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This article aimed to summarize the impact and burden of pediatric postintensive care syndrome (PICS-p) in the physical, mental, cognitive, and social health domains after a review of the current pediatric literature in MEDLINE and PubMed. We also aimed to elucidate the limitations of the current evaluation tools used in limited-resource settings. PICS-p can impact a child’s life for decades. Most validated tools are time-consuming, require qualifications, and expertise, are often limited to older children, and can evaluate only one domain. A novel, simple, and comprehensive surveillance tool can aid healthcare providers in the early detection and intervention of PICS-p. Further studies should validate and refine the parameters that will enhance the outcomes of pediatric intensive care unit survivors.

Background: The use of indwelling central venous access devices (CVADs) in children can result in complications such as infection, occlusion, and dislodgement.Purpose: To evaluate whether reinforcing CVAD care bundles by using a regular direct feedback system could reduce such complications in children.Methods: The intervention in this retrospective interrupted time-series study was initiated in January 2019. The study was divided into the preintervention (October–December 2018), 3-month postintervention (January–March 2019), and 6-month postintervention (April–June 2019) phases. Risk difference and Poisson regression analyses were used to illustrate the effectiveness of the intervention.Results: The hospital-wide central line-related bloodstream infection rate decreased from 10.0/1,000 catheter-days to 4.5/1,000 catheter-days at 3-month postintervention (P=0.39) and to 1.4/1,000 catheter-days at 6-month postintervention (P=0.047). The central line occlusion rate significantly decreased from 30% to 12.8% (P=0.04) and 8.3% (P=0.002) at 3 and 6 months, respectively. Approximately 7% of CVADs became dislodged during the preintervention phase versus 8.5% (P=0.364) and 3.3% (P=0.378) at 3 and 6 months, respectively.Conclusion: Reinforcing CVAD care bundles with direct feedback could significantly decrease CVAD-associated complications in terms of infection at 6-month postintervention, and occlusion at 3- and 6-month postintervention. Thus, reinforcement and regular direct feedback might improve care quality in children with CVADs.

Background Physical impairment is the major morbidity in children surviving intensive care. The main objective of this study was to evaluate the effectiveness of a nurse-driven protocol in the early mobilization of critically ill children in terms of reduction of motor dysfunction, pediatric intensive care unit stays, and ventilator days. The secondary objective was to evaluate the safety in terms of injury, dislodgement of the medical devices, and cardiorespiratory instabilities attributable to the intervention. Methods The intervention of early rehabilitation was initiated in July 2020. This retrospective interrupted time-series study was divided into the pre-implementation phase (January - June 2020) and the post-implementation phase (July - December 2020). Functional Status Scale in the domain of motor function was used to define the motor dysfunction after PICU discharge. Results Twenty-five children were allocated in each group. The median age of the whole cohort was 11.5 months and approximately 58% of the population were male. The baseline characteristics of both groups were not statistically significant. There was a statistically significant reduction in motor dysfunction after protocol implementation (64.0 % VS 36.0 %; p = 0.044) with an absolute risk reduction of 28%. The number needed to treat was 3.6 children. There were no statistically significant differences in the median ventilator days, length of stay in the intensive care unit, and hospital length of stay. No complication was found. Conclusions Nurse-driven protocol for the early mobilization of critically ill children was feasible and could be effective in reducing post-intensive care motor dysfunction.

Objective Physicochemical approach such as strong ion difference provides a novel concept in understanding and managing acid–base disturbance in patients. However, its application in pediatrics is limited. This study aimed to evaluate a correlation between the physicochemical approach and blood gas pH for acid–base determination in critically ill pediatric patients. Results A total of 130 pediatric patients were included, corresponding to 1338 paired measures for analyses. Of these, the metabolic subgroup (743 paired measures) was defined. Among physicochemical parameters, the effective strong ion difference showed the best correlation with the blood gas pH in the whole cohort (R = 0.398; p

A child with Down syndrome, who had undergone uneventful ventricular septal defect repair one year earlier with a normal heart rate during routine follow-up, presented with recurrent seizure-like episodes that did not respond to antiepileptics. She was subsequently found to have complete heart block with significant bradycardia requiring permanent pacemaker insertion. This late and unusual presentation of complete heart block after ventricular septal defect repair is discussed. Prudence must be applied in the evaluation of children who have undergone surgical correction of congenital heart defects and presented with recurrent seizure-like episodes.

Background One of the most important functions of the emergency department (ED) is to assess patient status. Only one, the pediatric early warning score (PEWS), has been designed for ED with acceptable validity, but it has never been validated in Thailand. The objective of this study was to validate PEWS in predicting hospitalization in children visiting the ED. Methods During the initial phase, two triage nurses performed blind scoring (in order to determine inter-rater reliability using kappa statistics) for the first 30 patients who presented to the ED at Ramathibodi Hospital between March and May 2014 and who were aged

Introduction Hemodynamic parameters measurements were widely conducted using pulmonary artery catheter (PAC) with thermodilution as a reference standard. Due to its technical difficulties in children, transthoracic echocardiography (TTE) has been widely employed instead. Nonetheless, TTE requires expertise and is time-consuming. Noninvasive cardiac output monitoring such as ultrasonic cardiac output monitor (USCOM) and electrical velocimetry (EV) can be performed rapidly with less expertise requirement. Presently, there are inconsistent evidences, variable precision, and reproducibility of EV, USCOM and TTE measurements. Our objective was to compare USCOM, EV and TTE in hemodynamic measurements in critically ill children. Materials and methods This was a single center, prospective observational study in critically ill children. Children with congenital heart diseases and unstable hemodynamics were excluded. Simultaneous measurements of hemodynamic parameters were conducted using USCOM, EV, and TTE. Inter-rater reliability was determined. Bland-Altman plots were used to analyse agreement of assessed parameters. Results Analysis was performed in 121 patients with mean age of 4.9 years old and 56.2% of male population. Interrater reliability showed acceptable agreement in all measured parameters (stroke volume (SV), cardiac output (CO), velocity time integral (VTI), inotropy (INO), flow time corrected (FTC), aortic valve diameter (AV), systemic vascular resistance (SVR), and stroke volume variation (SVV); (Cronbach’s alpha 0.76–0.98). Percentages of error in all parameters were acceptable by Bland-Altman analysis (9.2–28.8%) except SVR (30.8%) and SVV (257.1%). Conclusion Three noninvasive methods might be used interchangeably in pediatric critical care settings with stable hemodynamics. Interpretation of SVV and SVR measurements must be done with prudence.