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Paediatric intensive care

Khansoudaphone Phakhounthong, Pimwadee Chaovalit, Podjanee Jittamala, Stuart D Blacksell, Michael J Carter, Paul Turner, Kheng Chheng, Soeung Sona, Varun Kumar, Nicholas P J Day, Lisa J White, Wirichada Pan-Ngum
BACKGROUND: Dengue fever is a re-emerging viral disease commonly occurring in tropical and subtropical areas. The clinical features and abnormal laboratory test results of dengue infection are similar to those of other febrile illnesses; hence, its accurate and timely diagnosis for providing appropriate treatment is difficult. Delayed diagnosis may be associated with inappropriate treatment and higher risk of death. Early and correct diagnosis can help improve case management and optimise the use of resources such as hospital staff, beds, and intensive care equipment...
March 13, 2018: BMC Pediatrics
Yang Liu, Weishuai Bian, Ping Liu, Xuefeng Zang, Xuyun Gu, Wei Chen
OBJECTIVES: Dexmedetomidine has been shown to decrease cardiac complications in adults undergoing cardiac surgery. Results from clinical trials of dexmedetomidine on outcomes following paediatric cardiac surgery are controversial. METHODS: We searched EMBASE, PubMed and Cochrane CENTRAL databases for randomized controlled trials comparing the effect of dexmedetomidine versus placebo or other anaesthetic drugs in paediatric patients undergoing cardiac surgery. The primary outcome was the duration of mechanical ventilation...
March 7, 2018: Interactive Cardiovascular and Thoracic Surgery
John Henry McDermott, Charles Reynard, Jonathan Perry, James W Dear, Fran Child, Rachel Jenner
BACKGROUND: Recent public health strategies have contributed towards a significant reduction in the incidence of carbon monoxide (CO) poisonings. When events do occur, symptoms can vary dramatically depending on the carboxyhaemoglobin level and individual factors. Most reports to date focus on individual cases or larger retrospective reviews of diverse cohorts. There are very few reports of CO exposure related to scuba diving activities. METHODS: We describe the clinical sequelae experienced by 10 children who were exposed to CO during a scuba diving lesson...
March 8, 2018: Clinical Toxicology
Ben McNaughten, Caroline Hart, Stephen Gallagher, Carol Junk, Patricia Coulter, Andrew Thompson, Thomas Bourke
AIM: Differences in the gaze behaviour of experts and novices are described in aviation and surgery. This study sought to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency. METHODS: Clinicians from four clinical areas undertook a simulated emergency. Participants wore SMI (SensoMotoric Instruments) eye tracking glasses. We measured the fixation count and dwell time on predefined areas of interest and the time taken to key clinical interventions...
March 7, 2018: Archives of Disease in Childhood
Andreas Entenmann, Susann Dittrich, Vera Hessling, Christian Niederwanger, Gerard Cortina, Miriam Michel
BACKGROUND: Junctional ectopic tachycardia is a serious complication of surgery for paediatric congenital heart disease. R-wave synchronized atrial (AVT) pacing, an innovative temporary pacing technique, restores atrioventricular synchrony in these patients. The method is highly effective but technically complex. A standardized training model exists for doctors but not for paediatric intensive care nurses. AIMS: This study seeks to evaluate whether a standardized programme involving simulation and vignettes increases knowledge of AVT pacing and accuracy of its documentation, as well as recognition and management of specific complications...
March 6, 2018: Nursing in Critical Care
Anwarul Haque, Zehra Dhanani, Amin Ali, Basit Salam, Qalab Abbas, Gohar Javed, Humaira Jurair
BACKGROUND: The Rotterdam Score (RS) on CT head is a new evolving clinical tool as a predictor of mortality in Traumatic Brain Injury (TBI). The objective of this study is to assess the outcome of children with TBI admitted in paediatric intensive care unit (PICU) of a tertiary-care, university hospital by using RS. METHODS: This was a prospective observational study conducted on children (age: 1mo -16yr) with TBI admitted in PICU of Aga Khan University Hospital from 2013 to 2016...
