
Anjuli Sinha Campbell
Clinical Assistant Professor, Pediatrics - Cardiology
Clinical Focus
- Pediatric Critical Care Medicine
Professional Education
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Residency: Children's Hospital of Philadelphia Dept of Pediatrics (2014) PA
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Board Certification: American Board of Pediatrics, Pediatric Critical Care Medicine (2020)
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Board Certification, American Board of Pediatrics, Pediatric Critical Care (2020)
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Board Certification: American Board of Pediatrics, Pediatric Cardiology (2018)
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Board Certification: American Board of Pediatrics, Pediatrics (2014)
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Fellowship: Children's Hospital of Philadelphia Pediatric Critical Care Program (2020) PA
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Fellowship: Boston Children's Hospital (2018) MA
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Medical Education: Case Western Reserve School of Medicine (2011) OH
All Publications
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Navigating Time-Critical Decisions in Pediatric Critical Care: A Proactive Communication Guide for Cultivating Prognostic Awareness.
Journal of palliative medicine
2025
Abstract
Background: Clinical teams face many barriers to communicating with the parents/caregivers of patients experiencing an acute decline. Outside of these time-critical situations, clinicians often can iteratively assess and cultivate prognostic awareness of the patient and parents/caregivers and elicit values and goals over multiple conversations. However, in emergent circumstances, a modified approach to support prognostic awareness is necessary. Methods: We developed a clinical practice guideline for time-critical decision making through consensus with an interprofessional group. Results: Our proposed strategy starts with a concise statement naming the situation and urgent decision to be made, followed by an outline of the medical options with individualized clinical contextualization for the child and/or parents/caregivers. Finally, incorporating responses (verbal and nonverbal) from the parents/caregivers, recommendations for next steps are offered, with a check-in to ensure agreement with the recommendation(s). Conclusion: This framework is intended to supplement, not replace, existing guidelines for eliciting values and making medical recommendations in time-critical situations.
View details for DOI 10.1089/jpm.2024.0497
View details for PubMedID 40384441
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Unplanned reinterventions after congenital cardiac surgery and hospital mortality: a report from the Pediatric Cardiac Critical Care Consortium (PC4).
The Journal of thoracic and cardiovascular surgery
2025
Abstract
Unplanned cardiac reinterventions (UCR) after congenital cardiac surgery may complicate the post-operative course. We sought to identify incidence rates and risk factors for UCRs and associations between UCRs and hospital mortality.Patients in the Pediatric Cardiac Critical Care Consortium (PC4) registry undergoing an index cardiac operation from February 2019 to January 2022 were included. Multivariable logistic regression, adjusted for center effect, was used to evaluate patient risk factors for UCR and the impact of reintervention on hospital mortality.Included were 34,495 patients from 62 centers. UCRs occurred in 2,635 (7.6%) patients with wide center variation. Risk factors for UCR included Black race, extracardiac and chromosomal anomalies, younger age, lower weight for age, prior cardiac surgeries, and higher surgical complexity category. The performance of an UCR was associated with higher hospital mortality (16.1%) compared to those who did not undergo reintervention (1.3%) (aOR, 6.45; 95% CI, 5.51-7.56, P<0.001). The odds of mortality after UCR increased with higher STAT-EACTS category. Mortality was highest in patients who underwent both reoperation and interventional catheterization (31.9%) compared to those who only underwent reoperation (16.3%) or catheterization (9.8%).UCRs occur in approximately one in 13 patients after congenital cardiac surgery, and approximately one in six patients with an UCR will die. Patients at greatest risk for UCR may share patient and disease-specific risk factors. Further investigation is needed to minimize the incidence of residual lesions, understand why Black children have more UCRs, and explore modifiable risk factors for and optimal timing of UCRs.
View details for DOI 10.1016/j.jtcvs.2025.03.005
View details for PubMedID 40090460
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Acute neurological injury in pediatric patients with single-ventricle congenital heart disease.
Journal of neurosurgery. Pediatrics
2021: 1-9
Abstract
OBJECTIVE: Single-ventricle congenital heart disease (CHD) in pediatric patients with Glenn and Fontan physiology represents a unique physiology requiring the surgical diversion of the systemic venous return from the superior vena cava (Glenn) and then the inferior vena cava (Fontan) directly to the pulmonary arteries. Because many of these patients are on chronic anticoagulation therapy and may have right-to-left shunts, arrhythmias, or lymphatic disorders that predispose them to bleeding and/or clotting, they are at risk of experiencing neurological injury requiring intubation and positive pressure ventilation, which can significantly hamper pulmonary blood flow and cardiac output. The aim of this study was to describe the complex neurological and cardiopulmonary interactions of these pediatric patients after acute central nervous system (CNS) injury.METHODS: The authors retrospectively analyzed the records of pediatric patients who had been admitted to a quaternary children's hospital with CHD palliated to bidirectional Glenn (BDG) or Fontan circulation and acute CNS injury and who had undergone intubation and mechanical ventilation. Patients who had been admitted from 2005 to 2019 were included in the study. Clinical characteristics, surgical outcomes, cardiovascular and pulmonary data, and intracranial pressure data were collected and analyzed.RESULTS: Nine pediatric single-ventricle patients met the study inclusion criteria. All had undergone the BDG procedure, and the majority (78%) were status post Fontan palliation. The mean age was 7.4 years (range 1.3-17.3 years). At the time of acute CNS injury, which included traumatic brain injury, intracranial hemorrhage, and cerebral infarct, the median time interval from the most recent cardiac surgical procedure was 3 years (range 2 weeks-11 years). Maintaining normocarbia to mild hypercarbia for most patients during intubation periods did not cause neurological deterioration, and hemodynamic profiles were more favorable as compared to periods of hypocarbia. Hypocarbia was associated with unfavorable hemodynamics but was necessary to decrease intracranial hypertension. Most patients were managed using low mean airway pressure (MAWP) in order to minimize the impact on preload and cardiac output.CONCLUSIONS: The authors highlight the complex neurological and cardiopulmonary interactions with respect to partial pressure of arterial CO2 (PaCO2) and MAWP when pediatric CHD patients with single-ventricle physiology require mechanical ventilation. The study data demonstrated that tight control of PaCO2 and minimizing MAWP with the goal of early extubation may be beneficial in this population. A multidisciplinary team of pediatric critical care intensivists, cardiac intensivists and anesthesiologists, and pediatric neurosurgeons and neurologists are recommended to ensure the best possible outcomes.
View details for DOI 10.3171/2021.2.PEDS2142
View details for PubMedID 34243155