1,112 results on '"Paediatric intensive care unit"'
Search Results
152. Impact of thrombelastography in paediatric intensive care.
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Carter, B. G., Carland, E., Monagle, P., Horton, S. B., and Butt, W.
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THROMBELASTOGRAPHY , *HEMOSTASIS , *PEDIATRIC intensive care , *KAOLIN , *HEPARIN lyase , *ARTERIAL catheters , *THERAPEUTICS - Abstract
We assessed the clinical impact of thrombelastography (TEG®) results (TEG® 5000, Haemonetics Corporation, Braintree, MA, USA) by measuring their ability to cause changes in a theoretical treatment plan and contribute to the understanding of haemostasis. We prospectively included paediatric intensive care unit (PICU) patients who had standard tests of haemostasis and TEG ordered and had an arterial catheter or extracorporeal access port in situ. Blood for standard tests and TEG was taken simultaneously. Independent of patient care, general patient information and results of standard laboratory tests were presented to five clinicians who were asked to document their theoretical treatment plan. Clinicians were then shown TEG results and asked if they caused a change in their plan, if they confirmed initial standard laboratory test results, if they enabled a better understanding of haemostasis and if they provided additional information. Inter-rater agreement between the clinicians was determined. Forty-two TEG results were obtained from 34 patients. Overall, the inclusion of TEG results led to a change in treatment plan in 97 of 207 occasions (47%), confirmed standard laboratory test results in 177 of 204 occasions (87%), enabled a better understanding of haemostasis in 140 of 204 occasions (69%) and provided additional information in 131 of 204 occasions (64%). Variation existed between clinicians, seemingly due to individual differences, with poor inter-rater agreement. We conclude that TEG results led to changes in treatment plans almost half the time, confirmed findings of standard tests and provided a better understanding of haemostasis, but randomised controlled trials are required to determine the role and influence of TEG results on patient outcome. [ABSTRACT FROM AUTHOR]
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- 2017
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153. Mental health problems among nurses in paediatric cardiac intensive care.
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Tito, Renata Santos, Baptista, Patrícia Campos Pavan, da Silva, Fabio José, and Felli, Vanda Elisa Andres
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PEDIATRIC nursing , *PSYCHOLOGY of nurses , *NURSES , *PSYCHOLOGICAL stress , *JOB stress , *MENTAL health , *PSYCHIATRIC epidemiology , *ACADEMIC medical centers , *ANXIETY , *CHI-squared test , *MENTAL depression , *INDUSTRIAL hygiene , *INTENSIVE care nursing , *INTENSIVE care units , *INTERVIEWING , *RESEARCH methodology , *PEDIATRICS , *QUESTIONNAIRES , *RESEARCH , *STATISTICAL sampling , *QUANTITATIVE research , *CROSS-sectional method , *DESCRIPTIVE statistics - Abstract
At present, there are growing rates of psychiatric symptoms among some occupational categories, with emphasis on health professionals who work in hospitals. This study aimed to identify the occurrence of mental health problems (anxiety and depression) among 92 nursing workers in a paediatric cardiac intensive care unit. This is an exploratory, cross-sectional study, with a quantitative approach. The research was conducted in a public university hospital specialising in cardiology, pneumology, and thoracic and cardiac surgery. The data were collected between June and July of 2012 through socio-demographic and Self-Reporting Questionnaire (SRQ-20) instruments. The analysis of the results revealed the occurrence of mental health problems in 45% (41) of the workers. There was the prevalence of tension, nervousness and worry symptoms, followed by headache. Findings highlight the need for protective measures towards the mental health of workers who assist children with serious heart disease. [ABSTRACT FROM AUTHOR]
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- 2017
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154. Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients: a propensity-adjusted analysis.
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Yamaguchi, Ricardo, Noritomi, Danilo, Degaspare, Natalia, Muñoz, Gabriela, Porto, Ana, Costa, Silvia, Ranzani, Otavio, Yamaguchi, Ricardo Silveira, Noritomi, Danilo Teixeira, Degaspare, Natalia Viu, Muñoz, Gabriela Ortega Cisternas, Porto, Ana Paula Matos, Costa, Silvia Figueiredo, and Ranzani, Otavio T
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PERIPHERALLY inserted central catheters , *CENTRAL venous catheters , *CENTRAL line-associated bloodstream infections , *INTENSIVE care units , *SENSITIVITY analysis , *PARENTERAL feeding , *PHYSIOLOGY , *BACTEREMIA prevention , *BACTEREMIA , *COMPARATIVE studies , *INTRAVENOUS catheterization , *RESEARCH methodology , *MEDICAL cooperation , *PEDIATRICS , *PROBABILITY theory , *RESEARCH , *TIME , *EVALUATION research , *DISEASE incidence , *PROPORTIONAL hazards models , *RETROSPECTIVE studies , *CENTRAL venous catheterization , *CATHETER-related infections , *INFECTION prevention - Abstract
Purpose: Central line-associated bloodstream infection (CLABSI) is an important cause of complications in paediatric intensive care units (PICUs). Peripherally inserted central catheters (PICCs) could be an alternative to central venous catheters (CVCs) and the effect of PICCs compared with CVCs on CLABSI prevention is unknown in PICUs. Therefore, we aimed to evaluate whether PICCs were associated with a protective effect for CLABSI when compared to CVCs in critically ill children.Methods: We have carried out a retrospective multicentre study in four PICUs in São Paulo, Brazil. We included patients aged 0-14 years, who needed a CVC or PICC during a PICU stay from January 2013 to December 2015. Our primary endpoint was CLABSI up to 30 days after catheter placement. We defined CLABSI based on the Center for Disease Control and Prevention's National Healthcare Safety Networks (NHSN) 2015 surveillance definitions. To account for potential confounders, we used propensity scores with inverse probability weighting.Results: A total of 1660 devices (922 PICCs and 738 CVCs) in 1255 children were included. The overall CLABSI incidence was 2.28 (95% CI 1.70-3.07)/1000 catheter-days. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR 2.20, 95% CI 1.05-4.61; p = 0.037) compared with PICCs. In a sensitivity analysis, CVCs remained associated with higher risk of CLABSI (adjHR 2.18, 95% CI 1.02-4.64; p = 0.044) after adding place of insertion and use of parenteral nutrition to the model as a time-dependent variable.Conclusions: PICC should be an alternative to CVC in the paediatric intensive care setting for CLABSI prevention. [ABSTRACT FROM AUTHOR]- Published
- 2017
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155. Challenges of paediatric organ donation.
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Gelbart, Ben
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ORGAN donation , *CHILD patients , *CHILD mortality , *BRAIN death in children , *INTENSIVE care units - Abstract
Paediatric organ donation represents a small fraction of overall organ donation in Australia and New Zealand and indeed world-wide. Many factors contribute to low donation rates including low paediatric intensive care mortality, consent rates and medical suitability relating to disease, age and size. In the past decade, the re-emergence of donation after circulatory death has changed the landscape for the paediatric population. This article reviews the current status and challenges of organ donation for the paediatric population. [ABSTRACT FROM AUTHOR]
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- 2017
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156. Nasal high flow in management of children with status asthmaticus: a retrospective observational study.
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Baudin, Florent, Buisson, Alexandra, Vanel, Blandine, Massenavette, Bruno, Pouyau, Robin, and Javouhey, Etienne
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ASTHMA in children , *PRIMARY care , *ARTIFICIAL pneumothorax , *BLOOD gases , *HEART beat - Abstract
Background: Asthma is the most common obstructive airway disease in children and adults. Nasal high flow (NHF) is a recent device that is now used as a primary support for respiratory distress. Several studies have reported use of NHF as a respiratory support in status asthmaticus; however, there are no data to recommend such practice. We therefore conducted this preliminary study to evaluate NHF therapy for children with status asthmaticus admitted to our PICU in order to prepare a multicentre randomized controlled study. Results: Between November 2009 and January 2014, 73 patients with status asthmaticus were admitted to the PICU, of whom 39 (53%) were treated with NHF and among these 10 (26%) presented severe acidosis at admission (pH < 7.30). Thirty-four less severe children (41%) were treated with standard oxygen. For one child (2.6%) NHF failed and was then switched to non-invasive ventilation. NHF was discontinued in another patient because of the occurrence of pneumothorax after 31 h with NHF; the patient was then switched to standard oxygen therapy. Mean ± SD heart rate (165 ± 21 vs. 141 ± 25/min, p < 0.01) and respiratory rate (40 ± 13 vs. 31 ± 8/min, p < 0.01) decreased significantly, and blood gas improved in the first 24 h. In the subgroup of patients with acidosis, median [IQR] pH increased significantly between hour 0 and 2 (7.25 [7.21-7.26] vs. 7.30 [7.27-7.33], p = 0.009) and median [IQR] pCO decreased significantly (7.27 kPa [6.84-7.91 vs. 5.85 kPa [5.56-6.11], p = 0.007). No patient was intubated. Conclusion: This retrospective study showed the feasibility and safety of NHF in children with severe asthma. Blood gas and clinical parameters were significantly improved during the first 24 h. NHF failed in only two patients, and none required invasive ventilation. [ABSTRACT FROM AUTHOR]
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- 2017
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157. Standard concentration infusions in paediatric intensive care: the clinical approach.
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Perkins, Joanne, Aguado‐Lorenzo, Virginia, and Arenas‐Lopez, Sara
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PEDIATRIC intensive care , *INTRAVENOUS therapy , *DOSAGE forms of drugs , *DRUG delivery systems , *DRUG infusion pumps - Abstract
The use of standard concentrations of intravenous infusions has been advocated by international organisations to increase intravenous medication safety in paediatric and neonatal critical care. However, there is no guidance on how to identify and implement these infusions leading to great interunit variability. Objective To identify the most appropriate clinical concentrations required by our paediatric intensive care unit ( PICU) population with regard to accuracy of delivery and overall fluid allowance. Methods Firstly a matrix was used to balance the concentration, dose and infusion volume (weight range 1.5-50 kg). Results were further refined considering: patient fluid allowance based on fluid volume targets, infusion pump accuracy and challenging each infusion against clinical scenarios requiring administration of multiple drug infusions found in PICU. Consideration was given to the standard concentrations routinely used in adults, in order to assess whether alignment with paediatrics was possible for some of the concentrations proposed. Finally a risk assessment of the infusions was conducted using the NPSA 20 tool. Key findings Twenty-five drugs identified as the most commonly used intravenous infusions in the unit. For the majority of the medicines, three weight bands of standard concentrations were necessary to cover the children's weight ranges and kept within predefined fluid requirements and accuracy of delivery. Conclusions This work shows a patient focused systematic approach for defining and evaluating standardised concentrations in intensive care children. [ABSTRACT FROM AUTHOR]
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- 2017
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158. Safe implementation of standard concentration infusions in paediatric intensive care.
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Arenas‐López, Sara, Stanley, Isabel M., Tunstell, Paul, Aguado‐Lorenzo, Virginia, Philip, Jo, Perkins, Joanne, Durward, Andrew, Calleja‐Hernández, Miguel Angel, and Tibby, Shane M.
