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An editorial is presented which expresses the views on peer review processes, emphasizing its importance in ensuring the quality and validity of academic manuscripts. Topics include the definition and types of peer review, its significance in critical care nursing for advancing clinical practice through high-quality evidence, debates on the necessity of peer review, and the future of peer reviewing with considerations of artificial intelligence (AI) integration.

Background: Establishing and sustaining enteral feeding in critically ill children is challenging and has met with many problems. Aims and objectives: The aim of this study was to investigate (a) how actual calorie intake compared with estimated caloric requirements and (b) whether feeding guideline adherence resulted in improved nutritional intake. Design and methods: A prospective observational study was undertaken over 1 month in a tertiary referral paediatric intensive care unit (PICU) in the northwest of England. Results: Forty-seven children were studied, with a wide range of diagnoses in a 1-month period. Only 47% of the children had enteral feeds started within our 6 h post-admission target. Over half (55%) of the children received less than half of their estimated calorie requirements, but if feeding guidelines were followed, this resulted in a significantly higher ( p = 0·004) delivery of the child's estimated requirements. Conclusions: This study found that many children are not receiving adequate nutrition in PICU and that the use of feeding guidelines significantly improves calorie delivery in PICU patients. Relevance to clinical practice: This paper highlights the dearth of research related to enteral feeding in critically ill children. We found that the use of feeding guidelines improved calorie delivery and so units should be encouraged to develop their own guidelines based on the best evidence available. [ABSTRACT FROM AUTHOR]

AIM: This paper aims to present an overview of the literature relating to the effects of endotracheal suctioning (ETS) in children and adults with severe traumatic brain injury (TBI). BACKGROUND: TBI is the leading cause of death in children worldwide and continues to result in widespread mortality and morbidity. In intensive care, ETS is an essential nursing procedure that is undertaken but is known to produce some adverse effects in children. METHOD: A comprehensive literature search was undertaken using a Parahoo and quality of reporting of meta-analyses (QUOROM) approach. A range of databases was searched to identify published papers with key search terms. The databases searched included Cochrane Library, Medline, PubMed Central, CINAHL, Proquest and Science Direct. FINDINGS: This review is based on 21 papers (with 433 patients in total), but specific papers in paediatric head injury children were extremely limited, and the evidence was largely dated and inconclusive. Although the majority of papers demonstrate an increase in intracranial pressure (ICP) with ETS, there are contradictory results with regard to recovery times. CONCLUSIONS: Further research is needed specifically into the effect of ETS on ICP and cerebral perfusion pressure of children with severe TBI, taking into account all the known confounding variables. [ABSTRACT FROM AUTHOR]

Research in adult patients, in the last decade, has highlighted suboptimal care and failures in the recognition of sick adults in ward areas. In addition, many of these patients (at least 50%) demonstrated documented evidence, on observation charts, of clinical deterioration in the 24-48 h preceding cardiopulmonary arrest or emergency intensive care unit admission. However, there is little published data on whether these findings apply to children (0-17 years). The aim of the study was to examine the extent of inpatient deterioration and critical care unit admission within a children's hospital based in the North West of England, during a 4-month period. The design included a prospective chart review of clinical observations. As noted in adult patients, there is considerable documented evidence (in terms of abnormal vital signs) of physiological deterioration in the 24 h preceding intensive care or high-dependency unit admission. The use of a Paediatric Early Warning (PEW) tool could potentially have identified 87% of these children of being 'at risk' of deterioration. It is recommended that a PEW tool be incorporated into the routine paediatric ward observation charts and practice to identify children 'at risk' of deterioration. [ABSTRACT FROM AUTHOR]

Although data about vital signs is needed to develop early warning tools for use with children in paediatric wards, the validity and reliability of nurses' recordings must be considered, as Lyvonne Tume and Ian Bullock explain. [ABSTRACT FROM AUTHOR]

The author argues that the paediatric intensive care unit workforce should move beyond the traditional model of physician only service delivery to a more flexible team approach. She mentions that the new model should be responsive to the needs of patients and families in a time of ICU service deficits and budget cuts. She notes that the ICU nursing workforce should include assistant critical care practitioners in the team.

