Julie C. Fitzgerald
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View article: Divergence Between Net Fluid and Weight-Based Evaluation in Calculating Cumulative Fluid Balance
Divergence Between Net Fluid and Weight-Based Evaluation in Calculating Cumulative Fluid Balance Open
Objective Although efforts have been made to standardize fluid balance calculations in the intensive care unit (ICU), there is a limited understanding of how different calculation methods relate to one another across an ICU admission. We q…
View article: Quantifying “Medical Renal Disease”: A Pediatric Pilot Study Using Ultrasound Radiomics for Differentiating Acute Kidney Injury and Chronic Kidney Disease
Quantifying “Medical Renal Disease”: A Pediatric Pilot Study Using Ultrasound Radiomics for Differentiating Acute Kidney Injury and Chronic Kidney Disease Open
Background: Differentiating acute kidney injury (AKI) from chronic kidney disease (CKD) in children remains a critical unmet need due to the limitations of current clinical and biochemical markers. Conventional ultrasound lacks the sensiti…
View article: Post-hurricane fluid conservation measures fail to reduce IV fluid use in critically ill children
Post-hurricane fluid conservation measures fail to reduce IV fluid use in critically ill children Open
View article: Integrating Pulmonary and Systemic Transcriptomic Profiles to Characterize Lung Injury after Pediatric Hematopoietic Stem Cell Transplant
Integrating Pulmonary and Systemic Transcriptomic Profiles to Characterize Lung Injury after Pediatric Hematopoietic Stem Cell Transplant Open
Hematopoietic stem cell transplantation (HCT) is potentially curative for numerous malignant and non-malignant diseases but can lead to lung injury due to chemoradiation toxicity, infection, and immune dysregulation. Bronchoalveolar lavage…
View article: Identifying Opportunities for Fluid Balance Optimization in Critically Ill Children
Identifying Opportunities for Fluid Balance Optimization in Critically Ill Children Open
Introduction Fluid overload (FO), a state of pathologic positive cumulative fluid balance (CFB), is common in Pediatric Intensive Care Units (PICU) and associated with morbidity and mortality. Because different PICUs may have unique needs,…
View article: Post-Hurricane Fluid Conservation Measures Fail to Reduce IV Fluid Use in Critically Ill Children
Post-Hurricane Fluid Conservation Measures Fail to Reduce IV Fluid Use in Critically Ill Children Open
View article: Molecular mimicry in multisystem inflammatory syndrome in children
Molecular mimicry in multisystem inflammatory syndrome in children Open
View article: Aberrant STAT signaling drives T cell dysregulation in a targetable pediatric sepsis endotype
Aberrant STAT signaling drives T cell dysregulation in a targetable pediatric sepsis endotype Open
Sepsis is a leading cause of morbidity and mortality in critically ill children, yet heterogeneity in immune responses complicates the development of targeted therapies. Although immune dysregulation is associated with poor outcomes in sep…
View article: Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill Children
Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill Children Open
These prospective, pediatric, multicenter studies demonstrate that uNGAL in the first 24-hours performs very well to predict Kidney Disease Improving Global Outcomes (KDIGO) stage 2/3 AKI at 48- to 72-hours into an ICU course. We suggest t…
View article: Diagnostic Identification of Acute Brain Dysfunction in Pediatric Sepsis and Septic Shock in the Electronic Health Record: A Comparison of Four Definitions in a Reference Dataset*
Diagnostic Identification of Acute Brain Dysfunction in Pediatric Sepsis and Septic Shock in the Electronic Health Record: A Comparison of Four Definitions in a Reference Dataset* Open
OBJECTIVES: Acute brain dysfunction (ABD) in pediatric sepsis has a prevalence of 20%, but can be difficult to identify. Our previously validated ABD computational phenotype (CP ABD ) used variables obtained from the electronic health reco…
View article: Revisiting Post-ICU Admission Fluid Balance Across Pediatric Sepsis Mortality Risk Strata: A Secondary Analysis of a Prospective Observational Cohort Study
Revisiting Post-ICU Admission Fluid Balance Across Pediatric Sepsis Mortality Risk Strata: A Secondary Analysis of a Prospective Observational Cohort Study Open
OBJECTIVES: Post-ICU admission cumulative positive fluid balance (PFB) is associated with increased mortality among critically ill patients. We sought to test whether this risk varied across biomarker-based risk strata upon adjusting for i…
View article: Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes
Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes Open
Sepsis and septic shock are major causes of morbidity, mortality, and health care costs for children worldwide, including >3 million deaths annually and, among survivors, risk for new or worsening functional impairments, including reduc…