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DRUG therapy , *MORPHINE , *DRUG infusion pumps , *MEDICATION safety , *PEDIATRIC intensive care , *DRUG efficacy - Abstract
Objective To evaluate safety, following introduction of standard concentrations of morphine infusions in paediatric critical care. Methods Implementation: A multidisciplinary team was convened, and several workstreams designated, including derivation of concentrations, manufacturing, supply, prescribing, administration using smart pump technology, training and evaluation. Safety Evaluation: Retrieval of all existing data on medication errors linked to morphine use using our hospital incident reporting system and risk assessment of errors in relation to standard concentration implementation. Key findings The pilot identified several areas for improvement, stock control, reasons for reverting from standard to variable concentrations and sources of error. Improvements included the following: refining morphine concentrations and weight limits for bands, pump reprogramming and education. Long-term Safety: Over an 8-year period, 126 morphine-related incidents occurred (two-thirds in the 3 years around introduction). Of note, 67% (85/126) resulted in no patient harm; the remainder 33% resulted in low harm. Analysis of administration errors revealed that up to 70% could be eliminated by refining technology to include bar coding. These included the following: wrong syringe selection (24%), wrong pump mode (28%) and wrong patient weight inputted (18%). Conclusion Introduction of standard infusions is safe and effective. We are exploring ways to further refine safety and extending to other drugs. [ABSTRACT FROM AUTHOR]
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- 2017
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159. Measurement of parent satisfaction in the paediatric intensive care unit -- Translation, cultural adaptation and psychometric equivalence for the French-speaking version of the EMPATHIC-65 questionnaire.
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Grandjean, Chantal, Latour, Jos M., Cotting, Jacques, Fazan, Marie-Christine, Leteurtre, Stéphane, and Ramelet, Anne-Sylvie
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Introduction: Within paediatric intensive care units (PICUs), only a few parent satisfaction instruments are validated and none are available for French-speaking parents. The aims of the study were to translate and culturally adapt the Dutch EMPATHIC-65 questionnaire into a French version and to test its psychometric equivalence. Methods: Two French-speaking PICUs in Switzerland and France participated. The questionnaire was translated using a standardised method and parents with PICU experience were interviewed to assess clarity of the translated version. Secondly, parents of children hospitalised for at least 24 hours and who were fluent in French, were invited to complete the French translated version of the EMPATHIC-65 questionnaire. Reliability and validity measures were used to examine its psychometric equivalence. Results: The overall mean clarity agreement reached 90.2% by 17 French-speaking parents. Eight unclear items have subsequently been reworded. One hundred seventy-two parents completed the French version questionnaire. Reliability and convergent validity have been confirmed by an adequate internal consistency (0.59-0.89) and convergent validity (r
s 0.25-0.63, p < 0.01). Conclusion: Psychometric equivalence of the French EMPATHIC-65 questionnaire highlights the appropriateness of relying on available valid instrument to expand the availability of health instrument measure in French. [ABSTRACT FROM AUTHOR]- Published
- 2017
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160. Effect of three enteral diets with different protein contents on protein metabolism in critically ill infants: a randomized controlled trial.
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Fernández Montes R, Urbano Villaescusa J, Carrillo Álvarez Á, Vivanco Allende A, Solana García MJ, Díaz Coto S, Rey Galán C, and López-Herce Cid J
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- Child, Humans, Infant, Prospective Studies, Blood Proteins metabolism, Diet, Retinol-Binding Proteins, Nitrogen metabolism, Prealbumin metabolism, Critical Illness therapy
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Introduction: The optimal intake to improve protein metabolism without producing adverse effects in seriously ill infants has yet to be established. The aim of our study was to analyse whether an increased protein intake delivered through enteral nutrition would be associated with an improvement in nitrogen balance and serum protein levels in critically ill infants., Methods: We conducted a multicentre, prospective randomized controlled trial (December 2016-June 2019). The sample consisted of critically ill infants receiving enteral nutrition assigned randomly to 3 protein content groups: standard diet (1.7 g/dL), protein-enriched diet (2.7 g/dL) and high protein-enriched diet (5.1 g/dL). Blood and urine tests were performed, and we assessed nitrogen balance at baseline and at 3-5 days of the diet. We analysed variations in nitrogen balance and serum protein levels (total protein, albumin, transferrin, prealbumin, and retinol-binding protein) throughout the study period., Results: Ninety-nine infants (33 per group) completed the study. We did not find any differences were between groups in demographic characteristics, severity scores or prescribed medications, except for corticosteroids, administered in a higher proportion of patients in the third group. We observed significant increases in prealbumin and retinol-binding protein levels in patients receiving the protein-enriched and high protein-enriched diets at 3-5 days compared to baseline. The nitrogen balance increased in all groups, but the differences were not significant in the high protein-enriched group. There were no differences in gastrointestinal tolerance. Patients fed high protein-enriched formula had higher levels of serum urea, with a higher incidence of hyperuraemia in this group., Conclusion: Enteral administration of higher amounts of protein improves serum protein levels in critically ill children. A protein intake of 2.2 g/kg/day is generally safe and well tolerated, whereas an intake of 3.4 g/kg/day may produce hyperuraemia in some patients., (Copyright © 2023 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2023
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161. Paediatrics and discomfort with death and dying.
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Johnson KT and Dahl N
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Death and dying, while uncommon in day-to-day paediatrics practice, are becoming increasingly common occurrences as children with life-limiting illnesses are living longer. We reflect on our experiences with death and dying in our residency training and whether paediatrics, as a specialty, is uncomfortable with death. Paediatric trainees should be included in honest discussions about disease trajectories and participate in providing end-of-life care. Anticipatory guidance helps personalize care and can prevent unnecessary procedures or suffering that patients may experience. While trainees may not be present at the end-of-life for many patients, managing death and dying are important competencies for future paediatricians. Current paediatricians should reflect on their comfort with death and how this may impact their patient care., Competing Interests: The authors have no conflicts to declare., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2023
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162. Constructing the Bodies of Critically Ill Children: an Ethnography of Intensive Care
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Place, Bernard, Prout, Alan, editor, and Campling, Jo, editor
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- 2000
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163. DOES CHLORHEXIDINE WIPE HELP IN REDUCING HOSPITAL ACQUIRED INFECTIONS (HAIS) AMONG CRITICALLY ILL CHILDREN ADMITTED TO A PAEDIATRIC INTENSIVE CARE UNIT?
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Jolly Chandran, Pragathesh Pragathesh, Kala Ebenezer, Ebor Jacob Gnananayagam, Madhan Kumar, and Hema Paul
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0303 health sciences ,medicine.medical_specialty ,030306 microbiology ,business.industry ,Critically ill ,Chlorhexidine ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,Medicine ,030212 general & internal medicine ,business ,Intensive care medicine ,medicine.drug - Abstract
OBJECTIVE: To determine the effect of chlorhexidine wipes in reducing the incidence of hospital acquired infections (HAIs) among critically ill children admitted in Paediatric Intensive Care Unit (PICU). METHODS: An interventional study, wherein enrolled children were wiped with chlorhexidine after routine bath. The incidence of HAIs were noted and compared with data from historical controls of previous year during the same period (pre-intervention). RESULTS: One hundred and ninety nine children in the intervention period were compared with 271 children from pre-intervention period. The numbers of ventilator-days were 777 and 696 respectively for the intervention period and pre-intervention periods. Incidence of ventilator associated pneumonia (VAP) reduced from 12.9/1000 ventilator-days in the pre-intervention period to 6.4/1000 ventilator-days in the intervention period (p=0.1). VAP prevalence was 3.3% in the pre-intervention period as compared to 2.5% in the intervention period (p=0.6). The incidence of CLABSI was 3.6/1000 catheter-days (catheter days: 1377) with prevalence of 2.5% in the intervention period, whereas among the historic controls of the previous year it was 4.2/1000 days (catheter days 1432) with a prevalence of 2.2% (p= 0.8). No untoward effect was reported. CONCLUSION: The use of chlorhexidine wipes in ICU was feasible but did not signicantly decrease HAIs.
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- 2021
164. Burnout in the Paediatric Intensive Care Unit
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Lucy Dockrell, Suzanne Crowe, and Gregory Nolan
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medicine.medical_specialty ,business.industry ,health care facilities, manpower, and services ,education ,Psychological intervention ,Prevalence ,Burnout ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,health services administration ,030225 pediatrics ,Intervention (counseling) ,Intensive care ,Health care ,medicine ,General Earth and Planetary Sciences ,Intensive care medicine ,business ,Emotional exhaustion ,psychological phenomena and processes ,030217 neurology & neurosurgery ,General Environmental Science - Abstract
Burnout syndrome is characterised by depersonalisation, emotional exhaustion, and low personal accomplishment. This paper seeks to discuss the prevalence of burnout in the paediatric intensive care unit (PICU), contributing factors, and potential interventions. There is marked variation in the reported prevalence rates for burnout syndrome among healthcare workers, but PICU physicians appear to be at increased risk. There is currently insufficient evidence to support any one intervention to ameliorate the symptoms of burnout syndrome, but a multifaceted approach with systematic interventions in the PICU environment and individual-focused treatment of early signs of BOS may be reasonable to reduce the impact of burnout in this critical care setting. Burnout syndrome is increasingly recognised in physicians in intensive care, particularly in the PICU. Prevention and early treatment may significantly improve outcomes for healthcare workers in the PICU, with the potential to enhance patient care.
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- 2020
165. Morbidity and Mortality Pattern of Patients Admitted into Paediatric Intensive Care Unit of Tertiary Level Hospital of Nepal
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Prajwal Paudel, Anil Shrestha, Prem Lal Basel, and Susan Bhattarai
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medicine.medical_specialty ,Paediatric intensive care unit ,business.industry ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,medicine ,Tertiary level ,business - Abstract
Introduction: The paediatric intensive care unit (PICU) takes care of critically ill paediatric patients. Regular evaluation of the outcomes of patients admitted to PICU is important to assess the effectiveness of various interventions. This study aimed to find the morbidity and mortality pattern of patients admitted to PICU of tertiary level Paediatric hospital of Nepal. Methods: We conducted a retrospective, cross sectional observational study using the records of all the patients admitted to PICU of a tertiary level hospital from January 2017 to August 2017. We collected data on age, sex, geographical distribution, duration of PICU stay and the morbidity and mortality outcomes. Outcome is classified as transfer to ward, leave against medical advice (LAMA) and death. Data were analysed descriptively using SPSS version 23. Results: Out of 358 patients admitted to PICU, the mean age was 1.83 years. Majority were infants (54.5%) with male:female ratio of 1.8:1. The major causes of PICU admission were respiratory disease (27.7%) followed by CNS disease (19.6%) and infections (17.3%). The average length of stay was 6.27 days. Overall mortality was 22.7%. Conclusion: Respiratory infections were the primary cause of PICU admission and overall mortality rate was high at 22.7%. However, mortality rate was even worse for patients with multi-system involvement. We need prospective studies to examine the underlying reasons for mortality among patients with multi-system involvement.
