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Pediatric intensive care

Kirsten Beck, Elaine Albert, Andrew Johnsen, Courtney Newhouse, John McGuire
Medical rounds in the Pediatric Intensive Care Unit (PICU) took about four hours each day to complete. The length of rounds was affecting the advancement of care of the patients, the engagement of sub-specialty providers who needed to be present on other rounds, and the engagement of the PICU faculty and staff due to overburdening waste created by the long duration of rounds. Specific interventions were identified aimed at reducing the duration of rounds each day, increasing engagement of the rounding team and satisfying the needs of the patients and families...
2016: BMJ Quality Improvement Reports
Amira Mustafa, Samar Mahgoub
Delays in the discharge of hospital patients cause a backlog for new admissions from the Emergency Departments (ED), outpatient clinics, and transfers from the Intensive Care Units (ICU). A variety of initiatives have been reported on previously which aim to tackle this problem with variable success. In this quality improvement project, we aimed to increase the proportion of discharged patients who leave the paediatric unit by 12:00 Noon from 7% to 30% by May 2015. A baseline discharge process map was studied to understand the possible causes of the delays...
2016: BMJ Quality Improvement Reports
Folafoluwa O Odetola, Renee R Anspach, Yong Y Han, Sarah J Clark
PURPOSE: To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care. METHODS: Interviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao2)/Fio2 (32%), and inflation pressure (16%)...
October 4, 2016: Journal of Critical Care
Adriana Yock-Corrales, Flory Varela-Bulgarelli, Cary Barboza, Alfonso Gutierrez-Mata, Mark T Mackay, Franz Babl
OBJECTIVES: The aim was to describe clinical presentation, management, and outcomes of stroke in a tertiary emergency department (ED) of a developing country. METHODOLOGY: Retrospective case series of patients aged 1 month to 18 years presenting to an ED with radiological confirmed acute stroke during a 7-year period were studied. RESULTS: Ninety-five patients were identified. Twenty-five patients were excluded because of incomplete records (8) or not presenting via ED (17)...
October 4, 2016: Pediatric Emergency Care
Julie C Fitzgerald, Scott L Weiss, Niranjan Kissoon
OBJECTIVE: To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers' Textbook of Pediatric Intensive Care. DATA SOURCES: The U.S. National Library of Medicine PubMed ( was searched for combination of the term "pediatric" and the following terms: "sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid." The abstract lists generated by these searches were screened for potential inclusion...
September 30, 2016: Pediatric Critical Care Medicine
Kelsey Chinnadurai, Lindy Fenlason, Brian Bridges, Mana Espahbodi, Sivakumar Chinnadurai, Jane Blood-Siegfried
BACKGROUND: Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (ICUs). Ventilator-associated pneumonia protocols decrease the incidence of VAP; however, many components of these protocols are not feasible in all settings. This study was done in a large pediatric hospital in Nicaragua. OBJECTIVE: The aim of this study is to implement a sustainable evidence-based VAP protocol, in a different culture, for the purpose of decreasing VAP rates...
November 2016: Dimensions of Critical Care Nursing: DCCN
Karen Thomson, Sophie R Pestieau, Janish J Patel, Heather Gordish-Dressman, Ariana Mirzada, Zeev N Kain, Matthew E Oetgen
BACKGROUND: The Perioperative Surgical Home (PSH) is a patient-centered, team-based approach that aims to improve the value of perioperative care. We implemented a PSH for patients with adolescent idiopathic scoliosis who were undergoing posterior spinal fusion at Children's National Health System. We hypothesized that this PSH would improve patient surgical outcomes and reduce hospital length of stay (LOS). METHODS: A multidisciplinary group created evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care of this patient population...
October 3, 2016: Anesthesia and Analgesia
Carolina López, Andrés José Alcaraz, Blanca Toledo, Lucía Cortejoso, Maite Augusta Gil-Ruiz
OBJECTIVE: Patients in PICUs frequently present hypochloremic metabolic alkalosis secondary to loop diuretic treatment, especially those undergoing cardiac surgery. This study evaluates the effectiveness of acetazolamide therapy for metabolic alkalosis in PICU patients. DESIGN: Retrospective, observational study. SETTING: A tertiary care children's hospital PICU. PATIENTS: Children receiving at least a 2-day course of enteral acetazolamide...
