13 results on '"Ibsen LM"'
Search Results
2. Submersion and asphyxial injury.
- Author
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Ibsen LM, Koch T, Ibsen, Laura M, and Koch, Thomas
- Published
- 2002
3. Inhaled sevoflurane for ICU sedation in pediatrics: what is the safest approach?
- Author
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Bratton SL and Ibsen LM
- Subjects
- Child, Humans, Intensive Care Units, Pediatric, Respiration, Artificial, Sevoflurane, Anesthetics, Inhalation, Methyl Ethers, Pediatrics
- Published
- 2019
- Full Text
- View/download PDF
4. PICU Early Mobilization and Impact on Parent Stress.
- Author
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Colwell BRL, Olufs E, Zuckerman K, Kelly SP, Ibsen LM, and Williams CN
- Subjects
- Adult, Child, Critical Illness psychology, Cross-Sectional Studies, Early Ambulation methods, Female, Humans, Male, Retrospective Studies, Critical Illness therapy, Early Ambulation psychology, Intensive Care Units, Pediatric, Parent-Child Relations, Parents psychology, Stress, Psychological psychology
- Abstract
Background and Objectives: Early mobilization of critically ill children may improve outcomes, but parent refusal of mobilization therapies is an identified barrier. We aimed to evaluate parent stress related to mobilization therapy in the PICU., Methods: We conducted a cross-sectional survey to measure parent stress and a retrospective chart review of child characteristics. Parents or legal guardians of children admitted for ≥1 night to an academic, tertiary-care PICU who were proficient in English or Spanish were surveyed. Parents were excluded if their child's death was imminent, child abuse or neglect was suspected, or there was a contraindication to child mobilization., Results: We studied 120 parent-child dyads. Parent mobilization stress was correlated with parent PICU-related stress ( r
s [119] = 0.489; P ≤ .001) and overall parent stress ( rs [110] = 0.272; P = .004). Increased parent mobilization stress was associated with higher levels of parent education, a lower baseline child functional status, more strenuous mobilization activities, and mobilization therapies being conducted by individuals other than the children's nurses (all P < .05). Parents reported mobilization stress from medical equipment (79%), subjective pain and fragility concerns (75%), and perceived dyspnea (24%). Parent-reported positive aspects of mobilization were clinical improvement of the child (70%), parent participation in care (46%), and increased alertness (38%)., Conclusions: Parent mobilization stress was correlated with other measures of parent stress and was associated with child-, parent-, and therapy-related factors. Parents identified positive and stressful aspects of mobilization therapy that can guide clinical care and educational interventions aimed at reducing parent stress and improving the implementation of mobilization therapies., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)- Published
- 2019
- Full Text
- View/download PDF
5. Pediatric Minor Traumatic Brain Injury With Intracranial Hemorrhage: Identifying Low-Risk Patients Who May Not Benefit From ICU Admission.
- Author
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Burns EC, Burns B, Newgard CD, Laurie A, Fu R, Graif T, Ward CS, Bauer A, Steinhardt D, Ibsen LM, and Spiro DM
- Subjects
- Adolescent, Brain Injuries, Traumatic complications, Brain Injuries, Traumatic therapy, Child, Child, Preschool, Clinical Decision-Making, Cohort Studies, Female, Humans, Infant, Intensive Care Units, Pediatric statistics & numerical data, Intracranial Hemorrhage, Traumatic therapy, Male, Oregon, Patient Acceptance of Health Care statistics & numerical data, Retrospective Studies, Risk Factors, Trauma Centers, Brain Injuries, Traumatic diagnosis, Critical Care statistics & numerical data, Hospitalization statistics & numerical data, Intracranial Hemorrhage, Traumatic diagnosis, Risk Assessment methods
- Abstract
Background: Pediatric patients with any severity of traumatic intracranial hemorrhage (tICH) are often admitted to intensive care units (ICUs) for early detection of secondary injury. We hypothesize that there is a subset of these patients with mild injury and tICH for whom ICU care is unnecessary., Objectives: To quantify tICH frequency and describe disposition and to identify patients at low risk of inpatient critical care intervention (CCI)., Methods: We retrospectively reviewed patients aged 0 to 17 years with tICH at a single level I trauma center from 2008 to 2013. The CCI included mechanical ventilation, invasive monitoring, blood product transfusion, hyperosmolar therapy, and neurosurgery. Binary recursive partitioning analysis led to a clinical decision instrument classifying patients as low risk for CCI., Results: Of 296 tICH admissions without prior CCI in the field or emergency department, 29 had an inpatient CCI. The decision instrument classified patients as low risk for CCI when patients had absence of the following: midline shift, depressed skull fracture, unwitnessed/unknown mechanism, and other nonextremity injuries. This clinical decision instrument produced a high likelihood of excluding patients with CCI (sensitivity, 96.6%; 95% confidence interval, 82.2%-99.9%) from the low-risk group, with a negative likelihood ratio of 0.056 (95% confidence interval, -0.053-0.166). The decision instrument misclassified 1 patient with CCI into the low-risk group, but would have impacted disposition of 164 pediatric ICU admissions through 5 years (55% of the sample)., Conclusions: A subset of low-risk patients may not require ICU admission. The proposed decision rule identified low-risk children with tICH who may be observable outside an ICU, although this rule requires external validation before implementation.