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- 2020
166. Necessity of early and continuous monitoring for possible infectious complications in children undergoing therapeutic hypothermia
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Johann Golej, Jennifer Bettina Brandt, Regina Vargha, Sabine Steiner, Gerald Schlager, Michael Hermon, and Kambis Sadeghi
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medicine.medical_specialty ,therapeutic hypothermia ,Intensive Care Units, Pediatric ,Observational period ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,infectious complications ,Hypothermia, Induced ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Medical history ,030212 general & internal medicine ,Child ,Immunodeficiency ,Retrospective Studies ,biology ,business.industry ,C-reactive protein ,Infant, Newborn ,Infant ,Regular Article ,General Medicine ,Hypothermia ,medicine.disease ,continuous monitoring ,C‐reactive protein ,Cold Temperature ,non‐invasive cooling ,Case-Control Studies ,Pediatrics, Perinatology and Child Health ,biology.protein ,Regular Articles & Brief Reports ,medicine.symptom ,Neonatology ,Cytokine synthesis ,business ,Leucocyte migration - Abstract
Aim Since therapeutic hypothermia (TH) is known for its inhibitory effects on leucocyte migration and cytokine synthesis, our aim was to underline the necessity of early monitoring for potential immunomodulatory risks. Methods Using a 13‐year retrospective case‐control study at the paediatric intensive care unit (PICU) of the Medical University in Vienna, all newborn infants and children receiving TH were screened and compared with a diagnosis‐matched control group undergoing conventional normothermic treatment (NT). TH was accomplished by using a non‐invasive cooling device. Target temperature was 32‐34°C. Children with evident infections, a medical history of an immunodeficiency or undergoing immunosuppressive therapy, were excluded. Results During the observational period, 108 patients were screened, 27 of which underwent TH. Culture‐proven infections occurred in 22% of the TH group compared with 4% of the normothermic controls (P = .1). From the second day following PICU admission, median C‐reactive protein (CRP) values were higher in the TH group (day two P = .002, day three P = .0002, day six P = .008). Conclusion Children undergoing TH showed earlier and higher increases in CRP levels when compared to normothermic controls. These data underline the necessity of early and continuous monitoring for possible infectious complications.
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- 2020
167. Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: our experience
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R. Garcés Gómez, M. Domínguez Cajal, P. Samper Villagrasa, I. Gil Hernández, P. Madurga Revilla, J. López Pisón, and J.P. García Íñiguez
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Pediatrics ,medicine.medical_specialty ,Child care ,business.industry ,Critically ill ,Mortality rate ,PIM2 ,Functional impact ,Disease ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,Medicine ,Functional status ,business ,030217 neurology & neurosurgery - Abstract
Introduction Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. Material and methods Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012 to 2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990 to 1999), and those of the international multicentre PANGEA study. Results 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60% vs 2.1%, P = .0003, and 8.44% vs 2.63%, P = .0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05% vs 13.32%, P Conclusions Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care.
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- 2020
168. The Influence of High Flow Nasal Cannulae on the Outcomes of Severe Respiratory Disease in Children Admitted to a Regional Hospital in South Africa
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Mark Richards, Louise Cooke, David M le Roux, and Andrew C. Argent
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Male ,medicine.medical_specialty ,Transfer capacity ,Respiratory Tract Diseases ,Intensive Care Units, Pediatric ,South Africa ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,030225 pediatrics ,medicine ,Retrospective analysis ,Cannula ,Humans ,Nasal Cannulae ,Hospital Mortality ,030212 general & internal medicine ,Retrospective Studies ,Respiratory Distress Syndrome ,business.industry ,Respiratory disease ,Oxygen Inhalation Therapy ,Infant ,Length of Stay ,medicine.disease ,Regional hospital ,Infectious Diseases ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Breathing ,Female ,High flow ,business - Abstract
In settings where access to paediatric intensive care unit (PICU) facilities is constrained and transfer capacity is limited, High Flow Nasal Cannulae (HFNC) might fill an important service gap. The aim of this study was to document the effect of HFNC on the outcomes of children admitted with severe respiratory disease at a regional hospital without a PICU in Cape Town, South Africa. It is a 4-year retrospective analysis documenting two periods of 2 years each, one before (2013–15) and one after (2016–18) the initiation of HFNC use. Patients were between the ages of 2 months and 13 years and had been admitted to a paediatric ward. Outcomes were defined by the need for transfer to a tertiary hospital, the need for invasive ventilation and death. There were 90 instances of HFNC use with a significant reduction in the number of children who were transferred (59 vs. 31), invasively ventilated (20 vs. 6, p ≤ 0.01) and who died (3 vs. 0, p = 0.02). Before HFNC implementation, there was also a significantly greater proportion of transferred children who remained on low flow nasal cannulae (15 vs. 2, p ≤ 0.001) at the tertiary hospital. Children who failed HFNC use tended to do this within a day of initiation (Median 11 vs. 60 h for success, p ≤ 0.001). There were no complications related to its use. We believe that in our setting the utilization of HFNC has helped to timeously and accurately identify children needing to be transferred and may mitigate against severe respiratory disease progression.
- Published
- 2020
169. Validación de la escala simplificada de puntuación de intervenciones terapéuticas (TISS-28) en niños críticamente enfermos
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Juan Mayordomo-Colunga, Corsino Rey, Alberto Medina, Andrés Concha, Ana Vivanco-Allende, and Pablo Martínez-Camblor
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03 medical and health sciences ,Paediatric Intensive Care Unit ,0302 clinical medicine ,030225 pediatrics ,Therapeutic Intervention Scoring System ,Pediatrics, Perinatology and Child Health ,Simplified Therapeutic Intervention Scoring System ,Pediatrics ,RJ1-570 - Abstract
Resumen: Introducción: En el ámbito de los cuidados intensivos, existen numerosas escalas para cuantificar la gravedad de los pacientes. La mayoría de ellas son muy útiles, aunque en ocasiones laboriosas de completar, por lo que su implantación en la práctica habitual es escasa. Una de ellas es la escala de puntuación de intervenciones terapéuticas (TISS 76), que ha sido validada en unidades de adultos y pediátricas. Su versión simplificada y actualizada, la escala simplificada de puntuación de intervenciones terapéuticas (TISS 28), no ha sido validada en unidades pediátricas, siendo este el objetivo del estudio, con idea de disponer de una escala sencilla y rápida. Material y método: Estudio observacional prospectivo sin intervención, en la Unidad de Cuidados Intensivos Pediátricos (UCIP) de un hospital universitario. Se recogieron datos de 935 pacientes ingresados consecutivamente en la UCIP durante un periodo de 3 años, incluyendo los valores de TISS 76 y TISS 28 de todos durante los 4 primeros días de ingreso y la posterior evolución de los pacientes. Resultados: Los valores medios de TISS 76 y TISS 28 para el primer día de ingreso fueron de 18,27 y de 18,02, respectivamente, siendo más elevados en los pacientes con secuelas o que fallecían. Se encontró muy buena correlación entre la TISS 76 y la 28, con coeficiente de correlación de Pearson y de correlación intraclase > 0,9 (excepto para el segundo día). La ecuación de correlación para los 4 días fue: TISS76 = –1,74 + 1,05 × TISS28. La TISS 28 fue capaz de explicar el 82,4% de la variabilidad de la TISS 76. El área bajo la curva con un intervalo de confianza del 95% para el primer día fue de 0,80 para la TISS 76 y de 0,76 para la TISS 28. Conclusiones: Con los resultados obtenidos, la TISS 28 puede reemplazar a la TISS 26 en nuestra UCIP, sin empeorar la información proporcionada. Siendo una escala fiable y más sencilla de aplicar, podría ser útil su aplicación práctica. Abstract: Introduction: There are numerous scales in intensive care units that are used to quantify the severity of patients. Most of them are very useful, although sometimes laborious to complete, thus limiting their use in usual practice. One of these scales, the Therapeutic Intervention Scoring System (TISS 76), has been validated in adult and paediatric units. Its simplified and updated version, the Simplified Therapeutic Intervention Scoring System (TISS 28), has not yet been validated in paediatric units. The aim of this study is to validate TISS 28, in order to have a simple and rapid scale. Material and method: A prospective non-interventional observational study was conducted in a Paediatric Intensive Care Unit (PICU) of a university hospital. Data were collected from 935 consecutive patients admitted to the PICU over a 3-year period. These included the values of TISS 76 and TISS 28 during the first 4 days of admission and the subsequent outcome of the patients. Results: The mean values of TISS 76 and TISS 28 for the first day of admission were 18.27 and 18.02, respectively. Values were higher in patients who had sequelae or died (17.58 versus 27.23 and 37.44, respectively for TISS 76 (P 0.9 (except for the 2 nd day). The correlation equation for the overall 4 days was: TISS76 = - 1.74 + 1.05 × TISS28. TISS 28 was able to explain 82.4% of variability of TISS 76. The area under the curve with a confidence interval (CI) of 95% for the first day was 0.80 (0.73-0.87) for TISS 76, and 0.76 (0.67-0.84) for TISS 28. Conclusions: On observing the results obtained, TISS 28 can replace TISS 26 in our PICU, without worsening the information provided. Being a reliable scale and easier to apply, its practical application could be useful.
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- 2020
170. Extravasation Injuries, Pressure Ulcers and Ocular Surface Disorders in a Tertiary Paediatric Intensive Care Unit in South India
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Puja Amatya and Kalaimaran Sadasivam
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Paediatric intensive care unit ,medicine.medical_specialty ,business.industry ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Medicine ,business ,Ocular surface ,Extravasation - Abstract
Introduction: Extravasation injuries, pressure ulcers (PU), and ocular surface disorders (OSD) like exposure keratitis are common problems that we encounter in critically ill children admitted in Paediatric Intensive Care unit (PICU). There is sparse data regarding these injuries due to under reporting by staffs in intensive care unit. The primary aim of this study was to know the prevalence of extravasation injuries, ocular surface disorders and pressure ulcers in tertiary intensive care unit of south India. The secondary objective of this study was to re-evaluate the prevalence of these injuries after interventions. Methods: During pre-intervention period, number of children with extravasation injuries, pressure ulcers and ocular surface disorders were identified. The qualitative improvement practices was implemented to decrease the prevalence of these injuries. This was followed by re-evaluation of these injuries during post-intervention period. Results: During pre-intervention period the overall prevalence of these injuries was 36/273 (13.2%). The prevalence of extravasation injuries, pressure ulcers and ocular surface disorders was 16/273 (5.9%), 12/273 (4.4%) and 8/273 (2.9%) respectively. The qualitative improvement practices were implemented in intensive care unit. During post-intervention period, the prevalence of these injuries was reduced to 10/157 (6.4%). The extravasation injuries reduced to 4/157 (2.5%), PUs to 4/157 (2.5%) and OSD to 2/157 (1.3%). Conclusions: The extravasation injuries, PUs and OSD are common problems in critically ill children. The qualitative improvement practices should be implemented and reinforced in intensive care units to prevent these injuries.
