BACKGROUND:Plateau pressure (Pplat) is routinely monitored during mechanical ventilation to assess the risk of ventilator-induced lung injury. Although Pplat is classically measured during controlled ventilation with a constant-flow pattern, it is increasingly applied during decelerating flow modes and in the presence of spontaneous respiratory effort. Uncertainty persists regarding the accuracy of Pplat for determining static respiratory system compliance (CRS) and the inspiratory hold duration required to obtain reliable measurements across varying flow patterns, levels of effort, and lung conditions. METHODS:We conducted a combined bench and clinical study. Using an ASL 5000 lung simulator, we compared measured versus set CRS across 3 pediatric age ranges, simulated lung conditions, levels of inspiratory effort, and 3 ventilation modes (volume-controlled continuous mandatory ventilation, pressure-controlled continuous mandatory ventilation with adaptive targeting, and pressure support ventilation) and determined the time required to achieve steady Pplat. In parallel, we performed a secondary analysis of airway pressure waveforms from children with pediatric ARDS enrolled in a lung- and diaphragm-protective ventilation trial to define the minimum inspiratory occlusion time required for reliable Pplat measurement during passive and spontaneous breathing. RESULTS:Across all bench conditions, CRS derived from driving pressure and tidal volume (VT) slightly overestimated set CRS (median bias 0.09 mL/cm H2O/kg [95% CI 0.06-0.16]). Bias increased with greater inspiratory effort, without meaningful differences among ventilation modes after stratification by effort. Time to steady Pplat increased progressively with higher effort (passive 0 [0-400] ms; moderate: 300 [200-400] ms; high: 500 [380-800] ms; P < .001). In patient data, steady Pplat was achieved within 500 ms under passive conditions but exceeded 1,500 ms during high effort. CONCLUSIONS:During both constant and decelerating flow modes of ventilation, Pplat combined with VT and PEEP provided a reliable measure of CRS. However, as spontaneous respiratory effort increases, the time to achieve a steady Pplat was prolonged, and CRS derived from Pplat may be overestimated.

Background: Hemoglobin thresholds alone may not identify cardiovascular surgical ICU patients who derive physiologic benefit from red blood cell (RBC) transfusion. Mixed venous oxygen saturation (SvO₂) reflects the balance between oxygen delivery and consumption and may help identify patients with transfusion-responsive oxygen supply-demand mismatch. Methods: We conducted a retrospective observational study of adult cardiovascular surgical ICU patients who underwent a first 2-unit RBC transfusion episode with pre-transfusion hemoglobin (Hb) ≥ 7.5 g/dL and paired pre- and post-transfusion SvO₂ measurements. The primary outcome was SvO₂ responsiveness, defined as ΔSvO₂ ≥ 5 percentage points from pre-transfusion baseline to approximately 60 minutes after transfusion initiation. Multivariable logistic regression was used to identify predictors of response, and receiver operating characteristic analysis was used to determine the optimal pre-transfusion SvO₂ cutoff. Subgroup analyses evaluated higher Hb thresholds, and sensitivity analyses included overlap-weighted transfusion-versus-no-transfusion trajectory comparisons and multivariable linear regression using continuous ΔSvO₂. Results: Among 18,117 eligible transfusion episodes, 1,352 unique patients met the final inclusion criteria. Mean Hb increased from 9.82 ± 0.92 to 10.24 ± 0.98 g/dL, whereas mean SvO₂ changed only minimally at the cohort level (73.79 ± 9.91% to 73.86 ± 9.37%). However, lower pre-transfusion SvO₂ was associated with larger increases in SvO₂ after transfusion. In multivariable logistic regression, baseline SvO₂ was the only independent predictor of SvO₂ response (adjusted OR, 0.89 per 1% increase; 95% CI, 0.86–0.91; P < 0.001). Pre-transfusion SvO₂ predicted a response with an AUC of 0.778 (95% CI, 0.74–0.816), and the optimal cutoff was 69%. The inverse association between baseline SvO₂ and ΔSvO₂ was preserved in the Hb ≥ 9 g/dL and Hb ≥ 10 g/dL subgroups. In overlap-weighted sensitivity analyses, 0–6-hour trajectories of SvO₂, Hb, and DO₂i differed significantly between transfusion and no-transfusion groups (all group-by-time interaction P < 0.001). Conclusions: In cardiovascular surgical ICU patients with Hb ≥ 7.5 g/dL, a low pre-transfusion SvO₂ identified patients more likely to show a physiologic rise in SvO₂ after RBC transfusion. Pre-transfusion SvO₂ may complement Hb when evaluating transfusion need in this population, but prospective validation is required before physiologic SvO₂-guided transfusion can be recommended.