- Published
- 2019
- Full Text
- View/download PDF
6. Mobilization Therapy in the Pediatric Intensive Care Unit: A Multidisciplinary Quality Improvement Initiative.
- Author
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Colwell BRL, Williams CN, Kelly SP, and Ibsen LM
- Subjects
- Academic Medical Centers, Age Factors, Child, Child, Preschool, Clinical Protocols, Critical Illness nursing, Early Ambulation adverse effects, Early Ambulation nursing, Humans, Infant, Patient Care Team, Severity of Illness Index, Critical Illness rehabilitation, Early Ambulation methods, Intensive Care Units, Pediatric organization & administration, Quality Improvement organization & administration
- Abstract
Background: Mobilization is safe and associated with improved outcomes in critically ill adults, but little is known about mobilization of critically ill children., Objective: To implement a standardized mobilization therapy protocol in a pediatric intensive care unit and improve mobilization of patients., Methods: A goal-directed mobilization protocol was instituted as a quality improvement project in a 20-bed cardiac and medical-surgical pediatric intensive care unit within an academic tertiary care center. The mobilization goal was based on age and severity of illness. Data on severity of illness, ordered activity limitations, baseline functioning, mobilization level, complications of mobilization, and mobilization barriers were collected. Goal mobilization was defined as a ratio of mobilization level to severity of illness of 1 or greater., Results: In 9 months, 567 patient encounters were analyzed, 294 (52%) of which achieved goal mobilization. The mean ratio of mobilization level to severity of illness improved slightly but nonsignificantly. Encounters that met mobilization goals were in younger ( P = .04) and more ill ( P < .001) patients and were less likely to have barriers ( P < .001) than encounters not meeting the goals. Complication rate was 2.5%, with no difference between groups ( P = .18). No serious adverse events occurred., Conclusions: A multidisciplinary, multiprofessional, goal-directed mobilization protocol achieved goal mobilization in more than 50% of patients in this pediatric intensive care unit. Undermobilized patients were older, less ill, and more likely to have mobilization barriers at the patient and provider level., (© 2018 American Association of Critical-Care Nurses.)