September 29, 2016: Pediatric Critical Care Medicine
Ruchi Kaushik, Isabelle M Krisch, Darrell R Schroeder, Randall Flick, Michael E Nemergut
BACKGROUND: Head injuries are the leading cause of death among cyclists, 85 % of which can be prevented by wearing a bicycle helmet. This study aims to estimate the incidence of pediatric bicycle-related injuries in Olmsted County and assess differences in injuries between those wearing helmets vs. not. METHODS: Olmsted County, Minnesota residents 5 to 18 years of age with a diagnostic code consistent with an injury associated with the use of a bicycle between January 1, 2002, and December 31, 2011, were identified...
December 2015: Injury Epidemiology
Laurence Ducharme-Crevier, Michele G Mills, Priya M Mehta, Craig M Smith, Mark S Wainwright
BACKGROUND: The primary objective of this study was to characterize changes in cerebral blood flow measured using transcranial Doppler in children with central nervous system infections. We hypothesized that children with central nervous system infections have abnormal cerebral blood flow, associated with a greater frequency of complications and poor neurological outcome. METHODS: We conducted a single-center, retrospective study of children admitted to the neonatal or pediatric intensive care unit with central nervous system infection and undergoing transcranial Doppler as part of routine care between March 2011 and July 2015...
September 4, 2016: Pediatric Neurology
Mehmet Bosnak, Seher Erdogan, E Habibe Aktekin, Ali Bay
We report two children who were diagnosed as having primary hemophagocytic syndrome and who successfully underwent therapeutic plasma exchange (TPE). The first patient was a 6-month-old girl diagnosed with HLH who was admitted to the pediatric intensive care unit. The patient's clinical condition worsened on the 9th day of the HLH-2004 treatment protocol. Her ferritin level was found 50.000 ng/mL, and TPE was performed for 9 sessions, after which her clinical condition and laboratory findings improved. The patient is still on the HLH-2004 protocol and waits for a suitable stem cell transplantation donor...
September 28, 2016: Transfusion and Apheresis Science
Ariel Brandwein, Kavita Patel, Myriam Kline, Peter Silver, Sandeep Gangadharan
OBJECTIVES: Patients with obstructive airway disease have varying degrees of pulsus paradoxus that correlate with illness severity. Pulsus paradoxus can be measured using plethysmography. We investigated whether plethysmograph (pleth) variability on admission to the pediatric emergency department (ED) could predict patient disposition. We hypothesized that patients with a larger pleth variability would have a higher likelihood of being admitted to a general pediatrics unit or the intensive care unit (ICU)...
October 6, 2016: Pediatric Emergency Care
Naveen Poonai Prakash Chandra, David Mainprize, Carolyn Travers, Lilian Lee Yan Vivas, Peter Tryphonopoulos, Gurinder Sangha, Ryan Arbeau, Jamie Seabrook, Michael Miller, Amrita Sarpal, Rodrick Lim
OBJECTIVES: Early identification of children at risk for adverse outcomes is important. Serum bicarbonate is easily collected and widely available. We described the relationship between bicarbonate and adverse outcomes in children presenting to the emergency department (ED). METHODS: We conducted a retrospective cohort study of children aged 0 to 17 years from January 1, 2007, to December 31, 2011, who had a serum bicarbonate measured in the ED. Primary outcome was the predictive ability of bicarbonate for the individual components of the composite outcome that included at least one of the following: intensive care unit admission, assisted ventilation, inotropic support, cardiopulmonary resuscitation, or death...
October 6, 2016: Pediatric Emergency Care
Riad Lutfi, Kamal Abulebda, Mara E Nitu, Jean P Molleston, Molly A Bozic, Girish Subbarao
Pediatric acute liver failure is rare but life-threatening illness that occurs in children without preexisting liver disease. The rarity of the disease, along with its severity and heterogeneity, presents unique clinical challenges to the physicians providing care for pediatric patients with acute liver failure. In this review, practical clinical approaches to the care of critically ill children with acute liver failure are discussed with an organ system specific approach. The underlying pathophysiological processes, major areas of uncertainty, and approaches to the critical care management of pediatric acute liver failure are also reviewed...