BACKGROUND:Delayed sternal closure is often necessary in pediatric cardiac surgery; however, its impact on the respiratory system and hemodynamics remains unclear. To our knowledge no prior studies have assessed intrapleural pressure (Ppl) changes after delayed sternal closure using esophageal pressure (Pes) measurements. This study aimed to investigate the respiratory system and hemodynamic changes associated with delayed sternal closure in pediatric patients using Pes measurement. METHODS:This retrospective observational study included subjects <2 years who underwent delayed sternal closure in a pediatric intensive care unit between January and November 2024. Respiratory and hemodynamic parameters were measured at 3 time points: before delayed sternal closure, immediately after delayed sternal closure, and 3 h post delayed sternal closure. Pes was used to estimate Ppl. Lung compliance (CL), chest wall compliance (CCW), respiratory system compliance (CRS), and end-expiratory transpulmonary pressure were calculated. Hemodynamic data included heart rate (HR), vasoactive-inotropic score (VIS), and surrogate indicators of cardiac output. RESULTS:Eight subjects were analyzed. End-expiratory Pes significantly increased after delayed sternal closure (before: 6.0 [4.8-7.0] cm H2O; immediately after: 7.3 [5.8-9.3] cm H2O; 3 h post delayed sternal closure: 8.1 [6.8-10.1] cm H2O; P = .044), indicating elevated Ppl. CL was numerically lower 3 h post delayed sternal closure (before: 0.72 [0.70-0.80] mL/cm H2O/kg; immediately after: 0.73 [0.65-0.80] mL/cm H2O/kg; 3 h post delayed sternal closure: 0.62 [0.56-0.74] mL/cm H2O/kg; P = .09). HR (before: 150 [138-157] beats/min; immediately after: 165 [148-167] beats/min; 3 h post delayed sternal closure: 151 [149-163] beats/min; P = .02) and VIS (before: 12.8 [9.8-14.3]; immediately after: 14.3 [12.1-15.8]; 3 h post delayed sternal closure: 14.8 [12.1-15.8]; P = .003) significantly increased post delayed sternal closure. CONCLUSIONS:Delayed sternal closure increased Ppl by ∼2 cm H2O, which may reduce lung compliance without affecting chest wall compliance and contribute to hemodynamic stress. These changes may necessitate optimized respiratory and circulatory support during and after delayed sternal closure.

Red blood cell (RBC) transfusion decisions after cardiovascular surgery require integration of hemoglobin (Hb), hemodynamics, bleeding status, and oxygen supply–demand balance. Mixed venous oxygen saturation (SvO₂) reflects the global relationship between oxygen delivery and oxygen consumption, but an increase in SvO₂ does not necessarily indicate improved tissue oxygenation or clinical benefit. We evaluated acute SvO₂ changes after RBC transfusion in cardiovascular surgical ICU patients. We conducted a single-center retrospective cohort study of adult cardiovascular surgical ICU patients who received one RBC-equivalent transfusion with pre-transfusion Hb ≥ 7.5 g/dL and paired pre- and post-transfusion SvO₂ measurements. The primary outcome was an individual-level SvO₂ response, defined a priori as ΔSvO₂ ≥5

