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pediatric critical care intensive care children

An Jacobs, Inge Derese, Sarah Vander Perre, Esther van Puffelen, Sören Verstraete, Lies Pauwels, Sascha Verbruggen, Pieter Wouters, Lies Langouche, Gonzalo Garcia Guerra, Koen Joosten, Ilse Vanhorebeek, Greet Van den Berghe
INTRODUCTION: Non-thyroidal illness (NTI), which occurs with fasting and in response to illness, is characterized by thyroid-hormone inactivation with low T3 and high rT3, followed by suppressed TSH. Withholding supplemental parenteral nutrition early in pediatric critical illness (late-PN), thus accepting low/no macronutrient intake up to day 8 in the pediatric intensive-care-unit (PICU), accelerated recovery as compared with initiating supplemental parenteral nutrition early (early-PN)...
February 14, 2019: Thyroid: Official Journal of the American Thyroid Association
Alberto García-Salido, A Martínez de Azagra-Garde, M A García-Teresa, G De Lama Caro-Patón, M Iglesias-Bouzas, M Nieto-Moro, I Leoz-Gordillo, C Niño-Taravilla, M Sierra-Colomina, G J Melen, M Ramírez-Orellana, A Serrano-González
The CD64 receptor has been described as an interesting bacterial infection biomarker. Its expression has not been studied in previously healthy children admitted to pediatric critical care unit (PICU). Our objective was firstly to describe the CD64 expression and secondly study its diagnostic accuracy to discriminate bacterial versus viral infection in this children. We made a prospective double-blind observational study (March 2016-February 2018). A flow cytometry (FC) was done from peripheral blood at PICU admission...
February 2, 2019: European Journal of Clinical Microbiology & Infectious Diseases
Thomas E Pearson, Meg A Frizzola, Henry H Khine
OBJECTIVE: The effect of using uncuffed endotracheal tubes in children during interfacility critical care transport has not yet been assessed. We hypothesized that many children with uncuffed endotracheal tubes experience complications leading to replacement with a cuffed tube after arrival at a tertiary pediatric care facility. METHODS: We conducted a retrospective case review of all intubated patients transported by our dedicated pediatric critical care transport team to our pediatric intensive care unit over a 3-year period...
January 2019: Air Medical Journal
Gabrielle Silver, Chani Traube
OBJECTIVE: Delirium is a frequent and severe complication of serious pediatric illness. Development of a nonpharmacologic approach to prevent pediatric delirium may improve short- and long-term outcomes in children and their families. In this brief report, we describe the development of a quality improvement project designed to methodically promote the family member's engagement, comforting, and orienting activities with their critically ill child to decrease delirium rates. METHOD: We created a developmentally specific Delirium Prevention Toolkit for families...
January 31, 2019: Palliative & Supportive Care
Saravanan Margabandhu, Suchitra Ranjit, Indira Jayakumar, Chitra Sundaramoorthy, Mahesh Janarthanan, Jayakumar Reddy, Meena Thiagarajan, Shyamala Jayamoorthy, Latha Vishwanathan
INTRODUCTION: Outcome data in pediatric plasma exchange, especially in nonrenal indications are scarce. We aimed to evaluate its role and outcome in our patients. SUBJECTS AND METHODS: A retrospective study of children admitted in the year 2016 to the Pediatric Intensive Care Unit requiring plasma exchange for nonrenal indications was undertaken. Plasma exchange was given as adjunctive therapy along with primary treatment for the disease concerned. Demographic and clinical data were studied, and descriptive statistical analysis was carried out...
July 2018: Asian Journal of Transfusion Science
Beth M McManus, Zachary Richardson, Margaret Schenkman, Natalie Murphy, Elaine H Morrato
Importance: Federal per-child early intervention (EI) appropriations have declined, while accountability for improving children's development and function has increased. It is critical to understand high-value EI services and systems. Objective: To examine EI service timeliness and intensity, and the association between service intensity and outcomes. Design, Setting, and Participants: This secondary data analysis cohort study linked pediatric primary care electronic health records and EI program records from October 1, 2014, to September 30, 2016...
