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Clinical Insights into Pediatric Critical Care
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Clinical Insights into Pediatric Critical Care

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: 20 January 2026 | Viewed by 1224

Special Issue Editors

Prof. Dr. Katherine Biagas

E-Mail Website
Guest Editor
Department of Pediatrics, The Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
Interests: pediatric critical care; neurocognitive outcome; pediatric emergency; extracorporeal membrane oxygenation; PICU
Dr. Daniel E Sloniewsky

E-Mail Website
Guest Editor Assistant
Department of Pediatrics, The Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
Interests: pediatric intensive care; trauma; acute respiratory failure; traumatic brain injury; anemia

Special Issue Information

Dear Colleagues,

The presence of anemia in critically ill children in the PICU is common. The etiology is multifactorial and includes blood loss, poor iron utilization, and decreased erythropoietin activity. Likely because of diminished oxygen delivery, anemia has been shown to worsen patient outcomes, though the degree of anemia that is present matters. One potential factor that has clinical significance is the presence of metabolic alterations in transfused red blood and storage time, although the clinical effects of these entities are controversial.

Additionally, transfusion of other blood product components—including platelets, fresh frozen plasma, and cryoprecipitate—has come under review for critically ill children with life-threatening bleeding. The use of whole blood as a resuscitative fluid in children with life-threatening bleeding and the use of tranexamic acid to help with blood clotting are areas of increasing interest in the management of hemorrhage in pediatric ICUs.

Clinicians and scientists are encouraged to submit original research papers or state-of-the-art reviews for the upcoming Special Issue focusing both on all aspects of transfusions in critically ill children and appropriate management of hemorrhage in critically ill children. This may include works that deal with the storage lesion of transfused blood, therapies related to traumatic hemorrhage, as well as new, innovative types of blood products.

Prof. Dr. Katherine Biagas
Guest Editor

Dr. Daniel E Sloniewsky
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • PICU
  • anemia
  • blood transfusion
  • critically ill children
  • traumatic hemorrhage

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Published Papers (3 papers)

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Research

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12 pages, 437 KB  
Article
Fluid Overload and Graft Injury Following Pediatric Liver Transplantation: A Single-Center Analysis
by Sapir Bar, Yael Mozer Glassberg, Michael Gurevich, Elhanan Nahum, Avichai Weissbach, Eytan Kaplan and Gili Kadmon
J. Clin. Med. 2025, 14(11), 3759; https://doi.org/10.3390/jcm14113759 - 27 May 2025
Viewed by 511
Abstract
Background: We aimed to compare graft injury and complications after liver transplantation in children with higher versus lower fluid balance. Methods: In a cohort of 79 pediatric liver transplant recipients, we analyzed the associations of decreases in alanine aminotransferase (ALT) and bilirubin (delta [...] Read more.
Background: We aimed to compare graft injury and complications after liver transplantation in children with higher versus lower fluid balance. Methods: In a cohort of 79 pediatric liver transplant recipients, we analyzed the associations of decreases in alanine aminotransferase (ALT) and bilirubin (delta ALT, delta bilirubin) with fluid balance in the first six postoperative days and associations of fluid balance with vascular complications and mean ALT one year after the transplantation. Results: Patients who developed vascular complications had significantly higher mean cumulative fluid balance during the first three postoperative days, as well as higher mean fluid balance on postoperative days 0 (POD0) and 2 (POD2) (p < 0.05), compared to those without complications. A negative correlation was observed between fluid balance and delta ALT on POD2. Additionally, patients with a cumulative fluid balance exceeding 200 mL/kg during the first three postoperative days had higher mean ALT levels one year after transplantation (p = 0.03). Conclusions: Fluid overload was associated with vascular complications and showed correlations with markers of graft injury. Prospective studies are needed to validate these findings and further clarify the role of fluid balance in pediatric liver transplantation. Full article
(This article belongs to the Special Issue Clinical Insights into Pediatric Critical Care)
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Review