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- 2020
171. Laktat / albümin oranı, kritik hasta çocuklarda mortalite için etkili bir belirleyicidir
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Haluk Çokuğraş, Fatih Varol, Cansu Durak, Fatih Aygün, and Yıldız Camcioğlu
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Inotrope ,Mechanical ventilation ,General and Internal Medicine ,medicine.medical_specialty ,business.industry ,Critically ill ,Paediatric intensive care unit,prognosis,lactate,albumin ,medicine.medical_treatment ,Albumin ,Pediatrik yoğun bakım ünitesi,prognoz,laktat,albumin ,Paediatric intensive care unit ,Internal medicine ,medicine ,Biomarker (medicine) ,Hyperlactatemia ,Renal replacement therapy ,business ,Genel ve Dahili Tıp - Abstract
Giriş: Kritik hastaçocukların prognozunu ve mortalitesini değerlendirmek için birçok öngörücübiyobelirteç geliştirilmiştir. Hiperlaktateminin kritik hastalarda mortalite ileilişkili olması nedeniyle serum laktat seviyesi yaygın bir biyobelirteçtir.Önceki çalışmalar, serum albümin seviyesinin de faydalı bir biyobelirteçolduğunu göstermiştir. Bazı yeni makaleler, serum laktat ve albüminkombinasyonunun kritik hastalardaki ölüm oranlarını daha etkili birbelirleyicisi olduğunu ileri sürdü. Bu çalışmada laktat / albümin (L / A)oranının tek başına serum laktat seviyesinden daha iyi bir prognostik faktörolup olmadığını belirlemeyi amaçladık. Gereç ve yöntemler: Bunedenle bu biyobelirteçler ile invaziv mekanik ventilasyon, invaziv olmayanmekanik ventilasyon desteği, inotropik ilaç ihtiyacı, akut böbrek hasarı,sürekli renal replasman tedavisi, mortalite ve hastanede kalış süresiarasındaki ilişkiyi geriye dönük olarak inceledik. Bulgular: Çalışmayayaş ortalamaları 4.8 ± 5.3 yıl (1 ay ile 18 ay arasında değişen) 379 hastadahil edildi. Pediatrik yoğun bakım ünitesinde ortalama kalış süresi 7.4 ± 11.5gün, ortanca L / A oranı 0.46 (dağılım, 0.11-10.0) idi. Bulgularımız kritikhasta çocuklarda L / A oranı ve serum laktat seviyesinin mortalite ile ilişkiliolduğunu göstermektedir. Bununla birlikte, analiz sonuçlarımız > 0.5 L / Aoranının genel olarak daha iyi bir mortalite belirleyicisi olduğunu düşündürmektedir.Sonuç: L / A oranının kritik hasta çocuklardamortalitenin yararlı ve etkili bir belirleyicisi olduğu sonucuna vardık., Introduction: Many predictive biomarkers were developed to evaluatethe prognosis and mortality of critically ill children. Serum lactate level isone common biomarker because hyperlactatemia is associated with mortality in thesepatients. Previous studies have shown that serum albumin level is also a usefulbiomarker. Several recent articles suggested that the combination of serumlactate and albumin is a more effective predictor of mortality in criticallyill patients. This study aimed to determine whether the lactate/albumin (L/A) ratiowas a better prognostic factor than serum lactate level alone. Material and Methods: Thus, we retrospectively investigated the relationship between these biomarkers and theirrelationship with invasivemechanical ventilation, noninvasive mechanical ventilation support, inotropicdrug need, acute renal kidney injury, continuous renal replacement therapy,mortality, and hospitalisation period. Results: A total of 379 patients with a mean age of 4.8±5.3 years (range,1 month to 18 years) were included in this study. The average duration of stayin the paediatric intensive care unit was 7.4±11.5days, and the median L/A ratiowas 0.46 (range, 0.11–10.0). Our findings indicate that the L/A ratio and serumlactate level were associated with mortality in critically ill children.However, our analysis also suggested that an L/A ratio of >0.5 uponadmission is an overall better predictor of mortality. Conclusion:We conclude that the L/A ratio is a useful andeffective predictor of mortality in critically ill children.
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- 2020
172. Development of a non-pharmacologic delirium management bundle in paediatric intensive care units
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Rikke Louise Stenkjaer, Suzanne Forsyth Herling, Ingrid Egerod, Janne Weis, Monique van Dijk, Sapna Ravi Kudchadkar, Anne‐Sylvie Ramelet, Erwin Ista, Pediatric Surgery, and Internal Medicine
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Infant, Newborn ,Australia ,Delirium ,Intensive Care Units, Pediatric ,Critical Care Nursing ,paediatric intensive care unit ,Intensive Care Units ,non-pharmacological ,delirium ,SDG 3 - Good Health and Well-being ,delphi study ,Surveys and Questionnaires ,Humans ,Child ,Sleep ,management - Abstract
Background: Non-pharmacologic interventions might be effective to reduce the incidence of delirium in pediatric intensive care units (PICU). Aim: To explore expert opinions and generate informed consensus decisions regarding the content of a non-pharmacologic delirium bundle to manage delirium in PICU patients. Study design: A two-round online Delphi study was conducted from February to April 2021. PICU experts (nurses, physicians, researchers, physical therapists, play specialists, and occupational therapists) located in Europe, North America, South America, Asia, and Australia participated. Results: We developed a questionnaire based on the outcomes of a comprehensive literature search in the domains: 1) cognition support; 2) sleep support; and 3) physical activity support. Under these domains, we listed 11 strategies to promote support with 61 interventions. Participants rated the feasibility of each intervention on a 9-point Likert scale (ranging from 1 strongly disagree to 9 strongly agree). A disagreement index and panel median were calculated to determine the level of agreement among experts. In the second round, participants reassessed the revised statements and ranked the interventions in each domain in order of importance for age groups: 0–2, 3–5, and 6–18 years of age. During the first Delphi round, 53 of 74 (72%) questionnaires were completed, and in the second round 45 of 74 (61%) were completed. Five of the highest ranked interventions across the age groups were: 1) developing a daily routine, 2) adjusting light exposure according to the time of day, 3) scheduling time for sleep, 4) providing eyeglasses and hearing aids if appropriate, 5) encouraging parental presence. Conclusions: Based on expert consensus, we developed an age-specific non-pharmacologic delirium bundle of interventions to manage delirium in PICU patients. Relevance to Clinical Practice: An age-specific Non-Pharmacological Delirium bundle is now ready to be tested in the PICU and will hopefully reduce pediatric delirium.
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- 2022
173. MRSA colonisation rates on a neonatal and paediatric intensive care unit
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Rebecca Borg and David Pace
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,030501 epidemiology ,MRSA infection ,medicine.disease_cause ,Confidence interval ,Colonisation ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,Infectious Diseases ,Short Reports ,Staphylococcus aureus ,Internal medicine ,medicine ,Infection control ,Molecular diagnostic techniques ,030212 general & internal medicine ,0305 other medical science ,business - Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) colonisation is a challenge in healthcare institutions worldwide. In this retrospective nation-wide study, the rates of MRSA colonisation and infection from 2012 to 2015, on the only neonatal and paediatric intensive care unit (NPICU) in the country, were determined. Mean local rates were compared to rates of MRSA colonisation reported in units in North America, Asia and Europe between 2001 and 2010. The average rate of MRSA colonisation on admission to NPICU from 2012 to 2015 was 3.71% (95% confidence interval [CI] 2.17–5.25), while the mean rate of acquired colonisation was 14.60% (95% CI 6.16–23.04). Both were significantly higher than in units abroad: 1.9% and 4.1%, respectively ( P = 0.04 and P < 0.001). There were no cases of invasive MRSA infection, while the mean rate of non-invasive infection was 0.77% (95% CI 0.54–1.01). Improved adherence to infection control measures and newer molecular diagnostic techniques are needed to further decrease the acquisition of MRSA.
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- 2019
174. Design and reporting characteristics of clinical trials investigating sedation practices in the paediatric intensive care unit: a scoping review by SCEPTER (Sedation Consortium on Endpoints and Procedures for Treatment, Education and Research)
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Jennifer S. Gewandter, Katherine V Biagas, Lena S. Sun, Maryam Y. Naim, Bethea A Kleykamp, Robert H. Dworkin, Jerri C Price, Jennifer J. Lee, and Denham S. Ward
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medicine.medical_specialty ,protocols & guidelines ,Sedation ,Critical Illness ,statistics & research methods ,Intensive Care Units, Pediatric ,Paediatric intensive care unit ,medicine ,Humans ,Anesthesia ,Child ,clinical trials ,business.industry ,Critically ill ,Paediatric intensive care ,paediatric intensive & critical care ,Infant, Newborn ,Intensive Care ,Infant ,General Medicine ,Length of Stay ,Respiration, Artificial ,Clinical trial ,Intensive Care Units ,Data extraction ,Sample size determination ,Child, Preschool ,Emergency medicine ,Medicine ,medicine.symptom ,business ,Neurological impairment - Abstract
ObjectivesTo conduct a scoping review of sedation clinical trials in the paediatric intensive care setting and summarise key methodological elements.DesignScoping review.Data sourcesPubMed, Embase, Cumulative Index to Nursing and Allied Health Literature and grey references including ClinicalTrials.gov from database inception to 3 August 2021.Study selectionAll human trials in the English language related to sedation in paediatric critically ill patients were included. After title and abstract screening, full-text review was performed. 29 trials were eligible for final analysis.Data extractionA coding manual was developed and pretested. Trial characteristics were double extracted.ResultsThe majority of trials were single centre (22/29, 75.9%), parallel group superiority (17/29, 58.6%), double-blinded (18/29, 62.1%) and conducted in an academic setting (29/29, 100.0%). Trial enrolment (≥90% planned sample size) was achieved in 65.5% of trials (19/29), and retention (≥90% enrolled subjects) in 72.4% of trials (21/29). Protocol violations were reported in nine trials (31.0%). The most commonly studied cohorts were mechanically ventilated patients (28/29, 96.6%) and postsurgical patients (11/29, 37.9%) with inclusion criteria for age ranging from 0±0.5 to 15.0±7.3 years (median±IQR). The median age of enrolled patients was 1.7 years (IQR=4.4 years). Patients excluded from trials were those with neurological impairment (21/29, 72.4%), complex disease (20/29, 69.0%) or receipt of neuromuscular blockade (10/29, 34.5%). Trials evaluated drugs/protocols for sedation management (20/29, 69.0%), weaning (3/29, 10.3%), daily interruption (3/29, 10.3%) or protocolisation (3/29, 10.3%). Primary outcome measures were heterogeneous, as were assessment instruments and follow-up durations.ConclusionsThere is substantial heterogeneity in methodological approach in clinical trials evaluating sedation in critically ill paediatric patients. These results provide a basis for the design of future clinical trials to improve the quality of trial data and aid in the development of sedation-related clinical guidelines.
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- 2021
175. Parameters affecting outcome of paediatric cardiomyopathies in the intensive care unit: Experience of an Egyptian tertiary centre over 7 years
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Alaa A. Sobeih, Sonia A. El-Saiedi, Noha S. Abdel Khalek, Baher M. Hanna, and Shereen A. Attia
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Male ,medicine.medical_specialty ,Cardiotonic Agents ,Critical Care ,medicine.medical_treatment ,Cardiomyopathy ,heart failure ,lcsh:Medicine ,law.invention ,Tertiary Care Centers ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,Liver Function Tests ,law ,medicine ,Humans ,030212 general & internal medicine ,Child ,Intensive care medicine ,Critical Care Outcomes ,business.industry ,lcsh:R ,dilated cardiomyopathy ,paediatric intensive care unit ,Infant ,Treatment options ,Dilated cardiomyopathy ,General Medicine ,medicine.disease ,Respiration, Artificial ,Intensive care unit ,Intensive Care Units ,Child, Preschool ,Ventricular assist device ,Heart failure ,cardiovascular system ,Original Article ,Egypt ,Female ,Hypotension ,Cardiomyopathies ,business ,cardiomyopathy ,030217 neurology & neurosurgery ,Research Article - Abstract
Introduction: Paediatric cardiomyopathies are rare but serious and often life-threatening conditions. In the absence of cardiac transplant and ventricular assist device as treatment options in our region, it is very important to identify patients at higher risk. The aim of this study was to determine the outcome of patients diagnosed with cardiomyopathies and their prognostic indicators. Patients and methods: This study included 92 cases representing all patients diagnosed with cardiomyopathy who were admitted into the pediatric cardiac intensive care unit during the period from January 2012 to September 2018. The patients were classified into two groups according to the outcome: the first group comprised 69 patients who survived, and the second group comprised 23 patients who died. All medical records were reviewed, and data were recorded and analysed. Results: Patients with cardiomyopathies represented 8.6% (92/1071) of all patients with cardiac diseases who were admitted in the study period and in the target age group (0.5–12 years). Dilated cardiomyopathy (DCM) was the most frequent type of cardiomyopathy among the admitted patients (80 patients), while 6 patients were diagnosed with hypertrophic cardiomyopathy (HCM), 4 were diagnosed with restrictive cardiomyopathy (RCM), and only 2 were diagnosed with mixed DCM-RCM. Seventy patients required inotropic support (76.1%). Assisted mechanical ventilation was used on 15 patients (16.3%). Twenty-three patients (25.0%) died during the 7-year study period. ConclusionsConclusions The occurrence of hypotension, abnormally high liver enzymes, the need for mechanical ventilation and the need for multiple inotropic drugs were found to be statistically significant predictors of mortality, while age, sex, fractional shortening, ejection fraction, presence of mitral regurgitation, mural thrombus, electrolyte disturbance and arrhythmias did not predict or affect patients’ outcomes.
