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Pediatric critically ill transport

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https://www.readbyqxmd.com/read/29565527/pediatric-emergency-transport-communication-and-coordination-are-key-to-improving-outcomes
#1
Abraham Gallegos, Vijay Prasad, Calvin G Lowe
Pediatric patients who are critically ill or who require urgent subspecialty evaluation or specialized imaging, equipment, or procedures must often be transferred to tertiary care centers. The safe execution of interfacility transfer requires the coordination between the facility healthcare teams at each end of the transfer as well as the transport team. This issue discusses the process of interfacility transfer, the required services, the role of the emergency clinician, the role of the pediatric transport team, and the commonly used diagnostic studies and treatment needed during interfacility transfers of pediatric patients...
April 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29538048/lymphatic-dysfunction-in-critical-illness
#2
Edmund Burke, Sanjeev A Datar
PURPOSE OF REVIEW: The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well recognized; however, there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions...
March 13, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29478576/safe-interfacility-transport-of-pediatric-patients-medical-control-training-an-interdisciplinary-approach
#3
Samantha W Gee, Philip L Holt, Michael J Stoner
INTRODUCTION: Critically ill children who require transfer to tertiary care centers often require transport by specialized transport teams (TT). These interfacility transports require a medical control physician (MCP). Traditionally this role is assigned to fellows who are taught "on-the-job", but achieving competency in communication for those trained this way may not be optimal. We sought to close this curriculum gap by developing a MCP training program immersing emergency medicine (EM) and critical care (CC) fellows together with TT members to manage a simulated patient...
March 2018: Air Medical Journal
https://www.readbyqxmd.com/read/29432405/interhospital-transport-of-critically-ill-children-to-picus-in-the-united-kingdom-and-republic-of-ireland-analysis-of-an-international-dataset
#4
Padmanabhan Ramnarayan, Konstantinos Dimitriades, Lynsey Freeburn, Aravind Kashyap, Michaela Dixon, Peter W Barry, Kathryn Claydon-Smith, Allan Wardhaugh, Caroline R Lamming, Elizabeth S Draper
OBJECTIVES: International data on characteristics and outcomes of children transported from general hospitals to PICUs are scarce. We aimed to 1) describe the development of a common transport dataset in the United Kingdom and Ireland and 2) analyze transport data from a recent 2-year period. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Specialist pediatric critical care transport teams and PICUs in the United Kingdom and Ireland...
February 9, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29404689/hyperchloremia-is-independently-associated-with-mortality-in-critically-ill-children-who-ultimately-require-continuous-renal-replacement-therapy
#5
Matthew F Barhight, Jennifer Lusk, John Brinton, Timothy Stidham, Danielle E Soranno, Sarah Faubel, Jens Goebel, Peter M Mourani, Katja M Gist
BACKGROUND: The optimal fluid management in critically ill children is currently under investigation with several studies suggesting that hyperchloremia, chloride load, and the use of chloride-rich fluids contribute to worse outcomes. METHODS: This is a single-center retrospective cohort study of Pediatric Intensive Care Unit patients from 2008 to 2016 requiring continuous renal replacement therapy (CRRT). Patients were excluded if they had end-stage renal disease, a disorder of chloride transport, or concurrent provision of extracorporeal membrane oxygenation therapy...
February 5, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29364955/removal-of-stabilizers-from-human-serum-albumin-by-adsorbents-and-dialysis-used-in-blood-purification
#6
Stephan Harm, Claudia Schildböck, Jens Hartmann
INTRODUCTION: Human serum albumin (HSA) is a monomeric multi-domain protein that possesses an extraordinary binding capacity. It plays an important role in storing and transporting endogenous substances, metabolites, and drugs throughout the human circulatory system. Clinically, HSA is used to treat a variety of diseases such as hypovolemia, shock, burns, hemorrhage, and trauma in critically ill patients. Pharmaceutical-grade HSA contains the stabilizers sodium caprylate and N-acetyltryptophanate to protect the protein from oxidative stress and to stabilize it for heat treatment which is applied for virus inactivation...
2018: PloS One
https://www.readbyqxmd.com/read/29319897/application-of-a-physiologically-based-pharmacokinetic-model-for-the-prediction-of-bumetanide-plasma-and-brain-concentrations-in-the-neonate
#7
Maria D Donovan, Khaled Abduljalil, John F Cryan, Geraldine B Boylan, Brendan T Griffin
Bumetanide is a loop diuretic that is proposed to possess a beneficial effect on disorders of the central nervous system, including neonatal seizures. Therefore, prediction of unbound bumetanide concentrations in the brain is relevant from a pharmacological prospective. A physiologically-based pharmacokinetic (PBPK) model was developed for the prediction of bumetanide disposition in plasma and brain in adult and paediatric populations. A compound file was built for bumetanide integrating physicochemical data and in vitro data...