Background Positive end-expiratory pressure (PEEP) titration targeting end-expiratory transpulmonary pressure close to zero was associated with favorable clinical outcomes in a secondary analysis of the EPVent-2 trial in adults with acute respiratory distress syndrome (ARDS). However, its relevance in children remains unknown. Research Question Is end-expiratory transpulmonary pressure close to zero associated with 28-day ventilator-free days in pediatric ARDS? Study Design and Methods We conducted a post hoc secondary analysis of a randomized controlled trial enrolling children with pediatric ARDS at a single center. End-expiratory transpulmonary pressure close to zero was defined as –2 to +2 cmH2O. The primary outcome was 28-day ventilator-free days, with ICU mortality and length of mechanical ventilation in survivors evaluated as its components. Secondary outcomes were respiratory system compliance and PaO2/FIO2 ratio. Results There were 198 patients included. Median end-expiratory transpulmonary pressure was -0.1 (IQR -2.5, 1.9) cmH2O, PEEP was 10.3 (8.3, 12.3) cmH2O, and end-expiratory esophageal pressure was 10.9 (8.6, 13.3) cmH2O. In primary analyses, end-expiratory transpulmonary pressure close to zero was not associated with more 28-day ventilator-free days, lower ICU mortality, or shorter length of mechanical ventilation in survivors. In secondary analyses, it was not associated with respiratory system compliance or PaO2/FIO2 ratio. Interpretation In this cohort, end-expiratory transpulmonary pressure close to zero ​was not associated with favorable clinical outcomes in pediatric ARDS, nor with respiratory mechanics or oxygenation. Prospective titration studies are needed to clarify the physiological relevance of end-expiratory transpulmonary pressure​ in pediatric ARDS.

The emergence of the concepts of patient self-inflicted lung injury and lung and diaphragm-protective ventilation has renewed interest in quantifying respiratory drive, respiratory effort, and work of breathing in real-time and at the bedside. Measurements derived from electromyography of respiratory muscles and esophageal manometry are the gold standard, but their current use in pediatric ICUs is scarce. There are other direct and indirect methods to quantify respiratory drive and effort that have been validated in critically ill pediatric patients. Direct methods have been adequately tested, specifically to customize the level of support provided from the acute phase to weaning from mechanical ventilation. Promising indirect methods may be the first step, and some of them have been adequately validated. Given the heterogeneity of the pediatric population and the scarcity of cut-off thresholds, decisions must be based on the trajectory of drive and effort, preferably using a multimodal approach. In this review, we summarize the current state of the art regarding direct methods and new tools for quantifying respiratory drive and effort, including their relevance and limitations in decision-making.

Nutrition therapy is important in the management of critically ill patients and is continuously evolving as new evidence emerges. The Japanese Critical Care Nutrition Guideline 2024 (JCCNG 2024) is specific to Japan and is the latest set of clinical practice guidelines for nutrition therapy in critical care that was revised from JCCNG 2016 by the Japanese Society of Intensive Care Medicine. An English version of these guidelines was created based on the contents of the original Japanese version. These guidelines were developed to help health care providers understand and provide nutrition therapy that will improve the outcomes of children and adults admitted to intensive care units or requiring intensive care, regardless of the disease. The intended users of these guidelines are all healthcare professionals involved in intensive care, including those who are not familiar with nutrition therapy. JCCNG 2024 consists of 37 clinical questions and 24 recommendations, covering immunomodulation therapy, nutrition therapy for special conditions, and nutrition therapy for children. These guidelines were developed in accordance with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system by experts from various healthcare professionals related to nutrition therapy and/or critical care. All GRADE-based recommendations, good practice statements (GPS), future research questions, and answers to background questions were finalized by consensus using the modified Delphi method. Strong recommendations for adults include early enteral nutrition (EN) within 48 h and the provision of pre/synbiotics. Weak recommendations for adults include the use of a nutrition protocol, EN rather than parenteral nutrition, the provision of higher protein doses, post-pyloric EN, continuous EN, omega-3 fatty acid-enriched EN, the provision of probiotics, and indirect calorimetry use. Weak recommendations for children include early EN within 48 h, bolus EN, and energy/protein-dense EN formulas. A nutritional assessment is recommended by GPS for both adults and children. JCCNG 2024 will be disseminated through educational activities mainly by the JCCNG Committee at various scientific meetings and seminars. Since studies on nutritional treatment for critically ill patients are being reported worldwide, these guidelines will be revised in 4 to 6 years. We hope that these guidelines will be used in clinical practice for critically ill patients and in future research.