Background: The timeline of the 3 Pediatric International Nutrition Studies (PINS) coincided with the publication of 2 major guidelines for the timing of parenteral nutrition (PN) and recommended energy and protein delivery dose., Objective: The study's main objective was to describe changes in the nutrition delivery practice recorded in PINS1 and PINS2 (PINS1-2) (conducted in 2009 and 2011, preexposure epoch) vs PINS3 (conducted in 2018, postexposure epoch), in relation to the published practice guidelines., Design: This study is a secondary analysis of data from a multicenter prospective cohort study., Participants/setting: Data from 3650 participants, aged 1 month to 18 years, admitted to 100 unique hospitals that participated in 3 PINS was used for this study., Main Outcome Measures: The time in days from pediatric intensive care unit admission to the initiation of PN and enteral nutrition delivery were the primary outcomes. Prescribed energy and protein goals were the secondary outcomes., Statistical Analyses Performed: A frailty model with a random intercept per hospital with stratified baseline hazard function by region for the primary outcomes and a mixed-effects negative binomial regression with random intercept per hospital for the secondary outcomes., Results: The proportion of patients receiving enteral nutrition (88.3% vs 80.6%; P < .001) was higher, and those receiving PN (20.6% vs 28.8%; P < .001) was lower in the PINS3 cohort compared with PINS1-2. In the PINS3 cohort, the odds of initiating PN during the first 10 days of pediatric intensive care unit admission were lower, compared with the PINS1-2 cohort (hazard ratio 0.8, 95% CI 0.67 to 0.95; P = .013); and prescribed energy goal was lower compared with the PINS1-2 cohort (incident rate ratio 0.918, 95% CI 0.874 to 0.965; P = .001)., Conclusions: The likelihood of initiation of PN delivery significantly decreased during the first 10 days after admission in the PINS3 cohort compared with PINS1-2. Energy goal prescription in children receiving mechanical ventilation significantly decreased in the postguidelines epoch compared with the preguidelines epoch., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Endotracheal suction is used to maintain endotracheal tube patency. There is limited guidance to inform clinical practice for children with respiratory infections., Objective: The objective of this study was to determine whether implementation of a paediatric endotracheal suction appropriate use guideline Paediatric AirWay Suction (PAWS) is associated with an increased use of appropriate and decreased use of inappropriate suction interventions., Methods: A mixed-method, pre-implementation-post-implementation study was conducted between September 2021 and April 2022. Suction episodes in mechanically ventilated children with a respiratory infection were eligible. Using a structured approach, we implemented the PAWS guideline in a single paediatric intensive care unit. Evaluation included clinical (e.g., suction intervention appropriateness), implementation (e.g., acceptability), and cost outcomes (implementation costs). Associations between implementation of the PAWS guideline and appropriateness of endotracheal suction intervention use were investigated using generalised linear models., Results: Data from 439 eligible suctions were included in the analysis. Following PAWS implementation, inappropriate endotracheal tube intervention use reduced from 99% to 58%, an absolute reduction (AR) of 41% (95% confidence interval [CI]: 25%, 56%). Reductions were most notable for open suction systems (AR: 48%; 95% CI: 30%, 65%), 0.9% sodium chloride use (AR: 23%; 95% CI: 8%, 38%) and presuction and postsuction manual bagging (38%; 95% CI: 16%, 60%, and 86%; 95% CI: 73%, 99%), respectively. Clinicians perceived PAWS as acceptable and suitable for use., Conclusions: Implementation of endotracheal tube suction appropriate use guidelines in a mixed paediatric intensive care unit was associated with a large reduction in inappropriate suction intervention use in paediatric patients with respiratory infections., Competing Interests: Conflict of interest The authors have no conflicts of interest to disclose., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Prolonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes., Methods: 10,495 children admitted to 18 paediatric intensive care units (ICUs) in the United Kingdom participated in a stepped-wedge, cluster randomised controlled trial, with 1955 clinical staff trained to deliver the intervention. The intervention comprised assessment and optimisation of sedation levels, and bedside screening of respiratory parameters to indicate readiness for a spontaneous breathing trial prior to liberation from ventilation. 193 clinical staff were interviewed towards the end of the trial. Interview data were thematically analysed, and quantitative adherence data were analysed using descriptive statistics., Results: The intervention led to a reduced duration of IMV (adjusted median difference- 7.1 hours, 95% CI -9.6 to -5.3, p = 0.01). Overall intervention adherence was 75% (range 59-85%). Ease and flexibility of the intervention promoted it use; designated responsibilities, explicit pathways of decision-making and a shared language for communication fostered proactivity and consistency towards extubation. Delivery of the intervention was hindered by established hospital and unit organisational and patient care routines, clinician preference and absence of clinical leadership., Conclusions: The SANDWICH trial showed a significant, although small, reduction in duration of IMV. Findings suggest that greater direction in decision-making pathways, robust embedment of new practice in unit routine, and capitalising on the skills of Advanced Nurse Practitioners and physiotherapists would have contributed to greater intervention effect., Trial Registration: isrctn.org Identifier: ISRCTN16998143., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Jordan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: In critically ill pediatric patients, optimal energy and protein intakes are associated with a decreased risk of morbidity and mortality. However, the determination of energy and protein needs is complex. The objective of this scoping review was to understand the extent and type of evidence related to the methods used to determine energy and protein needs in critically ill pediatric patients., Methods: An international expert group composed of dietitians, pediatric intensivists, a nurse, and a methodologist conducted the review, based on the Johanna Briggs Institute methodology. Two researchers searched for studies published between 2008 and 2023 in two electronic databases, screened abstracts and relevant full texts for eligibility, and extracted data., Results: A total of 39 studies were included, mostly conducted in critically ill children undergoing ventilation, to assess the accuracy of predictive equations for estimating resting energy expenditure (REE) (n = 16, 41%) and the impact of clinical factors (n = 22, 56%). They confirmed the risk of underestimation or overestimation of REE when using predictive equations, of which the Schofield equation was the least inaccurate. Apart from weight and age, which were positively correlated with REE, the impact of other factors was not always consistent. No new indirect calorimeter method used to determine protein needs has been validated., Conclusion: This scoping review highlights the need for scientific data on the methods used to measure energy expenditure and determine protein needs in critically ill children. Studies using a reference method are needed to validate an indirect calorimeter., (© 2023 The Authors. Nutrition in Clinical Practice published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.)

Paediatric early warning systems (PEWS) to reduce in-hospital mortality have been a laudable endeavour. Evaluation of their impact has rarely examined the internal validity of the components of PEWS in achieving desired outcomes. We highlight the assumptions made regarding the mode of action of PEWS and, as PEWS become more commonplace, this paper asks whether we really understand their function, process and outcome., Competing Interests: Competing interests: DR and GS are involved in the NHS England National Inpatient PEWS programme., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)