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- 2021
176. Higher rates of diabetic ketoacidosis and admission to the paediatric intensive care unit among newly diagnosed children with type 1 diabetes in Kuwait during the COVID‐19 pandemic
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Hessa Al-Kandari, Dalia Al-Abdulrazzaq, Fatemah Alhusaini, Abdullah Alkandari, Naser Alenazi, Unjali P. Gujral, and K.M. Venkat Narayan
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Research design ,Pediatrics ,medicine.medical_specialty ,Diabetic ketoacidosis ,Coronavirus disease 2019 (COVID-19) ,endocrine system diseases ,type 1 diabetes ,Endocrinology, Diabetes and Metabolism ,Newly diagnosed ,Intensive Care Units, Pediatric ,Diabetic Ketoacidosis ,Paediatric intensive care unit ,Endocrinology ,children ,COVID‐19 ,Diabetes mellitus ,Pandemic ,Internal Medicine ,medicine ,Humans ,Child ,Pandemics ,Type 1 diabetes ,business.industry ,SARS-CoV-2 ,COVID-19 ,medicine.disease ,Diabetes Mellitus, Type 1 ,Kuwait ,business ,Research Article - Abstract
Introduction The COVID-19 pandemic might have a multifaceted effect on children with type 1 diabetes (T1D), either directly through infection itself or indirectly due to measures implemented by health authorities to control the pandemic. Objective To compare data on children newly diagnosed with T1D in Kuwait during the COVID-19 pandemic to the pre-pandemic period. Research design and methods We analysed data on children aged 12 years or less registered in the Childhood-Onset Diabetes electronic Registry (CODeR) in Kuwait. Data were incidence rate (IR), diabetic ketoacidosis (DKA), and its severity and admission to the paediatric intensive care unit (PICU). Results The IR of T1D was 40.2 per 100,000 (95% CI; 36.0-44.8) during the COVID-19 pandemic period and was not statistically different from pre-pandemic. A higher proportion of incident T1D cases presented with DKA and were admitted to the PICU during the pandemic (52.2% vs. 37.8%: p ˂ 0.001, 19.8% vs. 10.9%; p = 0.002, respectively). The COVID-19 pandemic was positively associated with presentation of DKA and admission to PICU (AOR = 1.73; 95% CI, 1.13-2.65; p = 0.012, AOR = 2.04; 95% CI, 1.13-3.67; p = 0.018, respectively). Children of families with a positive history for diabetes were less likely to present with DKA and get admitted to the PICU during the COVID-19 pandemic (AOR = 0.38; 95% CI, 0.20-0.74; p = 0.004, AOR = 0.22; 95% CI, 0.08-0.61; p = 0.004, respectively). Conclusion High rates of DKA at presentation and admission to PICU in incident T1D cases during the COVID-19 pandemic warrant further studies and effective mitigation efforts through increasing awareness, early detection, and timely intervention.
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- 2021
177. 1667 A comparison of paediatric nursing experience caring for adult COVID-19 patients between the two surges
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Rebecca Horner and Kathryn Holliday
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Paediatric intensive care unit ,2019-20 coronavirus outbreak ,Positive response ,Nursing ,Coronavirus disease 2019 (COVID-19) ,Adult patients ,business.industry ,Critically ill ,Intensive care ,Paediatric intensive care ,Medicine ,business - Abstract
Background COVID-19 arrived in the UK and quickly gained pace in March 2020, threatening to overwhelm adult intensive care and thus hospitals across the country developed strategies to cope. Locally the adult and paediatric intensive care teams developed the novel idea of managing critically ill adult COVID-19 patients in the Paediatric Intensive Care Unit (PICU), with PICU caring for adult patients in March 2020 and again in January 2021. Objectives We sent an online survey to all the paediatric intensive care nursing team following both surges in order to understand their views on the protracted experience. Methods An anonymous online survey was sent out via a survey monkey link to all the paediatric intensive care nurses in our unit following both surge episodes. Results 32 nurses completed the first survey and 12 completed the second. Prior to caring for adults 26/32 (81%) felt not so confident or not at all confident looking after adult COVID- 19 patients. Following the first experience 29/32 (91%) nurses felt somewhat confident, very confident or extremely confident at looking after adult COVID-19 patients. 18/32 (56%) nurses found spending time on the adult COVID unit helpful. The majority (97%) preferred to work within their own unit rather than the adult ITU. 23/32 (72%) patients would be happy to care for adults again. Prior to the second re-purposing of the PICU 6/12 (50%) felt positive/very positive looking after adult patients again, 100% of nurses felt the first experience had increased their confidence in looking adult patients and following the second surge 12/12 (100%) felt somewhat confident, very confident or extremely confident at looking after adult COVID-19 patients. Following the experience 10/12 (83%) would be happy to care for adult patients again. Conclusions Prior to caring for adult COVID-19 patients in intensive care our paediatric intensive care nurses were anxious and had limited confidence. The majority of nurses however found the experience useful and gained confidence. Working within the familiarity of their own unit and team improved the experience. This confidence and experience appeared to be retained into the second surge and was shown by the overall positive response and willingness to look after adult patients in future.
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- 2021
178. Challenges of paediatric palliative care in the intensive care unit during the COVID-19 pandemic
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Marzieh Hasanpour, Batool Pouraboli, Mamak Tahmasebi, Masoud Mohammadpour, and Fahimeh Sabeti
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Advanced and Specialized Nursing ,2019-20 coronavirus outbreak ,Palliative care ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Palliative Care ,COVID-19 ,Iran ,medicine.disease ,Intensive care unit ,law.invention ,Paediatric intensive care unit ,Intensive Care Units ,law ,Pandemic ,medicine ,Humans ,Medical emergency ,business ,Child ,Pandemics ,Qualitative Research ,Qualitative research - Abstract
Background: The integration of paediatric palliative care into the Iranian health system is essential. Aims: The aim of this study was to identify the challenges of palliative care in the paediatric intensive care unit during COVID-19 through the experiences of healthcare providers. Methods: A qualitative study with content analysis approach was conducted. Fifteen physicians and nurses were selected by purposeful sampling. The semi-structured, in-depth interviews were applied in the data collection. Findings: Ten main categories were extracted from data analysis, including ‘caring in COVID-19’, ‘communication and family centre care’, ‘breaking bad news’, palliative care training’, ‘pain and symptom management’, ‘support of the child, family and clinical team’, ‘physical environment’, ‘guidelines’, ‘specialised staff’ and ‘home based palliative care’. Conclusion: Palliative care in the PICU faces several challenges, especially during COVID-19, but the clinical team are making every attempt to improve the comprehensive care of children and their families. Telehealth is important in COVID-19, and education is also a key component to improve palliative care in the PICU in Iran.
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- 2021
179. Compassion Fatigue and Compassion Satisfaction in Pediatric Intensive Care Professionals.
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Panagou E, Missouridou ED, Zartaloudi A, Koutelekos J, Dousis E, Dafogianni C, Vlachou E, and Evagelou E
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Background: Paediatric ICU doctors and nurses' quality of professional life is influenced by the intense emotions and distress experienced when caring for suffering children and their families., Objective: The aim of this study was to examine the prevalence of compassion satisfaction (CS) and compassion fatigue (CF) in Paediatric Intensive Care Units in Greece., Methods: Out of 147 intensive care professionals in public hospitals in Greece completed the ProQOL-V scale as well as a socio-demographic and professional-life characteristics questionnaire., Results: Almost two thirds of participants reported medium-risk for CF (74.8%) while 23.1% and 76.9% of professionals expressed high or medium potential for CS respectively. More than half of doctors and nurses in paediatric ICUs report being overprotective towards members of the family as a result of their professional life and that their work-life affects their attitude towards life in general., Conclusion: Recognizing factors related to CF may support paediatric intensive care professionals in avoiding the costs of exposure to the trauma and loss experiences of patients and their families. A trauma-informed intensive care culture and continuing trauma-informed education may shield professionals from the erosive effects of lingering emotions which may trigger secondary traumatic stress symptoms and also facilitate adequate reflection on their emotional reactions in the landscape of intensive care., Competing Interests: There are no conflicts of interest., (© 2023 Eleni Panagou, Evdokia D. Missouridou, Afroditi Zartaloudi, John Koutelekos, Evangelos Dousis, Chrisoula Dafogianni, Eugenia Vlachou, Eleni Evagelou.)
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- 2023
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180. A paediatric intensive care unit’s experience in managing adult patients with COVID-19 disease
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Lluisa Hernández-Platero, Iolanda Jordan, Anna Solé-Ribalta, Francisco José Cambra, and Martí Pons
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Adult patients ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Disease ,Paediatric intensive care unit ,Management of Technology and Innovation ,Medicine ,business ,Intensive care medicine ,Scientific Letter - Published
- 2022
181. Work stress, occupational burnout and depression levels: a clinical study of paediatric intensive care unit nurses in Taiwan.
