RPRT reduced the need for specialized pediatric IFT, while enabling regionalization when appropriate. This study may have implications for the broader implementation of RPRT, while reducing costs to the healthcare system.

No abstract

Elevated PedCTAS, TPEWS, and TRAP scores are strongly associated with PICU admission within the interfacility transport setting.

Severe pododermatitis is a common lesion in turkeys, unlike in broiler chickens. Both dietary factors (soybean meal, biotin, methionine) and poor litter conditions (wet litter) are documented etiologies of footpad lesions. In the United States and United Kingdom both farm managers and processors monitor lesions. The United Kingdom reports an average footpad relative score higher than that of the United States. In both countries, incidence in toms is higher than in hens. There is no significant difference by country. Data support no consistent association with other lesions (i.e., breast blisters or condemnations), breed, or performance parameters (i.e., weight gain or age). The litter type used in the United Kingdom is either straw or wood shavings, whereas in the United States producers predominantly use wood shavings. In the United Kingdom, diets are formulated with a higher protein, which affects the excreta and subsequent litter conditions. British United Turkey is the predominate breed in the United Kingdom. In the United States, three breeds, British United Turkey of America, hybrid, and Nicholas, are common. Recent research has demonstrated the association between biotin levels and pododermatitis. Factors associated with pododermatitis (such as production systems, wet litter, and stocking density) are discussed. There are some indications that increased stocking density is associated with pododermatitis lesions. Further research is needed to identify what management factors are associated with pododermatitis.

Early increased ICP is a common presentation of severe pediatric TBI during pre-trauma center management. However, what constitutes optimal care remains unknown. Given the difficulties of diagnosing early increased ICP in this setting, prophylactic raising ICP-lowering strategies may be considered.

A technique for scintigraphically quantitating solid-phase gastric emptying in the dog was developed in a Beagle model. The test meal was determined to empty in a linear fashion, indicating a solid-phase label. The evaluation was performed on a group of dogs presented for gastrointestinal signs that were judged to have normal liquid barium sulfate fluoroscopic and radiographic studies. The results of this study indicate that this technique is valuable for identifying those patients with surgically correctable pyloric obstruction that exhibit normal gastric emptying of liquid barium.

Background Delivery of non‐invasive ventilation commonly occurs in the pediatric intensive care unit (PICU). With the advent of high‐flow nasal cannula (HFNC), patients with respiratory distress may be rescued on the ward without a PICU admission. We evaluated our ward HFNC algorithm to determine its safety profile and independent predictors for non‐responders, defined as requiring subsequent PICU admission. Methods A retrospective chart review of patients <17 years of age admitted with respiratory distress between 2016 and 2017 was carried out. Pediatric Early Warning System (PEWS) respiratory score was used to assess the clinical response of patients requiring HFNC. Variables associated with non‐responders were evaluated, and their PICU admission was studied for escalation of care and criticality. Results Patients with comorbidities (P = 0.02) were more likely to require HFNC. Of the 18 patients initiated on HFNC, 44% (n = 8) remained on the ward. Non‐responders (n = 10; 56%) had higher (2.7 vs 1.8; P = 0.03) and worsening (−0.1 vs 0.3; P = 0.05) PEWS respiratory scores 90 min after HFNC initiation. Eighty percent (n = 8) of non‐responders required escalation to continuous positive airway pressure or bilevel positive airway pressure in the PICU. For both HFNC responders and non‐responders, there were no requirements for intubation, evidence of air leak or difference in days of respiratory support. Conclusions High and worsening PEWS scores 90 min after HFNC initiation may indicate non‐response when coupled with a standardized ward HFNC algorithm for respiratory distress. Further improvements may be seen with an earlier initiation of HFNC in the emergency department and more aggressive flow escalation on the ward.

There is an unmet need for clinicians with expertise in the practice of brain-directed critical care for children. Although much of the practice of PNCC may remain empiric, a focus on the regionalization of care, creating defined training paths, practice within multidisciplinary teams, protocol-directed care, and improved measures of long-term outcome to quantify the impact of such care can provide evidence to direct the maturation of this field.