March 2018: Biopharmaceutics & Drug Disposition
https://www.readbyqxmd.com/read/29206726/standardization-of-pediatric-interfacility-transport-handover-measuring-the-development-of-a-shared-mental-model
#8
Anthony A Sochet, Kelsey S Ryan, Jennifer L Bartlett, Thomas A Nakagawa, Ladonna Bingham
OBJECTIVES: To determine if standardization of pediatric interfacility transport handover is associated with the development of a prototypical shared mental model between healthcare providers. DESIGN: A single center, prepost, retrospective cohort study. SETTINGS: A 259-bed, tertiary care, pediatric referral center. PATIENTS: Children 0 to 18 years old transferred to our critical care units or emergency center from October 2016 to February 2017...
February 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29173798/portable-ct-pulmonary-angiogram-in-an-infant-on-veno-arterial-extracorporeal-membrane-oxygenation-in-the-pediatric-intensive-care-unit
#9
REVIEW
Simon S Ho, Meral M Patel, Renee M Mansour, Atul Vats, Nikhil K Chanani, Bradley S Rostad
PURPOSE: Computed tomography (CT) has been shown to change management in children on extracorporeal membrane oxygenation (ECMO). Although techniques have been described to transport these critically ill patients to the CT suite in the radiology department, transport out of the intensive care setting is not without risk, and using portable CT is a practical alternative. However, obtaining a CT pulmonary angiogram (CTPA) in a patient on veno-arterial (VA) ECMO presents unique challenges due to bypass of the cardiopulmonary system, which may lead to suboptimal opacification of the pulmonary arteries...
October 31, 2017: Current Problems in Diagnostic Radiology
https://www.readbyqxmd.com/read/29132597/retrospective-review-of-pediatric-transport-where-do-our-patients-go-after-transport
#10
REVIEW
Emily Krennerich, Curtis G Sitler, Manish Shah, Fong Lam, Jeanine Graf
OBJECTIVE: This review describes disposition of transported children and identifies contributing factors affecting optimal patient placement. The study describes timing and patient placement indicators in transport patients to identify areas of improvement, re-education, and training. METHODS: A retrospective chart review for transports via our pediatric specialty transport team from January 1, 2012, to December 31, 2014, was performed. Patients were identified by the transport quality assurance performance improvement database, hospital electronic medical records, and transport medical records...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29028420/the-effect-of-telemedicine-on-resource-utilization-and-hospital-disposition-in-critically-ill-pediatric-transport-patients
#11
Kimberly Fugok, Nicholas B Slamon
PURPOSE: Pediatric transport teams rely on communication to report patient data to medical command officers, who create care plans and determine disposition. Common destinations are the emergency department (ED), pediatric intensive care unit (PICU), or regular inpatient care area (RIPCA). Telephone report does not result in complete understanding of the patient's condition. Further workup in the ED is often required. Telemedicine allows the patient to be directly seen; parents to be interviewed; and laboratory studies, radiographs, and vital signs to be reviewed...
October 13, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28922271/the-impact-of-telemedicine-on-pediatric-critical-care-triage
#12
Jillian B Harvey, Brooke E Yeager, Christina Cramer, David Wheeler, S David McSwain
OBJECTIVE: To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations. DESIGN: Retrospective evaluation of consultations occurring between April 2012 and March 2016...
November 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28906421/the-relationship-between-remoteness-and-outcomes-in-critically-ill-children
#13
Megan Sample, Anand Acharya, Katharine O'Hearn, Shane Livingstone, Kusum Menon
OBJECTIVE: A significant number of children live in remote geographic areas without direct access to tertiary care PICU. Our objective was to explore the relationship between remoteness and outcomes of critically ill children in Canada. DESIGN: Retrospective cohort study of patients admitted to the PICU from February 1, 2015, to January 31, 2016. SETTING: Pediatric tertiary care PICU in Canada. PATIENTS: All children admitted to PICU during the study period...
September 12, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28828048/initial-evaluation-and-key-principles-of-critically-ill-pediatric-patient-aerial-transport
#14
Constanta Pick
Recent advances in more efficient communications, modern telemedicine systems, medical progress, better training of the medical professionals with the possibility of sub-specialisation has led to shorter transfer times in safer conditions of this and overall affording a better chance of survival. High altitude air transport has considerable implications on the respiratory system's efficiency. Caregiver selection is key in avoiding the dangers of debilitating altitude sickness on the medical team. Minimizing physiological or anatomical derangements and minimizing potential complications in the very small critically ill patients while achieving short transfer times are major objectives...