View article: Pulmonary microbiome and transcriptome signatures reveal distinct pathobiologic states associated with mortality in two cohorts of pediatric stem cell transplant patients
Pulmonary microbiome and transcriptome signatures reveal distinct pathobiologic states associated with mortality in two cohorts of pediatric stem cell transplant patients Open
Lung injury is a major determinant of survival after pediatric hematopoietic cell transplantation (HCT). A deeper understanding of the relationship between pulmonary microbes, immunity, and the lung epithelium is needed to improve outcomes…
View article: SERUM HUMANIN IN PEDIATRIC SEPTIC SHOCK–ASSOCIATED MULTIPLE-ORGAN DYSFUNCTION SYNDROME
SERUM HUMANIN IN PEDIATRIC SEPTIC SHOCK–ASSOCIATED MULTIPLE-ORGAN DYSFUNCTION SYNDROME Open
Background: Multiple-organ dysfunction syndrome disproportionately contributes to pediatric sepsis morbidity. Humanin (HN) is a small peptide encoded by mitochondrial DNA and thought to exert cytoprotective effects in endothelial cells and…
View article: Unmasking Critical Illness: Using Machine Learning and Biomarkers to See What Lies Beneath*
Unmasking Critical Illness: Using Machine Learning and Biomarkers to See What Lies Beneath* Open
For the past several decades, critical illness has been defined by overlapping clinical syndromes such as sepsis, acute respiratory distress syndrome (ARDS), and multiple organ dysfunction syndrome (MODS). Although defining these syndromes…
View article: Pediatric Sepsis Requiring Intensive Care Admission: Potential Structured Follow-Up Protocols to Identify and Manage New or Exacerbated Medical Conditions
Pediatric Sepsis Requiring Intensive Care Admission: Potential Structured Follow-Up Protocols to Identify and Manage New or Exacerbated Medical Conditions Open
Pediatric sepsis is a leading cause of morbidity and mortality in children globally. Children who require the pediatric intensive care unit (PICU) are at high risk for new or worsening co-morbidities, as well as readmission. This review de…
View article: SERUM SOLUBLE ENDOGLIN IN PEDIATRIC SEPTIC SHOCK–ASSOCIATED MULTIPLE ORGAN DYSFUNCTION SYNDROME
SERUM SOLUBLE ENDOGLIN IN PEDIATRIC SEPTIC SHOCK–ASSOCIATED MULTIPLE ORGAN DYSFUNCTION SYNDROME Open
Background: Endothelial activation is a key driver of multiple organ dysfunction syndrome (MODS). Soluble endoglin (sENG) is expressed by mature and progenitor endothelial cells and thought to have angiogenic properties. We sought to deter…
View article: Frequency of and Risk Factors Associated With Hospital Readmission After Sepsis
Frequency of and Risk Factors Associated With Hospital Readmission After Sepsis Open
OBJECTIVES Although children who survive sepsis are at risk for readmission, identification of patient-level variables associated with readmission has been limited by administrative datasets. We determined frequency and cause of readmissio…
View article: Serum Humanin in Pediatric Septic Shock Associated Multiple Organ Dysfunction Syndrome
Serum Humanin in Pediatric Septic Shock Associated Multiple Organ Dysfunction Syndrome Open
Background Multiple organ dysfunction syndrome (MODS) disproportionately contributes to pediatric sepsis morbidity. Humanin (HN) is a small peptide encoded by mitochondrial DNA and thought to exert cytoprotective effects in endothelial cel…
View article: To Broaden or Not to Broaden? Answers on Appropriate Antimicrobial Escalations for Pediatric Hematopoietic Cell Transplant Patients Remain Out of Reach*
To Broaden or Not to Broaden? Answers on Appropriate Antimicrobial Escalations for Pediatric Hematopoietic Cell Transplant Patients Remain Out of Reach* Open
1 Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA. 2 Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman Scho…
View article: A distinct cross-reactive autoimmune response in multisystem inflammatory syndrome in children (MIS-C)
A distinct cross-reactive autoimmune response in multisystem inflammatory syndrome in children (MIS-C) Open
Multisystem inflammatory syndrome in children (MIS-C) is a severe, post-infectious sequela of SARS-CoV-2 infection, yet the pathophysiological mechanism connecting the infection to the broad inflammatory syndrome remains unknown. Here we l…
View article: Prognostic and Predictive Value of Endothelial Dysfunction Biomarkers in Sepsis-Associated Acute Kidney Injury: Risk Stratified Analysis from a Prospective Observational Cohort of Pediatric Septic Shock
Prognostic and Predictive Value of Endothelial Dysfunction Biomarkers in Sepsis-Associated Acute Kidney Injury: Risk Stratified Analysis from a Prospective Observational Cohort of Pediatric Septic Shock Open
Background Sepsis Associated Acute Kidney Injury (SA-AKI) is associated with high morbidity, with no current therapies available beyond continuous renal replacement therapy (CRRT). Systemic inflammation and endothelial dysfunction are key …
View article: Serum Soluble Endoglin in Pediatric Septic Shock Associated Multiple Organ Dysfunction Syndrome.
