Prophylactic PD is associated with greater net negative fluid balance, decreased inotrope requirements, and lower serum concentrations of inflammatory cytokines in the early postoperative period.

Low cortisol obtained in the immediate postoperative period is not associated with worse postoperative outcomes or predictive of steroid responsiveness. In contrast, elevated levels of cortisol are positively correlated with severity of illness. The use of an absolute cortisol threshold to identify adrenal insufficiency and/or guide steroid therapy in neonates after cardiac surgery is unjustified.

SESSION TITLE: Miscellaneous Case Report Posters II SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM -02:30 PM INTRODUCTION: Myocarditis is a rare complication of many viral syndromes. Most commonly described viral etiologies are adenovirus, coxsackievirus, CMV, HIV, and parvovirus B-19. We present a rare case of coronavirus related fulminant myocarditis. CASE PRESENTATION:Nine month old male presented with two day history of cough, rhinorrhea, and fever. Initial vitals were significant for respiratory rate of 60 breaths per minute and a heart rate of 180 beats per minute. Physical examination revealed nasal flaring and crackles on auscultation. Electrocardiograph revealed diffuse ST segment elevation, and echocardiogram showed ejection fraction(EF) of 25 %. Intubation was performed for respiratory failure and shock. The patient suffered cardiovascular collapse post-intubation and received CPR for 1.5 hours until veno-arterial ECMO was initiated. On ECMO day two, a heart catheterization revealed left atrial hypertension (17mmHg) and balloon atrial septostomy was performed. Comprehensive PCR based viral respiratory panel (which has a sensitivity and specificity of more than 90%) was positive for coronavirus and Ebstein barr virus. Patient was treated with two doses of intravenous immunoglobulin (2 milligram per kilogram). He was successfully decannulated on ECMO day six. Repeat echocardiogram showed EF 55%. Patient subsequently was weaned off and had full neurological recovery.

Objectives: Assess the overall level of burnout in pediatric critical care medicine fellows and examine factors that may contribute to or protect against its development. Design: Cross-sectional observational study. Setting: Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs across the United States. Subjects: Pediatric critical care medicine fellows and program directors. Interventions: Web-based survey that assessed burnout via the Maslach Burnout Inventory, as well as other measures that elicited demographics, sleepiness, social support, perceptions about prior training, relationships with colleagues, and environmental burnout. Measurements and Main Results: One-hundred eighty-seven fellows and 47 program directors participated. Fellows from 30% of programs were excluded due to lack of program director participation. Average values on each burnout domain for fellows were higher than published values for other medical professionals. Personal accomplishment was greater (lower burnout) among fellows more satisfied with their career choice (β 9.319; p ≤ 0.0001), spiritual fellows (β 1.651; p = 0.0286), those with a stress outlet (β 3.981; p = 0.0226), those comfortable discussing educational topics with faculty (β 3.078; p = 0.0197), and those comfortable seeking support from their co-fellows (β 3.762; p = 0.0006). Depersonalization was higher for second year fellows (β 2.034; p = 0.0482), those with less educational debt (β –2.920; p = 0.0115), those neutral/dissatisfied with their career choice (β –6.995; p = 0.0031), those with nursing conflict (β –3.527; p = 0.0067), those who perceived burnout among co-fellows (β 1.803; p = 0.0352), and those from ICUs with an increased number of patient beds (β 5.729; p ≤ 0.0001). Emotional exhaustion was higher among women (β 2.933; p = 0.0237), those neutral/dissatisfied with their career choice (β –7.986; p = 0.0353), and those who perceived burnout among co-fellows (β 5.698; p ≤ 0.0001). Greater sleepiness correlated with higher burnout by means of lower personal accomplishment (r = –1.64; p = 0.0255) and higher emotional exhaustion (r = 0.246; p = 0.0007). Except for tangible support, all other forms of social support showed a small to moderate correlation with lower burnout. Conclusions: Pediatric critical care medicine fellows in the United States are experiencing high levels of burnout, which appears to be influenced by demographics, fellow perceptions of their work environment, and satisfaction with career choice. The exclusion of fellows at 30% of the programs may have over or underestimated the actual level of burnout in these trainees.

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