OBJECTIVES:Pediatric acute respiratory distress syndrome (PARDS) guidelines recommend limiting airway plateau pressure (Pplat) to 28 cm H 2 O, allowing for higher limits when chest wall compliance (C CW ) is poor since less of the pressure is transmitted to lung (transpulmonary pressure). Transpulmonary pressure depends on Pplat and the ratio of lung elastance to respiratory system elastance (E L /E RS ). E L /E RS measurement requires esophageal manometry, although it is not routinely available. We sought to determine if routinely available clinical data could reliably predict E L /E RS or changes in E L /E RS , to understand when Pplat greater than 28 cm H 2 O could be acceptable. DESIGN:Secondary analysis of randomized controlled trial with esophageal manometry monitoring. SETTING:Quaternary PICU. PATIENTS:Mechanically ventilated children with PARDS. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Two hundred seven patients and 750 patient days were included. Using the first day per patient, median E L /E RS was 0.83 (interquartile range, 0.72-0.87), with a weak negative correlation with respiratory system compliance (C RS ) ( r = -0.26; p < 0.001). C RS was strongly correlated with lung compliance (C l ) ( r = 0.94; p < 0.001) and moderately correlated with C CW ( r = 0.53; p < 0.001). Multivariable analysis identified that higher C RS , younger age and peripheral neuromuscular disease were associated with higher C CW , while higher C RS was the only variable independently associated with higher C l (all p < 0.01). When trying to predict high (> 0.9) or low (< 0.7) E L /E RS , C RS was the only variable retaining an independent association: lower C RS (C RS × 10 [mL/cm H 2 O/kg × 1/10]) with high E L /E RS (odds ratio [OR], 0.70; 95% CI, 0.54-0.86; p = 0.002; area under the receiver operating characteristic curve [AUC], 0.73) and higher C RS (C RS × 10 [mL/cm H 2 O/kg × 1/10]) with low E L /E RS (OR, 1.14; 95% CI, 1.02-1.28; p = 0.017; AUC, 0.60). Change in E L /E RS from day to day was not predictable. CONCLUSIONS:In PARDS, C RS is more strongly tied to C l than C CW . While E L /E RS is not easily predictable from clinical variables, when C RS is low, E L /E RS is generally high. Therefore, increasing Pplat above the suggested thresholds when C RS is impaired may be inappropriate without measuring esophageal pressure.

Background: Transposition of the great arteries with intact ventricular septum causes severe hypoxia immediately after birth. Balloon atrial septostomy is often required for oxygenation improvement, and severe cases may require veno-venous extracorporeal membrane oxygenation (VV-ECMO). This case report highlights the critical role of balloon atrial septostomy in improving respiratory system compliance and facilitating early ECMO discontinuation in a neonate with transposition of the great arteries. Case summary: A neonate with transposition of the great arteries experienced persistent hypoxia, hypotension, and lactic acidosis, prompting VV-ECMO on the first day of life. Echocardiography revealed a restrictive atrial septal defect, and balloon atrial septostomy was performed. This resulted in increased oxygen saturation, improved respiratory system compliance (from 0.19 to 0.43 mL/cmH2O/kg), and reduced left atrial pressure. ECMO was successfully withdrawn on day 2, which was later followed by a successful Jatene procedure. Conclusion: Balloon atrial septostomy can significantly improve oxygenation and respiratory system compliance in patients with transposition of the great arteries, enabling rapid VV-ECMO discontinuation and informing future congenital heart disease management.

Breath stacking, particularly double triggering, is a common patient–ventilator asynchrony during strong inspiratory effort. It can cause excessive tidal volumes and high transpulmonary pressures, contributing to ventilator-induced lung injury (VILI). The mode-specific consequences of breath stacking induced by strong inspiratory effort remain unclear. In a porcine model of minimal lung injury, 17 animals were randomized to volume-controlled ventilation (VCV, n = 9) or pressure-controlled ventilation (PCV, n = 8). High respiratory drive was induced with continuous CO₂ inhalation, and ventilator settings were dynamically adjusted to maintain a breath stacking ratio of 40–70

