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Mitochondrial dysfunction plays a role in the pathophysiology of sepsis-related organ failure, and its role in pediatric febrile illness remains largely unexplored. The study by Sartori et al. uses a prospective design comparing febrile patients from both Emergency Department and ICU with appropriate controls. It is important to note that while this study was prospective for the Emergency Department patients with febrile illness, the sepsis data represents a secondary analysis of a previous study, which may limit direct comparisons between these groups. Mitochondrial function was evaluated using spare respiratory capacity (SRC), citrate synthase (CS) activity and mitochondrial to nuclear DNA ratio (mtDNA: nDNA) in peripheral blood mononuclear cells (PBMCs). A significant reduction in SRC was noted in both febrile illness and sepsis associated with lower CS activity. Interestingly, significantly lower mtDNA:nDNA ratio was noted in febrile illness compared to both ED/PICU controls and sepsis patients. Future studies should focus on assessment of mitochondrial function longitudinally and in individual cell types while trying to identify newer markers of mitochondrial dysfunction. Long term goal of discovering targeted mitochondrial therapy could improve survival in fatal illness including sepsis as we move closer to more personalized and effective treatment strategies for these critical conditions.

The study compared mitochondrial function in children with febrile illness, sepsis, and controls, but sepsis patients were from a different cohort (ICU) than febrile illness patients (ED), potentially limiting direct comparisons.

Reliable and long-lasting venous access in children is preferred outside the ICU settings where CVADs are essential for long-term treatment involving administration of long-term nutrition in gut enteropathies, chemotherapy, hemodialysis as well as in palliative situations requiring pain medications or administration of antibiotics as in chronic osteomyelitis. Alina Burek et al. have brought to light important aspects related to the use of CVADs outside the ICU settings. The authors found distinct benefits to healthcare facilities that have vascular access teams as they follow established guidelines for the use of CVADs. A dedicated specialized team with good knowledge of devices helped in the choice of appropriate CVAD and optimal CVAD utilization. It is important to follow the key principles when using CVADs. This includes the choice of appropriate devices depending on the duration of use. CVADs with the smallest outer diameter and least number of lumens should be chosen where the catheter outer diameter should be less than 45% of that of the vein to reduce risk of thrombosis. Infection prevention protocol must be strictly implemented and the CVAD promptly removed when no longer required. CVAD performance is often taken as a benchmark of hospital performance, highlighting its importance.

Central Venous Access Device use outside PICU is essential for administering medications and blood draw.