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Lin, Tzu‐Ching, Lin, Huey‐Shyan, Cheng, Su‐Fen, Wu, Li‐Min, and Ou‐Yang, Mei‐Chen
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MENTAL depression risk factors , *ACADEMIC medical centers , *PSYCHOLOGICAL burnout , *CONCEPTUAL structures , *STATISTICAL correlation , *FACTOR analysis , *INTENSIVE care nursing , *INTENSIVE care units , *JOB stress , *MARITAL status , *RESEARCH methodology , *MEDICAL cooperation , *NURSES' attitudes , *PATH analysis (Statistics) , *PEDIATRIC nursing , *PEDIATRICS , *POSTAL service , *RESEARCH , *STATISTICAL sampling , *T-test (Statistics) , *SAMPLE size (Statistics) , *MULTIPLE regression analysis , *EDUCATIONAL attainment , *REPEATED measures design , *CROSS-sectional method , *WORK experience (Employment) , *DESCRIPTIVE statistics , *ONE-way analysis of variance - Abstract
Aims and objectives This study aimed to examine the relationship between work stress and depression; and investigate the mediating effect of occupational burnout among nurses in paediatric intensive care units. Background The relationships among work stress, occupational burnout and depression level have been explored, neither regarding occupational burnout as the mediating role that causes work stress to induce depression nor considering the paediatric intensive care unit context. Design A cross-sectional correlational design was conducted. Methods One hundred and forty-four female paediatric intensive care unit nurses from seven teaching hospitals in southern Taiwan were recruited as the participants. Data were collected by structured questionnaires including individual demographics, the Nurse Stress Checklist, the Occupational Burnout Inventory and the Taiwan Depression Questionnaire. Results The results indicated that after controlling for individual demographic variables, the correlations of work stress with occupational burnout, as well as work stress and occupational burnout with depression level were all positive. Furthermore, occupational burnout may exert a partial mediating effect on the relationship between work stress and depression level. Conclusion This study provides information about work stress, occupational burnout and depression level, and their correlations, as well as the mediating role of occupational burnout among paediatric intensive care unit nurses. Relevance to clinical practice It suggests government departments and hospital administrators when formulating interventions to prevent work stress and occupational burnout. These interventions can subsequently prevent episodes of depression in paediatric intensive care unit nurses, thereby providing patients with a safe and high-quality nursing environment. [ABSTRACT FROM AUTHOR]
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- 2016
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182. Aspirin and Reye’s syndrome
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Strom, Brian L., Rainsford, K. D., editor, and Velo, G. P., editor
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- 1992
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183. Participation Of Nurses In The Development Of A Computerized Bedside Charting System
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Dorken, Sherri, Tait, Gordon, Brophy, Janet, Rienhoff, O., editor, Lindberg, D. A. B., editor, Turley, James P., editor, and Newbold, Susan K., editor
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- 1991
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184. In the eye of the storm: impact of COVID-19 pandemic on admission patterns to paediatric intensive care units in the UK and Eire
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Lyn Palmer, Elizabeth S Draper, Padmanabhan Ramnarayan, Mark J. Peters, C R Lamming, Peter Davis, Adrian Plunkett, Barnaby R. Scholefield, Hannah Buckley, Hari Krishnan Kanthimathinathan, Lee Norman, and Richard G. Feltbower
- Subjects
medicine.medical_specialty ,Diabetic ketoacidosis ,Coronavirus disease 2019 (COVID-19) ,COVID19 ,Critical Care and Intensive Care Medicine ,Intensive Care Units, Pediatric ,Case mix index ,Patient Admission ,Pandemic ,medicine ,Humans ,Paediatric intensive care unit ,Child ,Pandemics ,Admission patterns ,11 Medical and Health Sciences ,Retrospective Studies ,RC86-88.9 ,business.industry ,Mortality rate ,Research ,COVID-19 ,Medical emergencies. Critical care. Intensive care. First aid ,Retrospective cohort study ,medicine.disease ,Case mix ,Emergency & Critical Care Medicine ,Mental health ,United Kingdom ,Bronchiolitis ,Emergency medicine ,business ,Ireland - Abstract
Background The coronavirus disease-19 (COVID-19) pandemic had a relatively minimal direct impact on critical illness in children compared to adults. However, children and paediatric intensive care units (PICUs) were affected indirectly. We analysed the impact of the pandemic on PICU admission patterns and patient characteristics in the UK and Ireland. Methods We performed a retrospective cohort study of all admissions to PICUs in children Results There were 16,941 admissions in 2020 compared to an annual average of 20,643 (range 20,340–20,868) from 2016 to 2019. During 2020, there was a reduction in all PICU admissions (18%), unplanned admissions (20%), planned admissions (15%), and bed days (25%). There was a 41% reduction in respiratory admissions, and a 60% reduction in children admitted with bronchiolitis but an 84% increase in admissions for diabetic ketoacidosis during 2020 compared to the previous years. There were 420 admissions (2.4%) with either PIMS-TS or COVID-19 during 2020. Age and sex adjusted prevalence of unplanned PICU admission reduced from 79.7 (2016–2019) to 63.1 per 100,000 in 2020. Median probability of death [1.2 (0.5–3.4) vs. 1.2 (0.5–3.4) %], length of stay [2.3 (1.0–5.5) vs. 2.4 (1.0–5.7) days] and mortality rates [3.4 vs. 3.6%, (risk-adjusted OR 1.00 [0.91–1.11, p = 0.93])] were similar between 2016–2019 and 2020. There were 106 fewer in-PICU deaths in 2020 (n = 605) compared with 2016–2019 (n = 711). Conclusions The use of a high-quality international database allowed robust comparisons between admission data prior to and during the COVID-19 pandemic. A significant reduction in prevalence of unplanned admissions, respiratory diseases, and fewer child deaths in PICU observed may be related to the targeted COVID-19 public health interventions during the pandemic. However, analysis of wider and longer-term societal impact of the pandemic and public health interventions on physical and mental health of children is required.
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- 2021
185. Palliative Care of the Infant and Child in the Paediatric Intensive Care Unit
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Roisin Ni Charra, Julie Edwards, Maeve McAllister, Ann-Marie Crowe, and Suzanne Crowe
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Advance care planning ,Palliative care ,Symptom management ,business.industry ,Paediatric intensive care ,medicine.disease ,Multidisciplinary team ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,030225 pediatrics ,030220 oncology & carcinogenesis ,Intensive care ,medicine ,Medical emergency ,Organ donation ,business - Abstract
In this chapter we discuss the delivery of palliative care in the paediatric intensive care unit environment. Illustrated by challenging cases, we describe the role of intensive care in symptom management for the child with terminal or life-limiting illness. We detail the importance of a multidisciplinary team and their roles in the provision of individualised care for the child and their family. The importance of family-centred care and advance care planning is expanded upon. In addition, we explore end of life issues that are particular to children in intensive care such as withdrawal of life-sustaining therapies and organ donation. Finally, we discuss how to ensure the delivery of high-quality palliative care in the paediatric intensive care environment.
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- 2021
186. Discharged from paediatric intensive care: A mixed methods study of teenager's anxiety levels and experiences after paediatric intensive care unit discharge
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Leanne M. Aitken, Jo Wray, and Elizabeth Bichard
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medicine.medical_specialty ,Adolescent ,Critical Care ,RJ ,media_common.quotation_subject ,Critical Illness ,Population ,Anxiety ,Critical Care Nursing ,Hospital Anxiety and Depression Scale ,Intensive Care Units, Pediatric ,Paediatric intensive care unit ,medicine ,Humans ,education ,Child ,media_common ,education.field_of_study ,business.industry ,Paediatric intensive care ,Small sample ,Patient Discharge ,Feeling ,Family medicine ,Thematic analysis ,medicine.symptom ,business ,RA - Abstract
BACKGROUND: Teenagers represent a small proportion of patients on paediatric intensive care units (PICU) in the United Kingdom. During a time when their development is rapidly changing, an admission to PICU causes additional disruption. The impact of critical illness on psychological health after discharge has not been widely reported within this population. \ud \ud AIM AND OBJECTIVES: To measure anxiety that teenagers report 48-96 hours and 4 weeks after discharge from PICU. To explore teenagers' experiences of being admitted onto PICU. \ud \ud DESIGN: Two-phase mixed methods, explanatory sequential design. \ud \ud METHODS: This single-site study was conducted between February and July 2018. An NHS Ethics committee approved the study. Teenagers were screened if they were aged 13-18 years old and had an elective or emergency admission to PICU for longer than 24 hours. Hospital Anxiety and Depression Scale, Anxiety subscale (HADS-A) was administered on paper and completed with the researcher present. Semi-structured interviews were conducted in-person and over the telephone, audio-recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. \ud \ud RESULTS: Nine of eighteen participants (50%) obtained scores indicating levels of anxiety which were mild (n = 3; 17%), moderate (n = 2; 11%), or severe (n = 4; 22%) 48-96 hours after PICU discharge. Four weeks later, all participants scored below the clinically significant cut-off level for the HADS-A-1 Teenagers described their experiences on PICU within three themes: Memories of treatments, side effects, and the PICU environment Losing a sense of self Feeling cared for \ud \ud CONCLUSIONS: Measured levels of anxiety had resolved in this small sample, 4 weeks after PICU discharge. This finding was not consistent with qualitative data that indicated that many experiences shared by participants were anxiety provoking. \ud \ud RELEVANCE TO CLINICAL PRACTICE: Support for teenagers after PICU discharge should be available to meet individual needs; screening teenagers to identify support needs would be beneficial.
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- 2021
187. Differences between children with severe acute lower respiratory infection with or without SARS-Cov-2 infection
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Cristiana M. Nascimento-Carvalho and Vivian Botelho Lorenzo
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0301 basic medicine ,Microbiology (medical) ,Male ,medicine.medical_specialty ,SARSCoV-2 ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030106 microbiology ,Disease ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,Internal medicine ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Evidence-based medicine & outcomes ,Lower respiratory infection ,Child ,Letter to the Editor ,Male gender ,Retrospective Studies ,Mechanical ventilation ,business.industry ,SARS-CoV-2 ,COVID-19 ,Retrospective cohort study ,Respiration, Artificial ,body regions ,Infectious Diseases ,Acute respiratory infection ,Child, Preschool ,business ,Brazil - Abstract
AIM: to compare clinical features and outcome of children with severe acute lower respiratory infection (ALRI) with or without SARS-CoV-2 infection admitted to Paediatric Intensive Care Unit (PICU). METHODS: for this retrospective cohort study, all children aged
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- 2021
188. The Association between Weather Conditions and Admissions to the Paediatric Intensive Care Unit for Respiratory Syncytial Virus Bronchiolitis
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Linssen, Rosalie, Hollander, Bibiche den, Bont, Louis, Woensel, Job van, Bem, Reinout, Group, on behalf of the PICE Study, Paediatric Intensive Care, AII - Infectious diseases, Amsterdam Reproduction & Development (AR&D), and APH - Personalized Medicine
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Microbiology (medical) ,medicine.medical_specialty ,respiratory syncytial virus ,paediatric critical care ,Article ,symbols.namesake ,Paediatric intensive care unit ,Health care ,Epidemiology ,medicine ,Immunology and Allergy ,Poisson regression ,Molecular Biology ,climate ,General Immunology and Microbiology ,business.industry ,Paediatric intensive care ,Outbreak ,meteorological ,medicine.disease ,Infectious Diseases ,Bronchiolitis ,weather ,Emergency medicine ,symbols ,Respiratory syncytial virus bronchiolitis ,Medicine ,bronchiolitis ,epidemiology ,business - Abstract
Respiratory syncytial virus (RSV) bronchiolitis is a leading cause of global child morbidity and mortality. Every year, seasonal RSV outbreaks put high pressure on paediatric intensive care units (PICUs) worldwide, including in the Netherlands, and this burden appears to be increasing. Weather conditions have a strong influence on RSV activity, and climate change has been proposed as a potential important determinant of future RSV-related health care utilisation. In this national study spanning a total of 13 years with 2161 PICU admissions for RSV bronchiolitis, we aimed (1) to identify meteorological variables that were associated with the number of PICU admissions for RSV bronchiolitis in the Netherlands and (2) to determine if longitudinal changes in these variables occurred over time as a possible explanation for the observed increase in PICU burden. Poisson regression modelling was used to identify weather variables (aggregated in months and weeks) that predicted PICU admissions, and linear regression analysis was used to assess changes in the weather over time. Maximum temperature and global radiation best predicted PICU admissions, with global radiation showing the most stable strength of effect in both month and week data. However, we did not observe a significant change in these weather variables over the 13-year time period. Based on our study, we could not identify changing weather conditions as a potential contributing factor to the increased RSV-related PICU burden in the Netherlands.