January 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Melike Ayça Ay, Fatma Öz
BACKGROUND: Attitudes of nurses towards death and related concepts influence end-of-life care. Determining nurses' views and attitudes towards these concepts and the factors that affect them are necessary to ensure quality end-of-life care. OBJECTIVES: The purpose of this study was to determine nurses' views and attitudes about death, dying patient, euthanasia and the relationships between nurses' characteristics. METHODS: Participants consist of the nurses who volunteered to take part in this descriptive study from 25 hospitals (n = 340) which has a paediatric or adult intensive care unit and located within the boundaries of Ankara, Turkey...
January 1, 2018: Nursing Ethics
Martin Shaw, Laura Moss, Chris Hawthorne, John Kinsella, Ian Piper
OBJECTIVES: Raised intracranial pressure (ICP) is well known to be indicative of a poor outcome in traumatic brain injury (TBI). This phenomenon was quantified using a pressure time index (PTI) model of raised ICP burden in a paediatric population. Using the PTI methodology, this pilot study is aimed at investigating the relationship between raised ICP and length of stay (LOS) in adults admitted to a neurological intensive care unit (neuro-ICU). MATERIALS AND METHODS: In 10 patients admitted to the neuro-ICU following TBI, ICP was measured and data from the first 24 h were analysed...
2018: Acta Neurochirurgica. Supplement
T Lo, I Piper, B Depreitere, G Meyfroidt, M Poca, J Sahuquillo, T Durduran, P Enblad, P Nilsson, A Ragauskas, K Kiening, K Morris, R Agbeko, R Levin, J Weitz, C Park, P Davis
OBJECTIVES: Validated optimal cerebral perfusion pressure (CPP) treatment thresholds in children do not exist. To improve the intensive care unit (ICU) management of the paediatric traumatic brain injury (TBI) population, we are forming a new paediatric multi-centre collaboration to recruit standardised ICU data for running and reporting upon models for assessing autoregulation and optimal CCP (CPPopt). MATERIALS AND METHODS: We are adapting the adult BrainIT group's approach to develop a new Paediatric Brain Monitoring and Information Technology Group (KidsBrainIT), which will include a repository to store prospectively collected high-resolution physiological, clinical, and outcome data...
2018: Acta Neurochirurgica. Supplement
Adam M H Young, Joseph Donnelly, Xiuyun Liu, Mathew R Guilfoyle, Melvin Carew, Manuel Cabeleira, Danilo Cardim, Matthew R Garnett, Helen M Fernandes, Christina Haubrich, Peter Smielewski, Marek Czosnyka, Peter J Hutchinson, Shruti Agrawal
OBJECTIVE:  Although secondary insults such as raised intracranial pressure (ICP) or cardiovascular compromise strongly contribute to morbidity, a growing interest can be noticed in how the pre-hospital management can affect outcomes after traumatic brain injury (TBI). The objective of this study was to determine whether pre-hospital co-morbidity has influence on patterns of continuously measured waveforms of intracranial physiology after paediatric TBI. MATERIALS AND METHODS: Thirty-nine patients (mean age, 10 years; range, 0...
2018: Acta Neurochirurgica. Supplement
Luise V Marino, Michael J Griksaitis, John V Pappachan
We have previously shown that children with a bioelectrical impedance spectroscopy phase angle at 50° (PA 50°) of <2.7 on postoperative day 2 had a four-fold increase in the risk of prolonged paediatric intensive care length of stay. In this study, we demonstrate a relationship between a baseline measure of phase angle 200/5° and postoperative length of stay.
March 1, 2018: Cardiology in the Young
Christopher S Parshuram, Karen Dryden-Palmer, Catherine Farrell, Ronald Gottesman, Martin Gray, James S Hutchison, Mark Helfaer, Elizabeth A Hunt, Ari R Joffe, Jacques Lacroix, Michael Alice Moga, Vinay Nadkarni, Nelly Ninis, Patricia C Parkin, David Wensley, Andrew R Willan, George A Tomlinson
Importance: There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. Objective: To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. Design, Setting, and Participants: A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years)...
February 27, 2018: JAMA: the Journal of the American Medical Association
Alenka J Brooks, Philip J Smith, James O Lindsay
The transition of adolescents and young people (AYP) with inflammatory bowel disease (IBD) from paediatric to adult healthcare requires coordination between healthcare care providers to achieve optimum outcomes. Transition into adulthood is a time of major challenges physically, developmentally, emotionally and psychosocially for AYP living with IBD. Healthcare professionals must monitor the AYP progress proactively with attention to each of these parameters throughout the transition period to ensure that milestones are attained, and skills for self-management are formed...