December 2016: Mædica
https://www.readbyqxmd.com/read/28800001/basic-hemodynamic-monitoring-using-ultrasound-or-electrical-cardiometry-during-transportation-of-neonates-and-infants
#15
Angele Boet, Gilles Jourdain, Serge Demontoux, Sebastien Hascoet, Pierre Tissieres, Catherine Rucker-Martin, Daniele De Luca
OBJECTIVES: Electrical cardiometry and heart ultrasound might allow hemodynamic evaluation during transportation of critically ill patients. Our aims were 1) to test feasibility of stroke volume monitoring using electrical cardiometry or ultrasound during transportation and 2) to investigate if transportation impacts on electrical cardiometry and ultrasound reliability. DESIGN: Prospective, pragmatic, feasibility cohort study. SETTING: Mobile ICUs specialized for neonatal and pediatric transportation...
November 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28547532/prehospital-blood-transfusions-in-pediatric-trauma-and-nontrauma-patients-a-single-center-review-of-safety-and-outcomes
#16
Aodhnait S Fahy, Cornelius A Thiels, Stephanie F Polites, Maile Parker, Michael B Ishitani, Christopher R Moir, Kathleen Berns, James R Stubbs, Donald H Jenkins, Scott P Zietlow, Martin D Zielinski
PURPOSE: Prehospital transfusions are a novel yet increasingly accepted intervention in the adult population as part of remote damage control resuscitation, but prehospital transfusions remain controversial in children. Our purpose was to review our pediatric prehospital transfusion experience over 12 years to describe the safety of prehospital transfusion in appropriately triaged trauma and nontrauma patients. METHODS: Children (<18 years) transfused with packed red blood cells (pRBC) or plasma during transport to a single regional academic medical center between 2002 and 2014 were identified...
July 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28388599/abcb1-genotype-is-associated-with-fentanyl-requirements-in-critically-ill-children
#17
Christopher M Horvat, Alicia K Au, Yvette P Conley, Patrick M Kochanek, Lingjue Li, Samuel M Poloyac, Philip E Empey, Robert S B Clark
BackgroundThe gene ABCB1 encodes p-glycoprotein, a xenobiotic efflux pump capable of transporting certain opioids, including fentanyl. ABCB1 genotype has been previously associated with patient opioid requirements and may influence fentanyl dosing requirements in critically ill children.MethodsA diagnostically diverse cohort of 61 children who received a fentanyl infusion while admitted to the pediatric intensive care unit (PICU) were included in this study. We examined associations between fentanyl requirements, pain and sedation scores, serum fentanyl levels, and ABCB1 genotype...
July 2017: Pediatric Research
https://www.readbyqxmd.com/read/28375994/translating-research-to-practice-providing-critically-ill-children-the-opportunity-to-go-home-or-to-hospice-for-end-of-life-care
#18
Harriett Nelson, Sandra Mott
BACKGROUND: A freestanding quaternary pediatric hospital in New England has been facilitating parents' requests to take their child home or to a hospice facility from an Intensive Care Unit at end of life for the withdrawal of life sustaining measures for the past 16 years. However, knowledge of the aftermath of this decision was very limited. Before responding to a growing interest in making this service more available, an exploratory study was done to learn about the parents' perceptions of the experience over time...
May 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28217595/impact-of-pre-hospital-care-on-the-outcome-of-children-arriving-with-agonal-breathing-to-a-pediatric-emergency-service-in-south-india
#19
Debasis Das Adhikari, Krishna Mahathi, Urmi Ghosh, Indira Agarwal, Anila Chacko, Ebor Jacob, Kala Ebenezer
BACKGROUND: Data on the prehospital interventions received by critically ill children at arrival to Paediatric Emergency Services (PES) is limited in developing countries. This study aims to describe the pre-hospital care scenario, transport and their impact on outcome in non-traumatic, acutely ill children presenting in PES with agonal breathing. METHODS: Prospective observational study done on children aged below 15 years arriving in PES with agonal breathing due to non-trauma related causes...
July 2016: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/28197051/benefits-of-and-untoward-events-during-intrahospital-transport-of-pediatric-intensive-care-unit-patients
#20
M M Harish, Suhail Sarwar Siddiqui, Natesh R Prabu, Harish K Chaudhari, Jigeeshu V Divatia, Atul Prabhakar Kulkarni
BACKGROUND AND AIMS: The transport of critically ill patients for procedures or imaging outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. The literature about benefits of and untoward events (UEs) during intrahospital transport of pediatric critically ill patient is scarce. We, therefore, audited the UEs during and benefits of intrahospital transport of critically ill pediatric patients in our ICU. SUBJECTS AND METHODS: Eighty critically ill pediatric (<18 years) cancer patients, transported from the ICU for either diagnostic or therapeutic procedure over a period of 6 months, were included in the study...
January 2017: Indian Journal of Critical Care Medicine
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