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- 2021
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189. Tracheostomy trends in paediatric intensive care
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Steven Powell, Malcolm Brodlie, Hannah Buckley, Jason Powell, and Rachel S. Agbeko
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Male ,medicine.medical_specialty ,Adolescent ,Intensive Care Units, Pediatric ,Rate ratio ,law.invention ,03 medical and health sciences ,Paediatric intensive care unit ,Tracheostomy ,0302 clinical medicine ,law ,030225 pediatrics ,Intensive care ,medicine ,Humans ,Child ,Noninvasive Ventilation ,business.industry ,Incidence ,Paediatric intensive care ,Incidence (epidemiology) ,Infant, Newborn ,Infant ,Respiration, Artificial ,United Kingdom ,Hospitalization ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Ventilation (architecture) ,Emergency medicine ,Female ,business - Abstract
Paediatric tracheostomy is most commonly performed in children on the paediatric intensive care unit (PICU) to facilitate long-term ventilation. We sought to identify trends in UK tracheostomy practice in PICUs. Data were analysed from 250 261 admissions, including 4409 children tracheostomised between 2003 and 2017. The incidence of tracheostomy in 2017 was approximately half that in 2003 (incidence rate ratio=0.48, 95% CI 0.40 to 0.57). The percentage of patients tracheostomised during a PICU admission, as a proportion of all admissions, was 2.44% (n=319) in 2003 and reduced to 0.97% (n=180) in 2017. Nevertheless, we identified great variability in practice between different PICUs with tracheostomy rates between 0.0% and 4.0% of all admissions. Risk-adjusted PICU mortality was comparable between tracheostomised children and all admissions to PICU.
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- 2020
190. Meaning and comfort factors in the paediatric intensive care unit from an adult perspective: a descriptive phenomenological study
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Anna Falcó-Pegueroles, Iolanda Jordan, Dolors Rodríguez-Martín, and Alejandro Bosch-Alcaraz
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Adult ,Male ,Adolescent ,Critical Illness ,Nursing assessment ,Critical Care Nursing ,Intensive Care Units, Pediatric ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,Nursing ,Professional-Family Relations ,Humans ,Family ,Pediatricians ,030212 general & internal medicine ,Meaning (existential) ,Young adult ,Child ,Qualitative Research ,030504 nursing ,Critically ill ,Perspective (graphical) ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Infant ,Middle Aged ,Focus group ,Pediatric Nursing ,Patient Satisfaction ,Spain ,Child, Preschool ,Female ,Empathy ,Thematic analysis ,Nurses, Pediatric ,0305 other medical science ,Psychology - Abstract
Aims To explore the meaning of comfort and know the factors that contribute to it from the point of view of the young adults who received care in a paediatric intensive care unit, the family of the patient and the interdisciplinary team attending the patient. Findings A total of 30 people were invited to participate in the focus groups; 24 did so. Thematic analysis yielded the following common categories: meaning of comfort, environmental factors in paediatric intensive care unit, family accompaniment during paediatric intensive care unit stay, management of information in the paediatric intensive care unit and, finally, the intimacy and privacy of the critically ill paediatric patient and their family. Conclusions Paediatric intensive care unit professionals need to consider not only the environmental input that may lead to discomfort but also aspects such as continuous family accompaniment, the sharing of complete information with the family and the promoting of privacy.
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- 2019
191. Pain management interventions in the Paediatric Intensive Care Unit: A scoping review
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Ahmad Fauzi Ismail, Viola Polomeno, William Dagg, Denise Harrison, Huda Gharaibeh, and Paula Forgeron
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medicine.medical_specialty ,030504 nursing ,business.industry ,Sedation ,Psychological intervention ,MEDLINE ,Pain ,030208 emergency & critical care medicine ,CINAHL ,Pain management ,Intensive Care Units, Pediatric ,Critical Care Nursing ,Clinical trial ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,medicine ,Physical therapy ,Humans ,Pain Management ,medicine.symptom ,0305 other medical science ,business ,Adverse effect - Abstract
Objective To map research based pain management interventions used in the paediatric intensive care unit. Methodology A scoping review of research literature has been conducted. Five databases were searched from their inception to end 2015 (CINAHL, EMBASE, MEDLINE, PsychINFO, and ProQuest Dissertations & Theses Global). Reference lists from the screened full text articles were reviewed. Results 7046 articles were identified, 100 underwent full text screening and 27 were included in the scoping review. Seventeen (63%) were non-experimental, and 10 (37%) were experimental, of which 8 (30%) were randomised controlled trials. The majority of the articles focused on pharmacological interventions (n = 21, 78%), one on physical, and one on psychological interventions. Four studies included more than one category of interventions. The majority of the studies focused on post-operative pain management (n = 18, 67%), three (11%) on analgesia and sedation management and six (22%) on other pain management for different conditions. Discussion Most studies included in this scoping review focused on medications and post-operative pain management and most were non clinical trials. More research, including clinical trials, is warranted to determine the effectiveness of pharmacological and non-pharmacological interventions for pain management in the paediatric intensive care unit.
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- 2019
192. How nurses cope with death in the Paediatric Intensive Care Unit
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M.A. Quiñonez-Mora and Á.M. Henao-Castaño
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Sadness ,03 medical and health sciences ,Paediatric intensive care unit ,Coping (psychology) ,0302 clinical medicine ,030504 nursing ,Feeling ,Nursing ,media_common.quotation_subject ,030212 general & internal medicine ,0305 other medical science ,Psychology ,media_common - Abstract
The death of a child in the Paediatric Intensive Care Unit (PICU) is difficult, the loss generates feelings of sadness and pain; this study highlights the different coping strategies used by nurses to manage this situation and find the strength to provide care at the end of life. Objective Explore the strategies used by nurses in the PICU in coping with death. Methods Study conducted in the city of Manizales, Colombia, during the months of October, November and December. A qualitative, hermeneutical phenomenological approach was used. The method of intentional sampling for the selection of participating nurses (n = 10) working in PICU, in-depth interviews were conducted for the construction of the information and the data were analyzed according to the procedures proposed by Cohen, Kahn and Steeves. Results Nurses use coping strategies focused on emotions: they inhibit their feelings towards the patient and their family; they use communication and prayer with the patient, as well as accompaniment to alleviate the suffering of the family. Conclusion UCIP nurses develop coping strategies for end-of-life care using spiritual resources and communication with the family who require ongoing support, reflecting on death and accompanying the child in its transcendence.
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- 2019
193. Procalcitonin as an Early Laboratory Marker of Sepsis in Neonates: Variation in Diagnostic Performance and Discrimination Value
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Siti Nor Ismalina Isa, Julia Omar, Ismail Tst, Najib Majdi Yaacob, and Soh Naac
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medicine.medical_specialty ,neonatal sepsis ,medicine.diagnostic_test ,Receiver operating characteristic ,Neonatal sepsis ,business.industry ,General Medicine ,Gold standard (test) ,medicine.disease ,Gastroenterology ,Predictive value ,Procalcitonin ,Sepsis ,Paediatric intensive care unit ,diagnostic performance ,discrimination value ,Internal medicine ,parasitic diseases ,Medicine ,Original Article ,Blood culture ,business ,procalcitonin - Abstract
Background As an early recognition of neonatal sepsis is important for triggering the initiation of treatment, this study was thus designed to assess the diagnostic performance and discrimination value of procalcitonin (PCT) in neonatal sepsis cases. Methods This cross-sectional study, which was carried out at the Paediatric Intensive Care Unit of Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia, had involved 60 neonates admitted for suspected sepsis. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and the area under receiver operating characteristics curve (AUC) for PCT were determined at initial presentation (0 h) as well as 12 h and 24 h after presentation in comparison to blood culture as the gold standard. Results The study consisted of 27 (45.0%) male and 33 (55.0%) female neonates with a mean (SD) age of 76.8 (48.25) h. At cut-off PCT value of > 2 ng/mL, the sensitivity, specificity, PPV and NPV were 66.7%, 66.7%, 33.3% and 88.9% at 0 h. The respective parameters were 83.3%. 56.3%, 32.3% and 93.1% at 12 h and 83.3%, 52.1%, 30.3% and 92.6% at 24 h. AUC was 71.6%, 76.6% and 71.7% at 0 h, 12 h and 24 h. Conclusions Diagnostic performance and discrimination values of PCT for diagnosis of neonatal sepsis varied with time of obtaining the blood samples. The PCT result at 12 h demonstrates the most optimal diagnostic performance and discrimination values.
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- 2019
194. Predictors of Ventilator Associated Pneumonia of Neonate in a Neonatal and Paediatric Intensive Care Unit
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Uzzal Kumar Ghosh, Shafiul Hoque, Tithi Islam, M Monir Hossain, Mahfuza Shirin, and Sheikh Farjana Sonia
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Paediatric intensive care unit ,medicine.medical_specialty ,business.industry ,Emergency medicine ,Ventilator-associated pneumonia ,medicine ,General Medicine ,medicine.disease ,business ,respiratory tract diseases - Abstract
Background: Ventilator Associated Pneumonia (VAP) is defined as nosocomial pneumonia develops 48 hours or more after initiation of mechanical ventilation. Hospital acquired infection (HAI) is the second most common infection for the pediatric population. VAP about 20% of all HAI among patients in NICU & PICU. Higher mortality and morbidity rate for mechanically ventilated pediatric patients with VAP compared to those without VAP. Few data & very few researches exist regarding VAP in pediatric patients to identify risk factors of VAP and that might be helpful for preventing VAP. This study was done to find out the predictors of VAP of neonate in Neonatal and Pediatric Intensive Care Unit. Methodology: A prospective cohort study was carried out in NICU & PICU of Dhaka Shishu (Children) Hospital, Dhaka. Neonates those not had pneumonia; requiring mechanical ventilation at least 48 hours in the NICU or PICU were taken for this study. Then VAP patients were selected by radiographic changes after 48 hours of intubation. Portable chest x-ray was done after 48 hours and as required after initiation of ventilation. Then details history were taken and some relevant investigation were done. Result: Majority (51.4%) of the neonates belonged to age group 0-10 days. Male female ratio was 2.8:1. More than half (51.4%) were of gestational age 34 to < 37 weeks. Sixty nine point four percent of the neonates had Weight < 2.5 kg. Transferred from other NICU or PICU was found in 34.7% , prolonged mechanical ventilation was found in 40.3%, reintubation were 36.1%, prior antibiotics use were 73.6%, nosocomial infection were 76.4%, oropharyngeal aspiration were 11.1% and those having VAP were 79.2%. Age group 11-20 days (RR=1.41; 95% CI 1.18 to 1.67), gestational age
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- 2019
195. Resident duty hours: Families’ knowledge and perceptions in the paediatric intensive care unit
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Hilary Writer, Jason R. Frank, Katherine A. Moreau, Kaylee Eady, and Ronish Gupta
- Subjects
medicine.medical_specialty ,020205 medical informatics ,Descriptive statistics ,Critically ill ,business.industry ,media_common.quotation_subject ,Duty hours ,Context (language use) ,Resident education ,Original Articles ,02 engineering and technology ,03 medical and health sciences ,Paediatric intensive care unit ,Patient safety ,0302 clinical medicine ,Perception ,Family medicine ,Pediatrics, Perinatology and Child Health ,0202 electrical engineering, electronic engineering, information engineering ,Medicine ,030212 general & internal medicine ,business ,media_common - Abstract
Background and Objectives: Resident duty hours remain a controversial topic in the literature. Competing interests include patient safety, resident education, and resident well-being. No studies, however, have sought family members’ perspectives on duty hours in the paediatric context. This study aimed to explore family members’ knowledge of trainee duty hours, and their perspectives on the balance between shift duration and hand-off frequency. Methods: We surveyed family members of patients admitted ≥ 24 hours in the paediatric intensive care unit at an academic center. We simultaneously collected daily logs of hours worked by trainees. Descriptive statistics were used to analyze survey responses and trainee duty hours. Results: One-hundred and one family members responded (75%). Respondents demonstrated knowledge of trainees working long duty hours but reported lower averages than the trainee logs (55 versus 66 hours per week and 16 versus 24 hours per shift). Elements related to both potential trainee fatigue and hand-offs raised concern in more than half of respondents. When asked to choose between a familiar trainee working a prolonged shift, or an unfamiliar trainee at the start of their shift, respondents were divided (52% versus 48%, respectively). Conclusions: Family members of critically ill paediatric patients are aware that trainees provide patient care while working long duty hours with minimal sleep. Despite this awareness, long shifts retain value with some families, possibly due to continuity. Changes to duty hours and hand-off frequency may pose an unrealized harm on family-centered care, as well as patient–provider relationships, and further study is warranted.
