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The purpose of this policy statement is to update the 2004 American Academy of Pediatrics clinical report and provide enhanced guidance for institutions, administrators, and providers in the development and operation of a pediatric intermediate care unit (IMCU). Since 2004, there have been significant advances in pediatric medical, surgical, and critical care that have resulted in an evolution in the acuity and complexity of children potentially requiring IMCU admission. A group of 9 clinical experts in pediatric critical care, hospital medicine, intermediate care, and surgery developed a consensus on priority topics requiring updates, reviewed the relevant evidence, and, through a series of virtual meetings, developed the document. The intended audience of this policy statement is broad and includes pediatric critical care professionals, pediatric hospitalists, pediatric surgeons, other pediatric medical and surgical subspecialists, general pediatricians, nurses, social workers, care coordinators, hospital administrators, health care funders, and policymakers, primarily in resource-rich settings. Key priority topics were delineation of core principles for an IMCU, clarification of target populations, staffing recommendations, and payment. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate single-stage laryngotracheal reconstruction (ssLTR) outcomes before and after the implementation of a postoperative care protocol in pediatric patients. Methods: A case-control study with chart review was conducted at 2 tertiary academic centers from 2010 to 2016. Pediatric patients who underwent ssLTR with a postoperative care protocol were compared with those who did not receive care under this protocol. Data regarding perioperative management were collected and compared using χ2 and Wilcoxon rank tests. Planned extubation, length of intubation in the intensive care unit, and complications were examined. Results: Nineteen patients completed ssLTR after the protocol was initiated, and 26 prior patients were used as control subjects. Planned extubation failed in 9 patients (35%) in the control group compared with 1 patient (5%) in the protocol group (P <.05). Using a structured protocol demonstrated a decrease in delayed extubation and intensive care unit stay (P <.05). Despite more postprotocol patients' requiring posterior graft placement, preprotocol patients were less likely to be extubated within 7 days (P <.05). Conclusions: The authors propose an intensive care unit protocol that uses a combination of pharmacologic agents to optimally reduce the risk for adverse events that delay time to extubation and thus decannulation. Timely extubation was more likely with the use of this postoperative care protocol using a multidisciplinary approach involving otolaryngologists, pharmacists, intensivists, and anesthesiologists. [ABSTRACT FROM AUTHOR]

Severe global climate change led to the deterioration of environmental conditions in the oceans during the Toarcian Stage of the Jurassic. Carbonate platforms of the Western Tethys Ocean exposed in Alpine Tethyan mountain ranges today offer insight into this period of environmental upheaval. In addition to informing understanding of climate change in deep time, the effect of ancient carbon cycle perturbations on carbonate platforms has important implications for anthropogenic climate change; the patterns of early Toarcian environmental deterioration are similar to those occurring in modern oceans. This study focuses on the record of the early Toarcian Oceanic Anoxic Event (ca 183.1 Ma) in outcrops of the north‐west Adriatic Carbonate Platform in Slovenia. Amidst environmental deterioration, the north‐west Adriatic Platform abruptly transitioned from a healthy, shallow‐water environment with diverse metazoan ecosystems to a partially drowned setting with low diversity biota and diminished sedimentation. An organic carbon‐isotope excursion of −2.2‰ reflects the massive injection of CO2 into the ocean‐atmosphere system and marks the stratigraphic position of the Toarcian Oceanic Anoxic Event. A prominent dissolution horizon and suppressed carbonate deposition on the platform are interpreted to reflect transient shoaling of the carbonate compensation depth to unprecedentedly shallow levels as the dramatic influx of CO2 overwhelmed the ocean's buffering capacity, causing ocean acidification. Trace metal geochemistry and palaeoecology highlight water column deoxygenation, including the development of photic‐zone anoxia, preceding and during the Toarcian Oceanic Anoxic Event. Ocean acidification and reduced oxygen levels likely had a profoundly negative effect on carbonate‐producing biota and growth of the Adriatic Platform. These effects are consistent with the approximate doubling of the concentration of CO2 in the ocean‐atmosphere system from pre‐event levels, which has previously been linked to a volcanic triggering mechanism. Mercury enrichments discovered in this study support a temporal and genetic link between volcanism, the Toarcian Oceanic Anoxic Event and the carbonate crisis. [ABSTRACT FROM AUTHOR]

Competing Interests: Dr. Loscalzo received support for article research from the American Academy of Pediatrics. Dr. Liu disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.