- Published
- 2018
- Full Text
- View/download PDF
7. Metrics to Assess Extracorporeal Membrane Oxygenation Utilization in Pediatric Cardiac Surgery Programs.
- Author
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Bratton SL, Chan T, Barrett CS, Wilkes J, Ibsen LM, and Thiagarajan RR
- Subjects
- Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Extracorporeal Membrane Oxygenation mortality, Female, Hospitals, High-Volume, Hospitals, Low-Volume, Hospitals, Pediatric, Humans, Infant, Infant, Newborn, Male, Postoperative Care mortality, Retrospective Studies, Risk Adjustment, United States, Young Adult, Cardiac Surgical Procedures mortality, Extracorporeal Membrane Oxygenation statistics & numerical data, Postoperative Care methods, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Objectives: Only a small fraction of pediatric cardiac surgical patients are supported with extracorporeal membrane oxygenation following cardiac surgery, but extracorporeal membrane oxygenation use is more common among those undergoing higher complexity surgery. We evaluated extracorporeal membrane oxygenation metrics indexed to annual cardiac surgical volume to better understand extracorporeal membrane oxygenation use among U.S. cardiac surgical programs., Design: Retrospective analysis SETTING:: Forty-three U.S. Children's Hospitals in the Pediatric Health Information System that performed cardiac surgery and used extracorporeal membrane oxygenation., Patients: All patients (< 19 yr) undergoing cardiac surgery during January 2003 to July 2014., Interventions: None., Measurements and Main Results: Both extracorporeal membrane oxygenation use and surgical mortality were risk adjusted using Risk Adjustment for Congenital Heart Surgery 1. Extracorporeal membrane oxygenation metrics indexed to annual cardiac surgery cases were calculated for each hospital and the metric values divided into quintiles for comparison across hospitals. Among 131,786 cardiac surgical patients, 3,782 (2.9%) received extracorporeal membrane oxygenation. Median case mix adjusted rate of extracorporeal membrane oxygenation use was 2.8% (interquartile range, 1.6-3.4%). Median pediatric cardiac case mix adjusted surgical mortality was 3.5%. Extracorporeal membrane oxygenation-associated surgical mortality was 1.3% (interquartile range, 0.7-1.6%); without extracorporeal membrane oxygenation, median case mix adjusted surgical mortality would increase from 3.5% to 5.0%. Among patients who died, 36.7% (median) were supported with extracorporeal membrane oxygenation. The median reduction in case mix adjusted surgical mortality from extracorporeal membrane oxygenation surgical survival was 30.1%. The median extracorporeal membrane oxygenation free surgical survival was 95% (interquartile range, 94-96%). Centers with less than 150 annual surgical cases had significantly lower median extracorporeal membrane oxygenation use (0.78%) than centers with greater than 275 cases (≥ 2.8% extracorporeal membrane oxygenation use). Extracorporeal membrane oxygenation use and mortality varied within quintiles and across quintiles of center annual surgical case volume., Conclusions: Risk adjusted extracorporeal membrane oxygenation metrics indexed to annual surgical volume provide potential for benchmarking as well as a greater understanding of extracorporeal membrane oxygenation utilization, efficacy, and impact on cardiac surgery mortality.
- Published
- 2017
- Full Text
- View/download PDF
8. Neurologic complications and neurodevelopmental outcome with extracorporeal life support.
- Author
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Mehta A and Ibsen LM
- Abstract
Extracorporeal life support is used to support patients of all ages with refractory cardiac and/or respiratory failure. Extracorporeal membrane oxygenation (ECMO) has been used to rescue patients whose predicted mortality would have otherwise been high. It is associated with acute central nervous system (CNS) complications and with long- term neurologic morbidity. Many patients treated with ECMO have acute neurologic complications, including seizures, hemorrhage, infarction, and brain death. Various pre-ECMO and ECMO factors have been found to be associated with neurologic injury, including acidosis, renal failure, cardiopulmonary resuscitation, and modality of ECMO used. The risk of neurologic complication appears to vary by age of the patient, with neonates appearing to have the highest risk of acute central nervous system complications. Acute CNS injuries are associated with increased risk of death in a patient who has received ECMO support. ECMO is increasingly used during cardiopulmonary resuscitation when return of spontaneous circulation is not achieved rapidly and outcomes may be good in select populations. Economic analyses have shown that neonatal and adult respiratory ECMO are cost effective. There have been several intriguing reports of active physical rehabilitation of patients during ECMO support that is well tolerated and may improve recovery. Although there is evidence that some patients supported with ECMO appear to have very good outcomes, there is limited understanding of the long-term impact of ECMO on quality of life and long-term cognitive and physical functioning for many groups, especially the cardiac and pediatric populations. This deserves further study.