Rationale: The assessment of lung recruitability is gaining attention for the personalization of mechanical ventilation in ARDS patients. Accurate assessment is crucial. One method involves using quasistatic pressure-volume (PV) curves. We hypothesized that recruitability assessment using PV curves is affected by its peak pressure. Methods: This is a secondary analysis of two animal studies (PMID 11673214, 15187520) focused on the effect of volume history and peak pressure of the PV curve on its shape in an ARDS model using lung lavage. In those studies, the PV curve was created using a 2L supersyringe, and volume during the PV curve measurement was corrected for pressure, temperature, humidity, time, O2 consumption, and CO2 production. For this analysis, we calculated the hysteresis ratio (hysteresis area / (peak pressure x maximal volume)) and normalized maximal distance (maximal distance between the inspiratory and expiratory limbs of the curve / maximal volume) at 40 and 60 cmH2O peak pressure using methods employed in previous studies (PMID 32897667, 36370227) for evaluation of recruitability and compared them using paired t-tests. Results: Data from 17 sheep (28.9±2.7 kg) were analyzed. Following lung lavage, PaO2/FIO2 at a PEEP of 5 cmH2O was 67.4±21.5. Respiratory system compliance from 0 to 40 cmH2O was 20.3±4.7 mL/cmH2O. Hysteresis ratios at 40 and 60 cmH2O were 0.18±0.06 and 0.22±0.07 (P = 0.01). Normalized maximal distances at 40 and 60 cmH2O were 0.34±0.08 and 0.39±0.08 (P = 0.008). Conclusions: The higher the peak pressure of the PV curve, the higher the value indicating recruitability assessed using the PV curve may be. Ventilator pressure may influence recruitability assessment, highlighting the need for standardized assessment methods.

Pediatrics InternationalVolume 66, Issue 1 e15756 CLINICAL NOTE Compartment syndrome due to group A streptococcal infection associated with intramuscular venous malformation Masashi Taniguchi, Corresponding Author Masashi Taniguchi [email protected] orcid.org/0000-0002-3389-9492 Department of Pediatrics, Hirakata City Hospital, Hirakata, Osaka, Japan Correspondence Masashi Taniguchi, Department of Pediatrics, Hirakata City Hospital, 2-14-1, Kinyahonmachi, Hirakata, Osaka, Japan. Email: [email protected]Search for more papers by this authorYu Inata, Yu Inata orcid.org/0000-0002-2180-9517 Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, JapanSearch for more papers by this authorYoshiyuki Shimizu, Yoshiyuki Shimizu Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, JapanSearch for more papers by this authorDaisuke Tamura, Daisuke Tamura Department of Orthopedics Surgery, Osaka Women's and Children's Hospital, Izumi, Osaka, JapanSearch for more papers by this authorMuneyuki Takeuchi, Muneyuki Takeuchi Department of Intensive Care Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, JapanSearch for more papers by this author Masashi Taniguchi, Corresponding Author Masashi Taniguchi [email protected] orcid.org/0000-0002-3389-9492 Department of Pediatrics, Hirakata City Hospital, Hirakata, Osaka, Japan Correspondence Masashi Taniguchi, Department of Pediatrics, Hirakata City Hospital, 2-14-1, Kinyahonmachi, Hirakata, Osaka, Japan. Email: [email protected]Search for more papers by this authorYu Inata, Yu Inata orcid.org/0000-0002-2180-9517 Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, JapanSearch for more papers by this authorYoshiyuki Shimizu, Yoshiyuki Shimizu Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, JapanSearch for more papers by this authorDaisuke Tamura, Daisuke Tamura Department of Orthopedics Surgery, Osaka Women's and Children's Hospital, Izumi, Osaka, JapanSearch for more papers by this authorMuneyuki Takeuchi, Muneyuki Takeuchi Department of Intensive Care Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, JapanSearch for more papers by this author First published: 20 April 2024 https://doi.org/10.1111/ped.15756Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. CONFLICT OF INTEREST STATEMENT The authors declare no conflict of interest. REFERENCES 1Russell S, Watts RG, Royal SA, Barnhart DC. Group A streptococcal infection of an intramuscular venous malformation: a case report and review of the literature. Pediatr Emerg Care. 2008; 24(12): 839–841. 10.1097/PEC.0b013e31819080cd PubMedGoogle Scholar 2Legiehn GM, Heran MK. Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop Clin North Am. 2006; 37(3): 435–474, vii–viii. 10.1016/j.ocl.2006.04.005 PubMedWeb of Science®Google Scholar 3Matsuda N, Ishikawa K, Funayama E, Mitamura S, Sasaki S, Yamamoto Y, et al. Streptococcal toxic shock syndrome in a pediatric patient with intramuscular venous malformation in the neck. J Emerg Med. 2022; 63(3): e72–e76. 10.1016/j.jemermed.2022.07.018 PubMedGoogle Scholar 4Zundel S, Lemaréchal A, Kaiser P, Szavay P. Diagnosis and treatment of pediatric necrotizing fasciitis: a systematic review of the literature. Eur J Pediatr Surg. 2017; 27(2): 127–137. PubMedWeb of Science®Google Scholar 5Kleshinski J, Bittar S, Wahlquist M, Ebraheim N, Duggan JM. Review of compartment syndrome due to group a streptococcal infection. Am J Med Sci. 2008; 336(3): 265–269. 10.1097/MAJ.0b013e318165650a PubMedGoogle Scholar Volume66, Issue1January/December 2024e15756 ReferencesRelatedInformation