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- 2019
196. Factors associated with infection amongst paediatric patients with systemic lupus erythematosus treated in the intensive care unit
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L J Hernández-Zapata, N A Ríos, Mauricio Restrepo-Escobar, M Velásquez, and R Eraso
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,030204 cardiovascular system & hematology ,Infections ,law.invention ,Cohort Studies ,Young Adult ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,Rheumatology ,Risk Factors ,law ,Intensive care ,Humans ,Lupus Erythematosus, Systemic ,Medicine ,Intensive care medicine ,Cyclophosphamide ,Retrospective Studies ,Paediatric patients ,030203 arthritis & rheumatology ,biology ,business.industry ,C-reactive protein ,Intensive care unit ,Hospitalization ,Intensive Care Units ,biology.protein ,Female ,business ,Immunosuppressive Agents - Abstract
Objective To identify determinants and outcomes associated with infection in paediatric systemic lupus erythematosus (SLE) patients at admission and during hospitalization in intensive care units (ICUs). Patients and methods A retrospective cohort study of paediatric SLE patients admitted to two ICUs was conducted. Frequency and risk factors of infection as well as mortality were studied. Results Seventy-three infection episodes amongst 55 patients were analysed. The median age was 14.4 years (IQR 12.5–16). The median SLEDAI was 16 (IQR 12–20). Twenty-nine episodes were documented at admission; the CRP was higher in these patients (6.58 versus 1.04 mg/dl, pConclusion In paediatric lupus patients admitted to the ICU, elevated CRP should alert clinicians to possible infection. During hospitalization, SLE activity and cyclophosphamide were associated with infection. Infection at admission to the ICU was strongly associated with mortality.
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- 2019
197. Qualitative subjective assessment of a high‐resolution database in a paediatric intensive care unit—Elaborating the perpetual patient's ID card
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David Brossier, Philippe Jouvet, Audrey Mathieu, Michael Sauthier, Isabelle Goyer, and Guillaume Emeriaud
- Subjects
Response rate (survey) ,education.field_of_study ,Databases, Factual ,Database ,business.industry ,Health Policy ,media_common.quotation_subject ,Publications ,Population ,Public Health, Environmental and Occupational Health ,Psychological intervention ,Intensive Care Units, Pediatric ,computer.software_genre ,Database tuning ,Paediatric intensive care unit ,Data quality ,Humans ,Medicine ,Quality (business) ,Quality level ,Child ,education ,business ,computer ,media_common - Abstract
OBJECTIVE The main purpose of our study was to subjectively assess the quality of a paediatric intensive care unit (PICU) database according to the Directory of Clinical Databases (DoCDat) criteria. DESIGN AND SETTING A survey was conducted between April 1 and June 15, 2018, among the Sainte Justine PICU research group. POPULATION Every member of this group whose research activity required the use of the database and/or who was involved in the development/validation of the database. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All 10 research team members (one Information Technology specialist, one junior medical student, and eight clinician researchers) who used the high-resolution database fulfilled the survey (100% response rate). The median quality level of the Sainte Justine PICU database across all the 10 criteria was 3 (2-4), rated on a 1 (worst) to 4 (best) numeric scale. When compared with previously assessed databases through the DoCDat criteria, we found that the Sainte Justine PICU database performance was similar. CONCLUSIONS The PICU high-resolution database appeared of good quality when subjectively assessed by the DoCDat criteria. Further validation procedures are mandatory. We suggest that data quality assessment and validation procedures should be reported when creating a new database.
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- 2019
198. The sedation practices of paediatric intensive care unit nurses and the influencing factors in China
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Xiaohua Ge and Zuojia Liu
- Subjects
Male ,China ,Adolescent ,medicine.drug_class ,Sedation ,Conscious Sedation ,Intensive Care Units, Pediatric ,Critical Care Nursing ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,Nursing ,Surveys and Questionnaires ,Humans ,Hypnotics and Sedatives ,Medicine ,Child ,Response rate (survey) ,030504 nursing ,business.industry ,Infant, Newborn ,Infant ,Questionnaire ,030208 emergency & critical care medicine ,Workload ,Respiration, Artificial ,Pediatric Nursing ,Cross-Sectional Studies ,Child, Preschool ,Scale (social sciences) ,Sedative ,Female ,medicine.symptom ,0305 other medical science ,business - Abstract
Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross-sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73·4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric-validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high-quality training and hospital's policy, such as visiting regulation, should be promoted to improve the sedation practice.
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- 2019
199. Boussignac continuous positive airway pressure device during inter-hospital transportation in infants aged less than three months
- Author
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V Modesto Alaport, J González García, C. Molinos Norniella, P Del Villar Guerra, F Barbadillo Izquierdo, A. Medina Villanueva, and R Manso Ruiz de la Cuesta
- Subjects
Male ,Presión positiva en la vía aérea ,medicine.medical_treatment ,Transportation ,Endotracheal intubation ,Positive airway pressure ,Intensive Care Units, Pediatric ,Paediatric intensive care unit ,Intubation, Intratracheal ,Humans ,Medicine ,Intubation ,Continuous positive airway pressure ,Oxygen saturation (medicine) ,Continuous Positive Airway Pressure ,business.industry ,Infant, Newborn ,Infant ,Cardiorespiratory fitness ,Lactante ,Equipment Design ,General Medicine ,Bronquiolitis ,Transporte ,medicine.disease ,Transportation of Patients ,Bronchiolitis ,Anesthesia ,Female ,Airway ,business - Abstract
Resumen Fundamento El objetivo del presente estudio es evaluar la seguridad y efectividad del dispositivo de generación de presión positiva continua en la vía aérea de Boussignac® (CPAPB) durante su uso en el transporte en lactantes menores de tres meses con bronquiolitis. Material y métodos Estudio observacional analítico transversal de cuatro años de duración. Se recogieron datos de 25 lactantes que precisaron trasladado interhospitalario a la Unidad de Cuidados Intensivos Pediátrica (UCIP) de referencia con CPAPB e interfase tipo Helmet. Se registraron las caracteristicas epidemiológicas, del traslado y de la evolución en UCIP, además de los parámetros cardiorrespiratorios y gasométricos previos al traslado y a su llegada a UCIP. Resultados La mediana del nivel de presión continua en la vía aérea (CPAP) utilizada durante el traslado fue de 7 cm H2O (6-7,25). Ningún paciente precisó de intubación endotraqueal durante el traslado y un paciente la precisó durante las primeras seis horas de ingreso en UCIP. Los siguientes parámetros cardiorrespiratorios presentaron una mejoría estadisticamente significativa a su llegada a UCIP: score de Wood-Downes modificado [8,40 (2,1)vs5,29 (1,68)], frecuencia respiratoria [60,72 (12,73)vs47,28 (10,31)], frecuencia cardiaca [167,28 (22,60)vs154,48 (24,83)] y saturación de oxígeno [92,08 (5,63)vs97,64 (2,27)]. Conclusiones La aplicación de CPAPB resultó ser un método de soporte respiratorio seguro en lactantes menores de tres meses. Su uso durante el transporte suposo una mejoría en los parámetros cardiorrespiratorios. Abstract Background The present study aims to evaluate the safety and effectiveness of the Boussignac continuous positive airway pressure device (CPAPB) when used during the transportation of infants under three months of age with bronchiolitis. Methods Transversal analytical observational study of four years duration. Data was collected on 25 infants who needed inter-hospital transportation to the reference Paediatric Intensive Care Unit (PICU), with CPAPB and Helmet interface. The epidemiological characteristics of the transportation and evolution in the PICU were registered, as well as the cardiorespiratory gastronomic parameters prior to transfer and on arrival at the PICU. Results The median level of continuous airway pressure (CPAP) used during the transfer was 7 cm H2O (6-7.25). No patient required endotracheal intubation during transportation, while one patient required this during the first six hours of admission in the PICU. The following cardiorespiratory parameters presented a statistically significant improvement on arrival at the PICU: modified Wood-Downes score [8.40 (2.1)vs5.29 (1.68)], respiratory frequency [60.72 (12.73)vs47.28 (10.31)], cardiac frequency [167.28 (22.60)vs154.48 (24.83)] and oxygen saturation [92.08 (5.63)vs97.64 (2.27)]. Conclusions Application of CPAPB proved to be a safe method of respiratory support in infants under three months of age. Its use during transportation brought an improvement in cardiorespiratory parameters.
- Published
- 2019
200. The impact of family centred care interventions in a neonatal or paediatric intensive care unit on parents’ satisfaction and length of stay: A systematic review
- Author
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Elisabeth W. Segers, Irene C. van Eerden, Petra J. J. Baarendse, Henrietta D. L. Ockhuijsen, and Agnes van den Hoogen
- Subjects
Male ,Parents ,medicine.medical_specialty ,Neonatal intensive care unit ,Adolescent ,Psychological intervention ,CINAHL ,Intensive Care Units, Pediatric ,Critical Care Nursing ,03 medical and health sciences ,Paediatric intensive care unit ,0302 clinical medicine ,Intensive Care Units, Neonatal ,Patient-Centered Care ,medicine ,Family centred ,Humans ,Child ,030504 nursing ,business.industry ,Paediatric intensive care ,Infant, Newborn ,Infant ,030208 emergency & critical care medicine ,Length of Stay ,Patient Satisfaction ,Child, Preschool ,Family medicine ,Moderate evidence ,Female ,0305 other medical science ,business - Abstract
Objective To explore the impact of family centred care interventions on parents’ satisfaction and length of stay for patients admitted to a paediatric intensive care unit or a neonatal intensive care unit. Methods A systematic review was conducted. Searches have been done in Cinahl, Cochrane, Embase and PubMed from February 2016 till October 2017. All included studies were quality appraised. Due to the heterogeneity of interventions findings were narratively reviewed. Results Seventeen studies were included in this review of which 12/17 studies investigated parents’ satisfaction and 7/17 length of stay. For this review two types of interventions were found. Interventions improving parents-professional collaboration which increased parents’ satisfaction, and interventions improving parents’ involvement which decreased length of stay. Overall quality of the included studies was weak to good. Conclusions Strong evidence was found for a significant decrease in length of stay when parents where participating in caring for their infant in a neonatal intensive care unit. Moderate evidence was found in parents’ satisfaction, which increased when collaboration between parents and professionals at a neonatal intensive care unit improved. Studies performed in a paediatric intensive care setting were of weak to moderate quality and too few to show evidence regarding parents satisfaction and length of stay.
- Published
- 2019
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