- Published
- 2013
- Full Text
- View/download PDF
9. Volatile anesthetic rescue therapy in children with acute asthma: innovative but costly or just costly?.
- Author
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Char DS, Ibsen LM, Ramamoorthy C, and Bratton SL
- Subjects
- Adolescent, Adrenergic beta-2 Receptor Agonists therapeutic use, Albuterol therapeutic use, Anesthesia, Inhalation adverse effects, Anti-Bacterial Agents therapeutic use, Asthma economics, Bronchodilator Agents therapeutic use, Child, Child, Preschool, Disease Progression, Female, Helium therapeutic use, Hospital Charges, Humans, Intensive Care Units, Pediatric, Ipratropium therapeutic use, Length of Stay, Male, Neuromuscular Blocking Agents therapeutic use, Oxygen therapeutic use, Pneumonia, Aspiration etiology, Respiration, Artificial, Retrospective Studies, Anesthesia, Inhalation economics, Anesthesia, Inhalation statistics & numerical data, Anesthetics, Inhalation therapeutic use, Asthma therapy, Extracorporeal Membrane Oxygenation statistics & numerical data
- Abstract
Objectives: To describe volatile anesthesia (VA) use for pediatric asthma, including complications and outcomes., Design: Retrospective cohort study., Setting: Children's hospitals contributing to the Pediatric Health Information System between 2004-2008., Patients: Children 2-18 years old with a primary diagnosis code for asthma supported with mechanical ventilation., Intervention: Those treated with VA were compared to those not treated with VA or extracorporeal membrane oxygenation. Hospital VA use was grouped as none, <5%, 5-10% and >10% among intubated children., Measurements and Main Results: One thousand five hundred and fifty-eight patients received mechanical ventilation at 40 hospitals for asthma: 47 (3%) received VA treatment at 11 (28%) hospitals. Those receiving a VA were significantly less likely to receive inhaled b-agonists, ipratropium bromide, and heliox, but more likely to receive neuromuscular blocking agents than patients treated without VA. Length of mechanical ventilation, hospital stay (length of stay [LOS]) and charges were significantly greater for those treated with VA. Aspiration was more common but death and air leak did not differ. Patients at hospitals with VA use >10% were significantly less likely to receive inhaled b agonist, ipratropium bromide, methylxanthines, and heliox, but more likely to receive systemic b agonist, neuromuscular blocking agents compared to those treated at hospitals not using VA. LOS, duration of ventilation, and hospital charges were significantly greater for patients treated at centers with high VA use., Conclusions: Mortality does not differ between centers that use VA or not. Patients treated at centers with high VA use had significantly increased hospital charges and increased LOS.
- Published
- 2013
- Full Text
- View/download PDF
10. Providing adult and pediatric care in the same unit: multiple considerations.
- Author
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Ibsen LM, Conyers PM, and Pate MF
- Subjects
- Adolescent, Adult, Child, Humans, Young Adult, Intensive Care Units, Intensive Care Units, Pediatric
- Abstract
As always in acute and critical care, preparation is fundamental to positive patient and family outcomes. Although integration of diverse age populations may occur rarely in a unit, strategic planning should be in place for such occurrences,with relevant competencies considered, addressed, and evaluated on a continuing basis.
- Published
- 2013
- Full Text
- View/download PDF
11. Fulminant myocarditis and extracorporeal membrane oxygenation: what we know, what is there still to learn?
- Author
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Ibsen LM and Bratton SL
- Subjects
- Child, Extracorporeal Membrane Oxygenation adverse effects, Humans, Myocarditis mortality, Extracorporeal Membrane Oxygenation mortality, Myocarditis therapy
- Published
- 2010
- Full Text
- View/download PDF
12. Advances in postoperative care of pediatric cardiac patients.
- Author
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Zimmerman AT and Ibsen LM
- Abstract
Purpose of Review: The past two decades have seen tremendous technological advances in the care of infants and children with congenital and acquired heart disease. Recent advances in postoperative management have made it possible to support smaller and more fragile infants, extended the capabilities of extracorporeal circulation, and have brought new and innovative monitoring capabilities to the intensive care unit., Recent Findings: We chose to focus our review on four main themes: management of pulmonary hypertension, mechanical support of the myocardium, near infrared spectroscopy, and heparin-induced thrombocytopenia., Summary: As operative and cardiopulmonary bypass techniques have evolved, early complete repair in neonates and repair of more complex lesions is now possible, creating new challenges for postoperative care in the intensive care unit. Additionally, recognition and management of newly appreciated complications is essential.
- Published
- 2004
- Full Text
- View/download PDF
13. Radiological case of the month. Intracranial hypertension and reduced cerebral blood flow in meningococcal meningitis.
- Author
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Ibsen LM
- Subjects
- Adolescent, Blood Flow Velocity, Cerebrospinal Fluid cytology, Follow-Up Studies, Humans, Intracranial Hypertension complications, Intracranial Hypertension therapy, Magnetic Resonance Imaging methods, Male, Meningitis, Meningococcal complications, Meningitis, Meningococcal therapy, Sensitivity and Specificity, Intracranial Hypertension diagnostic imaging, Meningitis, Meningococcal diagnostic imaging, Tomography, X-Ray Computed methods
- Published
- 2002
- Full Text
- View/download PDF
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