Serum Soluble Endoglin in Pediatric Septic Shock Associated Multiple Organ Dysfunction Syndrome. Open
Background: Multiple organ dysfunction syndrome (MODS) is the final common pathway in critical illness and is associated with significant morbidity and mortality. Endothelial activation is a key driver of organ dysfunction. Soluble endogli…
View article: Data from Identification of Predictive Biomarkers for Cytokine Release Syndrome after Chimeric Antigen Receptor T-cell Therapy for Acute Lymphoblastic Leukemia
Data from Identification of Predictive Biomarkers for Cytokine Release Syndrome after Chimeric Antigen Receptor T-cell Therapy for Acute Lymphoblastic Leukemia Open
Chimeric antigen receptor (CAR)–modified T cells with anti-CD19 specificity are a highly effective novel immune therapy for relapsed/refractory acute lymphoblastic leukemia. Cytokine release syndrome (CRS) is the most significant and life-…
View article: Data from Identification of Predictive Biomarkers for Cytokine Release Syndrome after Chimeric Antigen Receptor T-cell Therapy for Acute Lymphoblastic Leukemia
Data from Identification of Predictive Biomarkers for Cytokine Release Syndrome after Chimeric Antigen Receptor T-cell Therapy for Acute Lymphoblastic Leukemia Open
Chimeric antigen receptor (CAR)–modified T cells with anti-CD19 specificity are a highly effective novel immune therapy for relapsed/refractory acute lymphoblastic leukemia. Cytokine release syndrome (CRS) is the most significant and life-…
View article: Fluid Overload Precedes and Masks Cryptic Kidney Injury in Pediatric Acute Respiratory Distress Syndrome
Fluid Overload Precedes and Masks Cryptic Kidney Injury in Pediatric Acute Respiratory Distress Syndrome Open
OBJECTIVES: Given the complex interrelatedness of fluid overload (FO), creatinine, acute kidney injury (AKI), and clinical outcomes, the association of AKI with poor outcomes in critically ill children may be underestimated due to definiti…
View article: Investigating Racial and Socioeconomic Characteristics in Pediatric Sepsis Using Electronic Health Data
Investigating Racial and Socioeconomic Characteristics in Pediatric Sepsis Using Electronic Health Data Open
BACKGROUND AND OBJECTIVES Racial/ethnic and socioeconomic disparities are reported in sepsis, with increased mortality for minority and low socioeconomic status groups; however, these studies rely on billing codes that are imprecise in ide…
View article: Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs
Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs Open
OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) has been used successfully to support adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiac or respiratory failure refractory to conventional therapi…
View article: Tachyarrhythmias During Hospitalization for COVID‐19 or Multisystem Inflammatory Syndrome in Children and Adolescents
Tachyarrhythmias During Hospitalization for COVID‐19 or Multisystem Inflammatory Syndrome in Children and Adolescents Open
Background Cardiac complications related to COVID‐19 in children and adolescents include ventricular dysfunction, myocarditis, coronary artery aneurysm, and bradyarrhythmias, but tachyarrhythmias are less understood. The goal of this study…
View article: Fluid Overload in Pediatric Acute Respiratory Distress Syndrome after Allogeneic Hematopoietic Cell Transplantation
Fluid Overload in Pediatric Acute Respiratory Distress Syndrome after Allogeneic Hematopoietic Cell Transplantation Open
The aim of the study is to examine the relationship between fluid overload (FO) and severity of respiratory dysfunction in children posthematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS). Th…