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Background In the United States, post-cardiac arrest debriefing has increased, but historically it has occurred rarely in our pediatric intensive care unit (PICU). A fellow-led debriefing tool was developed as a tool for fellow development, as well as to enhance communication amongst a multidisciplinary team. Methods A curriculum and debriefing tool for fellow facilitators was developed and introduced in a 41-bed cardiac and medical PICU. Pre- and post-intervention surveys were sent to multidisciplinary PICU providers to assess effectiveness of debriefings using newly-trained leaders, as well as changes in team communication. Results Debriefing occurred after 84% (63/75) of cardiac arrests post-intervention. Providers in various team roles participated in pre-intervention (129 respondents/236 invitations) and post-intervention (96 respondents /232 invitations) surveys. Providers reported that frequently occurring debriefings increased from 9 to 58%, pre- and post-intervention respectively ( p < .0001). Providers reported frequent identification and discussion of learning points increased from 32% pre- to 63% post-intervention. In the 12 months post-intervention, 62% of providers agreed that the overall quality of communication during arrests had improved, and 61% would be more likely to request a debriefing after cardiac arrest. Conclusion The introduction of a fellow-led debriefing tool resulted in regularly performed debriefings after arrests. Despite post-intervention debriefings being led by newly-trained facilitators, the majority of PICU staff expressed satisfaction with the quality of debriefing and improvement in communication during arrests, suggesting that fellow facilitators can be effective debrief leaders.

We describe 2 patients with coronavirus disease who had multiple clinical features suggestive of Kawasaki disease (KD). Both patients presented with fever lasting .5 days and were found to have rash, conjunctival injection, and swollen lips. One patient also had extremity swelling, whereas the other developed desquamation of the fingers. In both cases, laboratory results were similar to those seen in KD. These patients had highly unusual but similar features, and both appeared to respond favorably to treatment. It remains unclear whether these patients had true KD or manifestations of coronavirus disease that resembled KD.

Crosstalk signaling between the closely juxtaposed epithelial and endothelial membranes of pulmonary alveoli establishes the lung’s immune defense against inhaled and blood-borne pathogens. The crosstalk can occur in a forward direction, as from alveolus to capillary, or in a reverse direction, as from capillary to alveolus. The crosstalk direction likely depends on the site at which pathogens first initiate signaling. Thus, forward crosstalk may occur when inhaled pathogens encounter the alveolar epithelium, while reverse crosstalk may result from interactions of blood-borne pathogens with the endothelium. Here, we review the factors that regulate these two directions of signaling.

Purpose of Review The purpose of this review is to summarize the recent literature on pediatric acute respiratory distress syndrome (PARDS). This review will focus on, but not be limited to, literature using the recent definition of PARDS established by the Pediatric Acute Lung Injury Consensus Conference (PALICC) group in 2015. Recent Findings Mortality rates for PARDS have recently decreased to 10-15%. Clinical trials in PARDS have (1) emphasized the relative importance of early oxygenation in predicting mortality; (2) suggested a role for protocolized sedation in patients managed with extracorporeal membrane oxygenation (ECMO); (3) found no mortality benefit to highfrequency oscillatory ventilation (HFOV), exogenous surfactant, or corticosteroids; and (4) suggested biomarkers and whole exome sequencing as methods for personalizing management. Recent laboratory studies have suggested differences in responsiveness to high tidal volume injury in juvenile rodents. Summary The near future of PARDS management could include earlier risk stratification of patients by (1) oxygenation within 24 h of PARDS diagnosis and (2) use of biomarkers and subphenotypes. Despite challenges in performing clinical trials in children, the PALICC definition presents an opportunity to explore these and more research questions in PARDS separately from adult cohorts. Keywords Acute lung injury . ARDS . Pediatrics . Berlin definition . PARDS . PALICC This article is part of the Topical Collection on Intensive Care Medicine

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