Background We have previously reported a simple correction method for estimating pleural pressure (Ppl) using central venous pressure (CVP). However, it remains unclear whether this method is applicable to patients with varying levels of intravascular volumes and/or chest wall compliance. This study aimed to investigate the accuracy of our method under different conditions of intravascular volume and chest wall compliance. Results Ten anesthetized and paralyzed pigs (43.2 ± 1.8 kg) were mechanically ventilated and subjected to lung injury by saline lung lavage. Each pig was subjected to three different intravascular volumes and two different intraabdominal pressures. For each condition, the changes in the esophageal pressure (ΔPes) and the estimated ΔPpl using ΔCVP (cΔCVP-derived ΔPpl) were compared to the directly measured change in pleural pressure (Δd-Ppl), which was the gold standard estimate in this study. The cΔCVP-derived ΔPpl was calculated as κ × ΔCVP, where “κ” was the ratio of the change in airway pressure to the change in CVP during the occlusion test. The means and standard deviations of the Δd-Ppl, ΔPes, and cΔCVP-derived ΔPpl for all pigs under all conditions were 7.6 ± 4.5, 7.2 ± 3.6, and 8.0 ± 4.8 cmH 2 O, respectively. The repeated measures correlations showed that both the ΔPes and cΔCVP-derived ΔPpl showed a strong correlation with the Δd-Ppl (ΔPes: r = 0.95, p < 0.0001; cΔCVP-derived ΔPpl: r = 0.97, p < 0.0001, respectively). In the Bland–Altman analysis to test the performance of the cΔCVP-derived ΔPpl to predict the Δd-Ppl, the ΔPes and cΔCVP-derived ΔPpl showed almost the same bias and precision (ΔPes: 0.5 and 1.7 cmH 2 O; cΔCVP-derived ΔPpl: − 0.3 and 1.9 cmH 2 O, respectively). No significant difference was found in the bias and precision depending on the intravascular volume and intraabdominal pressure in both comparisons between the ΔPes and Δd-Ppl, and cΔCVP-derived ΔPpl and Δd-Ppl. Conclusions The CVP method can estimate the ΔPpl with reasonable accuracy, similar to Pes measurement. The accuracy was not affected by the intravascular volume or chest wall compliance.

麻酔科医が集中治療を研修することに利点があることは自明である．術後経過を知ることで，患者が安全に，快適に，そして早く回復するために必要な麻酔が何かを感じることができる．その上でさらに小児集中治療を学ぶことには，以下のような利点がある．①個別化診療をする習慣が身に付く．②患者やモニターから情報を得る能力が向上する．③鎮静薬の使い方が上手になる．④呼吸循環相互作用の影響について経験を積める．⑤家族説明が上手になる．⑥論文にする題材がたくさんある．これらを生かすために，成人を主に診療している麻酔科医が，普段慣れない小児集中治療において，安全で安心な研修ができる体制を作ることも重要である．