October 12, 2016: Journal of Pediatric Gastroenterology and Nutrition
Anu K Kaskinen, Laura Martelius, Turkka Kirjavainen, Paula Rautiainen, Sture Andersson, Olli M Pitkänen
BACKGROUND: Lung ultrasounds show vertical artifacts known as B-lines in the presence of increased extravascular lung water (EVLW). We aimed to investigate whether lung ultrasound could estimate EVLW after congenital cardiac surgery. METHODS: This prospective observational study comprised 61 children (age range 3 days to 7.4 years) undergoing congenital cardiac surgery. We compared postoperative B-line scores from lung ultrasounds, early postoperative ultrasound as our primary interest, with corresponding postoperative chest radiography (CXR) lung edema scores, with static lung compliance, and with short-term clinical outcome interpreted as time on mechanical ventilation and length of pediatric intensive care unit (PICU) stay...
October 14, 2016: Pediatric Pulmonology
Ramachandran Rameshkumar, Sriram Krishnamurthy, Rajesh Nachiappa Ganesh, Subramanian Mahadevan, Parameswaran Narayanan, Ponnarmeni Satheesh, Puneet Jain
BACKGROUND: Septic acute kidney injury (AKI) accounts for more than half of all cases of AKI in critically ill children. The renal histology was found to alter the management in more than two-third of cases of adult acute renal failure. Better insight into the pathogenesis of pediatric septic AKI could be based on developing a clearer appreciation of the histopathological changes. No comprehensive study of the histopathological features of septic AKI in critically ill children has yet been performed...
October 13, 2016: Clinical and Experimental Nephrology
Serdar Sadık Duran, Sultan Kavuncuoğlu, Ferhat Sarı, Esin Yıldız Aldemir, Nazlı Kavçık, Ferhat Demir
AIM: This study aimed to investigate the perinatal mortality rate with 37 864 deliveries which occured in two different periods in a single center, to compare the components of perinatal mortality and affecting factors with the results of the study related with perinatal mortality which we conducted in 1999 and to emphasize the precautions directed to reduce mortality rates. MATERIAL AND METHODS: All live births and stillbirths which occurred in Bakırköy Obstetrics and Pediatrics Training and Research Hospital between January 2007 and December 2007 were evaluated...
September 2016: Türk Pediatri Arşivi
Pilar Anton-Martin, Michael Papacostas, Elisabeth Lee, Paul A Nakonezny, Michael L Green
BACKGROUND: Malnutrition is associated with an increased risk of mortality in patients admitted to the intensive care unit. Children requiring extracorporeal membrane oxygenation (ECMO) support represent an extremely ill subset of this population. There is a lack of data on the impact of nutrition state on survival in this cohort. We examined the association between being underweight and in-hospital mortality among children supported with ECMO. MATERIALS AND METHODS: This article reports on an observational retrospective cohort study performed among neonatal and pediatric patients supported with ECMO in a tertiary children's hospital from May 1996 through June 2013...
October 13, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Márcia Oliveira Staffa Tironi, José Mário Meira Teles, Dalton de Souza Barros, Débora Feijó Villas Bôas Vieira, Colbert Martins da Silva Filho, Davi Felix Martins Júnior, Marcos Almeida Matos, Carlito Lopes Nascimento Sobrinho
OBJECTIVE: To estimate the prevalence of burnout in intensivist doctors working in adult, pediatric and neonatal intensive care units in five Brazilian capitals. METHODS: Descriptive epidemiological study with a random sample stratified by conglomerate with 180 intensivist doctors from five capitals representing the Brazilian geographic regions: Porto Alegre (RS), Sao Paulo (SP), Salvador (BA), Goiania (GO) and Belem (PA). A self-administered questionnaire examining sociodemographic data and the level of burnout was evaluated through the Maslach Burnout Inventory...
September 2016: Revista Brasileira de Terapia Intensiva
Eliana de Andrade Trotta, Fernanda Cristina Scarpa, Michel George El Halal, José Roberto Goldim, Paulo Roberto Antonacci Carvalho
OBJECTIVE: To evaluate the perceptions of physicians, nurses and nursing technicians of their participation in the decision-making process surrounding life support limitation in terminally ill pediatric patients, with comparisons by professional category. METHODS: A cross-sectional study was conducted in the pediatric intensive care unit of a tertiary public university hospital with the participation of physicians, nurses and nursing technicians. The MacArthur Admission Experience Survey Voice Scale was used to assess and quantify the perceptions of professionals who assisted 17 pediatric patients with life support limitation within 24 hours after the outcome of each patient was determined...
September 2016: Revista Brasileira de Terapia Intensiva
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