January 2018: Frontline Gastroenterology
Melissa Chan, Garth Meckler, Quynh Doan
Background: General emergency department crowding negatively impacts patient care, and increases patient morbidity. Objectives: This study seeks to determine if markers of paediatric emergency department (PED) flow are independently associated with negative outcomes and increased health care utilization. Methods: We conducted a retrospective cohort study of PED visits from 2008 to 2012. Data were pulled from an electronic administrative database...
October 2017: Paediatrics & Child Health
Ebtihal Ali, Nasser Al-Shafouri, Abrar Hussain, R John Baier
Objective: Developing less invasive methods for early detection of retinopathy of prematurity (ROP) is vital to minimizing blindness in premature infants. Lofqvist and colleagues developed a computer-based ROP risk algorithm (WINROP) (, which detects downtrends in postnatal weight gain that correlate with the development of sight-threatening ROP. The aim of this study is to investigate the sensitivity and specificity of the WINROP algorithm to detect vision-threatening ROP...
July 2017: Paediatrics & Child Health
Amanda Roth, Adam Rapoport, Kimberley Widger, Jeremy N Friedman
Objective: To retrospectively review trends of general paediatric inpatient deaths at a tertiary care children's hospital over a 15-year period. Methods: Data were collected for all patients who died on the general paediatric wards or paediatric intensive care unit (PICU) during 1998, 2005 or 2012 and had a 'general paediatric condition'-an underlying condition or diagnosis that would normally result in admission to a general paediatric ward. Data were related to: demographics, health services utilization, information about provision and orders related to cardiopulmonary resuscitation (CPR) at time of death and involvement of palliative care services...
May 2017: Paediatrics & Child Health
Neeta Rampersad, Barry Wilkins, Jonathan R Egan
AIM: The aim of this study was to characterise patients with asthma admitted to an Australian paediatric intensive care unit (PICU). METHODS: This was a retrospective review of patients with asthma admitted to a university-affiliated, 23-bed, tertiary PICU between January 2000 and December 2011, with a subset of pharmacotherapy and biochemical data from patients admitted between July 2007 and December 2011. RESULTS: A total of 589 admissions (501 patients) with asthma over 12 years constituted 4...
February 22, 2018: Journal of Paediatrics and Child Health
Dora Wood, Sophie Geoghegan, Padmanabhan Ramnarayan, Peter J Davis, John V Pappachan, Sarah Goodwin, Jo Wray
Critically ill adolescents are usually treated on intensive care units optimised for much older adults or younger children. The way they access and experience health services may be very different to most adolescent service users, and existing quality criteria may not apply to them. The objectives of this pilot study were, firstly, to determine whether adolescents and their families were able to articulate their experiences of their critical care admission and secondly, to identify the factors that are important to them during their intensive care unit (ICU) or high dependency unit (HDU) stay...
February 21, 2018: European Journal of Pediatrics
Sören Verstraete, Ilse Vanhorebeek, Esther van Puffelen, Inge Derese, Catherine Ingels, Sascha C Verbruggen, Pieter J Wouters, Koen F Joosten, Jan Hanot, Gonzalo G Guerra, Dirk Vlasselaers, Jue Lin, Greet Van den Berghe
BACKGROUND: Children who have suffered from critical illnesses that required treatment in a paediatric intensive care unit (PICU) have long-term physical and neurodevelopmental impairments. The mechanisms underlying this legacy remain largely unknown. In patients suffering from chronic diseases hallmarked by inflammation and oxidative stress, poor long-term outcome has been associated with shorter telomeres. Shortened telomeres have also been reported to result from excessive food consumption and/or unhealthy nutrition...
February 21, 2018: Critical Care: the Official Journal of the Critical Care Forum
C Fonzo-Christe, A Parron, C Combescure, P C Rimensberger, R E Pfister, P Bonnabry
AIM: Epidemiological data on the incidence and risk factors of extravasation of peripheral intravenous catheters (PIVC) in neonates and children are scarce and that is what this study explored. METHODS: This was a one-year retrospective study of all neonates and paediatric intensive care patients with at least one recorded PIVC at the Geneva University Hospitals, Switzerland, in 2013. The extravasation rate was determined for all patients, including neonates below 28 days, and for all PIVCs...
February 20, 2018: Acta Paediatrica
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