles using thermogravimetric analysis.

Textiles that are in direct contact with human skin are problematic due to the possibility of transferring the dyes or their aromatic amine metabolites through direct contact. 18 samples of women underwear panties of different colors and fabrics materials were examined for their content of azo dyes using thermogravimetric-gas chromatography-mass spectrometry (TGA-GCMS) technique. The nature of fabrics (cotton, nylon, and polyesters) was identified based on their unique thermogravimetric analyses (TGA) pattern. Aromatic amines produced from thermal degradation of the samples were identified using NIST mass spectra data base. Aniline was found in all samples regardless of their color or fabric composition. Black cotton textiles were characterized by the presence of diaminobenzene, red cotton sample showed the presence of 4-amino-3-nitrobenzene-1-sulfonic acid, blue cotton sample showed the presence of chlorobenzenediamine and chloroaniline, and purple cotton textiles showed the presence of 4-nitroaniline. All four purple nylon samples contained nitroaniline and biphenylamine, the three red nylon samples contained nitroaniline and methyldihydro-thiadiazole, the two pink samples showed the presence of chloro-2-(trifluoromethyl) anilinechloro- benzenediamine, the purple polyethylene sample show the presence of diphenyldiazene, and the brown polyester sample showed the presence of 2-amino-1,4-phenylene) dimethanol.[Formula: see text].

Effect of exposure to light emitted diode (LED) lights on essential oil composition of sweet mint plants.

Sweet mint plants (Mentha spicata) were separately exposed to blue, red and green light emitted diodes (LED) lights and natural sunlight as a control. Leaves were analyzed periodically for their essential oil composition using head space GCMS analysis. Control experiments showed that the main essential oil components were carvone (80%), limonene (17%) and other minor terpenes (3%). Exposed plants to green and red lights showed that their headspace essential oils were similar to that of the control plants. However, blue LED lights caused complete disappearance of carvone and limonene, which were never recovered. Disappearance of carvone and limonene were associated with the appearance of new chemicals at concentrations of 65 and 21% that were identified as carvone oxide and eucalyptol, respectively.