Editor’s Choice Articles for June

My Editor's Choice articles in the June issue of Pediatric Critical Care Medicine (PCCM) contain new material for three areas of practice: the availability of postacute care facilities across the United States (1,2); biomarkers and the sepsis phenotype characterized by persistent hypoxemia, encephalopathy, and shock (3); and healthcare burden and resource utilization following treatment for pediatric acute respiratory distress syndrome (PARDS) (4). In the PCCM Connections educational section we focus on cardiac critical care with more Entrustable Professional Activities (EPAs) for fellowship training (5,6), and new data on cardiac ICU (CICU) management (7–10). The PCCM International section highlights the worldwide state of continuous renal replacement therapy (CRRT) in pediatric critical care (11). And, last, we have a PCCM Narrative (12). WHAT IS THE SCALE OF PEDIATRIC POSTACUTE CARE FACILITIES ACROSS THE UNITED STATES? Straka NC, Franca UL, Franks JD, McManus ML: A National Survey of Pediatric Postacute Care Facilities (1). My first Editor's Choice article provides the results of a much-needed survey of pediatric facilities in the United States delivering rehabilitation for children requiring long-term, and subacute care, 2022 to 2023 (1). The authors used data from state regulatory websites within the Center for Medicare and Medicaid Services (CMS) and found information on 109 pediatric postacute care facilities in 39 states. The accompanying editorial comes from experts in the field (2). Their discussion extends our PCCM reporting and commentary on PICU survivorship with chronic medical complexity, special healthcare needs, and chronic medical illness (13–17). The editorial also emphasizes a continuum from the PICU through to rehabilitation facility placements, and the need to rethink "models of transition" from our acute care area of practice to the longer-term support needed by our patients and their families (18). WHAT ABOUT SERUM BIOMARKER PROFILES AND THE SEPSIS-RELATED HYPOXEMIA, ENCEPHALOPATHY, AND SHOCK PHENOTYPE? Atreya MR, Bennett TD, Geva A, et al; Novel Data-Driven Sepsis Phenotypes in Children Study and the Genomics of Pediatric Septic Shock Investigators: Biomarker Assessment of a High-Risk, Data-Driven Pediatric Sepsis Phenotype Characterized by Persistent Hypoxemia, Encephalopathy, and Shock (3). My second Editor's Choice article examines the association between cases defined with the sepsis-related phenotype of hypoxemia, encephalopathy, and shock (19,20), and their serum biomarker profile of systemic inflammation and endothelial activation (3). The authors used two datasets from 2003−2023, which involved 25 PICUs across the U.S. with over 15,000 patients, 1,800 of whom had septic shock. The authors use these data to encourage future research on phenotype, risk stratification, and trajectory in patients with sepsis. In fact, this information adds to two narratives about sepsis within PCCM: the Pediatric Sepsis Biomarker and Risk Model (PERSEVERE-II) and outcome data (21–24); and the analysis of "trajectory" in time series data (25,26). WHAT ABOUT POST-PICU ONGOING HEALTHCARE NEEDS AND BURDEN OF CARE FOR FAMILIES WITH CHILDREN WHO SURVIVE PARDS? Ames SG, Maddux AB, Burgunder L, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN): Healthcare Burden and Resource Utilization After Pediatric Acute Respiratory Distress Syndrome: A Secondary Analysis of the Collaborative Pediatric Critical Care Research Network Acute Respiratory Distress Syndrome Study (4). My third Editor's Choice article is a secondary analysis of a CPCCRN (Collaborative Pediatric Critical Care Research Network) PARDS dataset from eight U.S. PICUs, 2019−2020 (4). The authors identified over 100 patients with follow-up at 3- and 9-months after admission with PARDS. Of note, the authors were able to assess associations between long-term healthcare burden and preillness functional state and presence of chronic conditions. These data give us an additional dimension to the long-term outcomes after PARDS that warrant further research (27,28); there are also implications for long-term care that connect with the first Editor's Choice this month (1,2). "PCCM CONNECTIONS" FOR READERS The PCCM Connections educational topic this month is cardiac critical care. We have a commentary on fellowship training in the U.S. and Canada, which has been endorsed by the Pediatric Cardiac Intensive Care Society (5). In this article, the authors add to the nine EPAs in pediatric cardiac critical care published in 2022 (29,30), and map 110 training subcompetencies with the goal of standardizing a competency-based framework for trainees (5). There is also a thoughtful editorial about training pathways and certification in pediatric cardiac critical care (6). The remaining educational cardiac critical care material includes, first, a systematic review (up to 2023) on insertion of prophylactic peritoneal dialysis (PD) catheter in children undergoing cardiac surgery (7). These new data build on information from a previous systematic review (1981 to 2021) of early postoperative PD in infants after cardiac surgery (31,32), as well as findings in the 2018−2021 stepped-wedge cluster randomized trial in infants, comparing PD, continuous venovenous hemofiltration, and the Newcastle infant dialysis ultrafiltration system (33). Second, informative epidemiology from a single-center retrospective analysis (2007–2022) of length of stay after surgery for hypoplastic left heart syndrome in relation to a metric of social determinants of health, the area deprivation index (ADI) (8). This report should be read in the context of similar reports from the general PICU population that have examined geospatial social determinants of health (34), and the ADI (35). Third, see how practitioners in one center approached use of antihypertensive treatment for blood pressure control in infants after surgery for congenital heart disease (2016–2020) (9). This historical review compared use of nicardipine and nitroprusside; read both the authors conclusions for their contemporary practice, as well as the discussion in the accompanying editorial (10). "PCCM INTERNATIONAL" FOR READERS The international focus this month comes in the form of an Editorial Perspective written by experts from the United States, United Kingdom, Europe, Turkey, and Japan (11). The article is about contemporary CRRT practices in the PICU and CICU using surveys from Europe, Japan, and multinational settings (36–38). See the authors' Table of "Knowledge Gaps for Building Global Consensus," which should serve as a roadmap for future international collaborations. Finally, this month there is a PCCM Narrative titled "Meaning" (12). It is a poem and for prospective authors to this section look at the guidance on submitting such items in our narrative series (39,40).