Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

US-guided CVC placement in children is associated with decreased number of anatomical sites attempted and decreased number of attempts to gain placement. Time to placement by residents was decreased with US, but not the time to placement by other operators. US guidance increased the use of internal jugular catheter placement and decreased artery punctures. US guidance did not improve success rates.

Pediatric procedural sedation using propofol can be provided by pediatric critical care physicians effectively and with a low incidence of adverse events.

Objective-Most studies of ketamine administered to children for procedural sedation are limited to emergency department use. The objective of this study was to describe the practice of ketamine procedural sedation outside of the operating room and identify risk factors for adverse events.Design-Observational cohort review of data prospectively collected from 2007 to 2015 from the multicenter Pediatric Sedation Research Consortium.Setting-Sedation services from academic, community, free-standing children's hospitals and pediatric wards within general hospitals.Patients-Children from birth to 21 years old or younger. Interventions-None.Measurements and Main Results-Describe patient characteristics, procedure type, and location of administration of ketamine procedural sedation. Analyze sedation-related adverse Drs, Grunwell and Kamat conceived and developed the study and wrote the article. Drs. Travers and McCracken conducted statistical analyses and edited the article. Drs. Scherrer, Stormorken, Chumpitazi, Roback, and Stockwell edited the article. All authors read and approved the article.Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal).The remaining authors have disclosed that they do not have any potential conflicts of interest. Conclusions-This is a description of a large prospectively collected dataset of pediatric ketamine administration predominantly outside of the operating room. The overall incidence of severe adverse events was low. Risk factors associated with increased odds of adverse events were as follows: cardiac and gastrointestinal disease, lower respiratory tract infection, and the coadministration of propofol and anticholinergics. HHS Public AccessKeywords adverse events; ketamine; laryngospasm; pediatric procedure sedation; risk factorsThere is a growing demand to provide procedural sedation (PS) for children outside of the operating room (OR). Subspecialists such as intensivists, emergency medicine physicians, anesthesiologists, and hospitalists, all provide PS for children. Ketamine has been used by emergency medicine physicians for well over 2 decades for primarily painful procedures (1-13). We used the Pediatric Sedation Research Consortium (PSRC) database to describe the administration of ketamine during PS, characterize the adverse events (AEs), and identify the risk factors associated with AEs or severe AEs (SAEs). Based on previous studies, we hypothesized that age less than 12 months or greater than 13 years, coadministration of anticholinergics or benzodiazepines, lower respiratory tract illness, and American Society of Anesthesiologists-Physical Status (ASA-PS) greater than or equal to III would be associated with an AEs (12,(14)(15)(16)(17). METHODS Study Design and Data CollectionThis study is an observational cohort review of prospectively collected data obtained from the multicenter PSRC dat...

ABSTRACT. Objective. To describe findings of deep venous thrombosis (DVT) in association with femoral central venous catheter (CVC) placement for intensive fluid management in children with diabetic ketoacidosis (DKA) secondary to type 1 diabetes.Design. Retrospective cohort study. Setting. Pediatric intensive care unit (PICU) of a children's referral medical center.Patients. DKA patients from 1998 to 2002 of children with DKA with and without CVC placement. DKA patients were also compared with all PICU patients with CVC. CVC DVT was defined as ipsilateral leg swelling with CVC placement, confirmed by radiographic study, and persisting after CVC removal.Measurements and Main Results. Of 113 DKA PICU patients, 6 (5.3%) required femoral CVC for initial management. Three of these DKA/CVC patients developed ipsilateral DVT within 48 hours of CVC placement. All 3 patients required long-term therapy with low molecular weight heparin for persistent leg swelling. DKA/CVC patients with DVT were younger (median age: 10.5 months) than DKA/CVC patients without DVT. The number of DKA/CVC patients with DVT (1.4%) was significantly greater than for all femoral non-DKA/CVC patients. DKA/CVC patients were also significantly more likely to have DVT than age-matched shock/CVC patients. They also had significantly higher glucose, corrected sodium concentrations, and lower pH and serum bicarbonate than did age-matched shock/CVC patients.Conclusions. Femoral CVC placement is infrequently needed in pediatric DKA patients but can be associated with DVT. Femoral CVCs should be avoided in DKA patients or removed as soon as possible. DVT prophylaxis should be considered if a CVC is required. C entral venous catheter (CVC) placement can be essential for providing fluids and medications in the treatment of the child with hypoperfusion and difficulty obtaining adequate peripheral access. CVCs, however, are associated with a variety of infectious and noninfectious complications. 1,2 Both percutaneous and chronic indwelling CVCs are a significant risk factor for deep venous thrombosis (DVT) in children. 1,2 Pediatric venous thromboembolism registries have reported that 28% to 50% of DVT episodes in children occurred in the presence of an acute or chronic CVC. 3,4 The reported incidence of DVT in pediatric intensive care unit (PICU) patients with a CVC ranges widely depending on whether clinical or radiographic evidence of DVT is evaluated. 1,[5][6][7][8] One prospective study of acute CVC placement in PICU patients found a 7.5% incidence of symptomatic DVT but an incidence of 18.3% based on radiographic evidence. 1 Previous experience has demonstrated increased incidence of DVT in children with chronic conditions such as malignancy or congenital heart disease or with acute infection, surgery, trauma, or hypovolemia. 9,10 Diabetes mellitus has not been described as a specific isolated risk factor for DVT in children, although a propensity for hypercoagulability has been noted in diabetic adults. 11 Despite growing experience regarding CVC-relat...

The majority of cases (70.9%) admitted to the PICU following an intoxication did not undergo any significant intervention. Future studies should focus on distinguishing patient and intoxication characteristics associated with need for PICU intervention to optimize patient safety and minimize resource burden.

Presence of a URI, a history of OSA/snoring, ASA class III, obesity, and older age are associated with increased probability of failed sedation. A prospective, multicenter observational study would allow for the robust modeling of comorbidities to guide pediatric sedation management.