Editor’s Choice Articles for April

Another month of top-rated specialist articles in Pediatric Critical Care Medicine (PCCM). My three April 2024 Editor's Choice articles, each with editorials, cover familiar research themes in the Journal. For a change, alongside each of these highlights, I include some educational material usually found in the PCCM Connections section. The topics are pediatric acute respiratory distress syndrome (PARDS) (1,2), formal ethics consultation in cases of extracorporeal membrane oxygenation (ECMO) (3,4), and hemodynamics in cannulation for ECMO during active cardiopulmonary resuscitation (ECPR) (5,6). IS PARDS IN IMMUNOCOMPROMISING CONDITIONS (ICC) FUNDAMENTALLY DIFFERENT TO SEVERE PARDS IN CASES WITHOUT ICC? Gertz SJ, Bhalla A, Chima RS, et al; Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: Immunocompromised-Associated Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study (1). My first Editor's Choice article is a report using the 2016/2017 PARDS incidence and epidemiology (PARDIE) cohort. The accompanying editorial (2) is helpful because it reviews last year's articles using the PARDIE dataset: the association between platelet transfusion and diuretic use with unfavorable outcome (7); and the association between immunosuppression and noninvasive ventilation (NIV) failure (8,9). The PARDIE investigators delve deeper into the 2016/2017 dataset and compare 105 patients with ICC-associated PARDS with another 603 patients with severe PARDS without ICC. Platelet transfusion, diuretic use, and NIV-failure feature in the latest report (1). And of particular interest is how these factors could now add to our interpretation of the 2023 guidance in the Second Pediatric Acute Lung Injury Consensus Conference (10,11): should we consider ICC-associated PARDS as a separate clinical entity, and what about the utility of NIV-trials in such children? WHAT TYPE OF ETHICAL ISSUES IN ECMO PATIENTS ARE REFERRED TO A PEDIATRIC ETHICS COMMITTEE? Siegel B, Taylor LS, Alizadeh F, et al: Formal Ethics Consultation in Extracorporeal Membrane Oxygenation Patients: A Single-Center Retrospective Cohort of a Quaternary Pediatric Hospital (3). My second Editor's Choice article is a single-center review of formal ethics consultation in ECMO patients, 2012−2021 (3). This work is about 27 of 605 ECMO patients who were referred for ethics consultation, with a focus on frequent ethical themes that occur. The accompanying editorial provides a helpful discussion on how to maximize the benefits of ethics consultation (4). Read this material with the 2023 systematic review on prognostic and goals of care communication in the pediatric intensive care unit (12), and the 2022 reports on ECMO candidacy decisions (13–15). WHAT ARE THE RELATIONSHIPS BETWEEN EARLY-ARREST HEMODYNAMICS, CPR QUALITY METRICS, AND OUTCOMES IN ECPR PATIENTS? Yates AR, Naim MY, Reeder RW, et al: Early Cardiac Arrest Hemodynamics, End-Tidal Co2, and Outcomes in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016-2021) (5). My third Editor's Choice article is a secondary analysis of the ICU-Resuscitation project (ICU-RESUS) dataset, with a focus on invasive arterial waveform data in 97 patients undergoing ECPR. The potential usefulness of such monitoring in gauging pathophysiology is covered in the accompanying editorial (6). For a broader view, read this work from 2016−2021 with the recent ECPR data from the Extracorporeal Life Support Organization dataset (2017−2021) (16), and the Virtual Pediatric System database (2010−2018) (17). "PCCM CONNECTIONS" FOR READERS There are two other PCCM Connections educational items this month. The first is a Special Article from the Pediatric Data Science and Analytics (PEDAL) subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators network (18). The PEDAL article combines a scoping review on the use of supervised machine learning applications in PCCM research with a position paper on the standard needed for future PCCM articles using machine learning (19). The second item is a Professional Organization research perspective from the Sedation Consortium on Endpoints and Procedures for Treatment, Education and Research (SCEPTER) IV Workshop (20). The SCEPTER group has defined 25 consensus statements to improve the methodology of clinical studies involving analgesia and sedation in practices such as the PICU. Read these statements along with the Society of Critical Care Medicine clinical practice guidelines published in 2022 (21), because they relate to adding more to our evidence base. Finally, we have the return of the PCCM Narrative. This month I am pleased to present n essay from a 3rd year medical student giving us a touching piece called "Superhero" (22).