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22 pages, 923 KB  
Review
Rheological Theory Applied to Mechanical Ventilation in Acute Respiratory Distress Syndrome: A New Paradigm for Understanding and Preventing Ventilator-Induced Lung Injury
by Alberto Medina, Pablo del Villar Guerra, Juan Ramón Valle Ortiz and Vicent Modesto I Alapont
J. Clin. Med. 2025, 14(18), 6544; https://doi.org/10.3390/jcm14186544 - 17 Sep 2025
Abstract
The concept of mechanical power (MP) has emerged as a comprehensive indicator of ventilator-induced lung injury (VILI). It integrates the effects of tidal volume, airway pressures, respiratory rate, and flow. However, applying MP as a universal threshold (e.g., 12 J/min) across heterogeneous patients [...] Read more.
The concept of mechanical power (MP) has emerged as a comprehensive indicator of ventilator-induced lung injury (VILI). It integrates the effects of tidal volume, airway pressures, respiratory rate, and flow. However, applying MP as a universal threshold (e.g., 12 J/min) across heterogeneous patients with acute respiratory distress syndrome (ARDS) may be inadequate. This review introduces the rheological model, which conceptualizes the lung as a viscoelastic body (i.e., one that exhibits both elastic and viscous properties), and applies it to ARDS ventilation. The rheological model may offer individualized MP thresholds. The potential benefits of adjusting MP based on ideal body weight (J/min/kg) are discussed and, more accurately, on static compliance (J/min/L). Static compliance could better reflect functional lung size, though clinical validation remains needed. Preliminary clinical and modeling evidence suggests that normalized MP correlates more closely with mortality than absolute MP and aligns with pulmonary stress–strain behavior. This normalization provides a more precise risk stratification and facilitates the easier setting of ventilation targets, particularly in patients with low compliance or abnormal body composition. This review clarifies definitions and consolidates evidence, highlights the clinical implications of rheology for lung-protective strategies. MP normalization within a lung-protective strategy could enhance the safety and efficacy of mechanical ventilation; however, clinical validation is still required. This review summarizes the theoretical foundations, supporting evidence, and clinical implications of this approach within the broader context of rheological modeling in ARDS. Full article
(This article belongs to the Special Issue Clinical Insights into Pediatric Critical Care)
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14 pages, 398 KB  
Review
Hemoadsorption in Children with Cytokine Storm Using the Jafron HA330 and HA380 Cartridges
by Kamila Azenova and Vitaliy Sazonov
J. Clin. Med. 2025, 14(18), 6359; https://doi.org/10.3390/jcm14186359 - 9 Sep 2025
Viewed by 346
Abstract
Background: A cytokine storm can lead to organ dysfunction and death in critically ill children. Extracorporeal hemoperfusion aims to reduce hyperinflammation by filtering out mid-range cytokines (e.g., IL-6), but pediatric data remain limited. Methods: We conducted a narrative review with PRISMA-guided screening of [...] Read more.
Background: A cytokine storm can lead to organ dysfunction and death in critically ill children. Extracorporeal hemoperfusion aims to reduce hyperinflammation by filtering out mid-range cytokines (e.g., IL-6), but pediatric data remain limited. Methods: We conducted a narrative review with PRISMA-guided screening of PubMed, Scopus, and Google Scholar for pediatric reports of HA330/HA380 from January 2020 to June 2025. Due to heterogeneity in populations, circuits, and outcome timing, the results were synthesized descriptively. Three studies met the inclusion criteria: a prospective series of 12 patients with septic shock using HA330, a single case of a pediatric heart transplant with HA380 during cardiopulmonary bypass, and a retrospective comparative cohort study of Pediatric Intensive Care Unit (PICU) oncology patients on continuous renal replacement therapy (CRRT) comparing HA330 (n = 11) versus CytoSorb (n = 10). Results: Three studies involving 23 pediatric patients were analyzed. The median age was 8 years, and 56.5% of patients were male. Most patients underwent hemoadsorption with HA330 via continuous renal replacement therapy (CRRT) or continuous venovenous hemodiafiltration (CVVHDF). Post-treatment reductions were noted in interleukin-6 (IL-6) (mean −69.6%), C-reactive protein (CRP) (−59.0%), and procalcitonin (PCT) (−70.4%). Severity scores (Pediatric Logistic Organ Dysfunction-2 (PELOD-2), Pediatric Risk of Mortality-3 (PRISM-3), and Pediatric Sequential Organ Failure Assessment (pSOFA) improved significantly (p = 0.002). The mean PICU stay was 15.6 days. The survival rate was 87%, and no hemoadsorption-related adverse events were reported. Conclusions: HA330/380 hemoadsorption is a safe and potentially effective treatment for pediatric cytokine storms, reducing inflammation and improving clinical status. However, larger, standardized studies are needed to confirm these findings and guide clinical use. Full article
(This article belongs to the Special Issue Clinical Insights into Pediatric Critical Care)
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