January 4, 2019: JAMA network open
Aurélien Jacquot, Frédéric Victor Valla, Thibault Mura, Lyvonne Nicole Tume, Héléna Bertet, Carole Ford-Chessel, Christophe Milesi, Gilles Cambonie, Arnaud De Luca, Bénédicte Gaillard-Le Roux
BACKGROUND: Impaired nutritional status is adversely associated with suboptimal outcomes in critically ill children. Undernutrition at pediatric intensive care unit (PICU) admission ranges from 15 to 65%. A lack of knowledge of the nutritional status of children in French PICUs prevents us from specifically targeting education. This study aims to describe the nutritional status of children in French PICUs and to assess nutritional practices and physicians' knowledge of nutrition, in order to focus NutriSIP (the French-speaking PICU nutrition group) future education programs...
January 22, 2019: Annals of Intensive Care
S Christopher Derderian, Ryan Good, Raphael N Vuille-Dit-Bille, Todd Carpenter, Denis D Bensard
BACKGROUND: Central venous catheters (CVC) are vital to the management of critically ill children. Despite efforts to minimize complications, central line associated bloodstream infection (CLABSI) and venous thromboembolisms (VTE) still occur. METHODS: We performed a retrospective review of a prospectively collected database for children admitted to the pediatric intensive care unit (PICU) between November 2013 and December 2016. RESULTS: In total, 2714 CVC were in place, 979 of which were percutaneous CVC...
December 27, 2018: Journal of Pediatric Surgery
Laura Beth Kalvas
AIMS AND OBJECTIVES: The purpose of this article is to create a framework for future research through application and critique of the Life Course Health Development Model to the phenomenon of pediatric delirium. BACKGROUND: Delirium in the pediatric intensive care unit is associated with increased duration of mechanical ventilation, length of stay, and mortality. Nurses are uniquely positioned at the bedside to identify, prevent, and treat delirium. An understanding of the potential long-term consequences of pediatric delirium is necessary to provide impetus for nursing research and practice change...
January 17, 2019: Journal of Clinical Nursing
Esther van Puffelen, Jessie M Hulst, Ilse Vanhorebeek, Karolijn Dulfer, Greet Van den Berghe, Sascha C A T Verbruggen, Koen F M Joosten
Importance: Undernourishment has been associated with poor outcomes of critical illness in children. The effects of withholding parenteral nutrition (PN) for 1 week in undernourished critically ill children are unknown. Objective: To assess the outcome effects of withholding PN for 1 week in undernourished critically ill children. Design, Setting, and Participants: This is a subanalysis of the randomized clinical trial Pediatric Early vs Late Parenteral Nutrition in Intensive Care Unit (PEPaNIC; N = 1440), which focused on the subgroup of pediatric intensive care unit (PICU) patients identified as undernourished on admission...
September 7, 2018: JAMA network open
Tessie W October, Zoelle B Dizon, Robert M Arnold, Abby R Rosenberg
Importance: Pediatric intensive care unit care conferences often involve high-stakes decisions regarding critically ill children, resulting in strong family emotions. Families often report the need for physician empathy. Objective: To evaluate the characteristics of physician empathetic statements during pediatric intensive care unit care conferences. Design, Setting, and Participants: In this single-center, cross-sectional, qualitative phenomenology study, 68 transcripts of audio-recorded care conferences were analyzed from an urban, quaternary medical center from January 3, 2013, to January 5, 2017...
July 6, 2018: JAMA network open
Ozden Ozgur Horoz, Dincer Yildizdas, Yusuf Sari, Ilker Unal, Faruk Ekinci, Ercument Petmezci
PURPOSE: To the best of our knowledge, in the literature, there is no data regarding clinical utility of the abdominal perfusion pressure (APP) in critically ill children. Thus, in the present study, we aimed to investigate the clinical utility of APP in predicting of survival in critically ill children with IAH. DESIGN: A prospective cohort study of patients between 1 month to 18 years who had risk for intra-abdominal hypertension from June 2013 to January 2014...
December 13, 2018: Journal of Pediatric Surgery
Jolanda M Maaskant, Marieke A Tio, Reinier M van Hest, Hester Vermeulen, Vincent G M Geukers
Objective: Medication errors (MEs) are one of the most frequently occurring types of adverse events in hospitalized patients and potentially more harmful in children than in adults. To increase medication safety, we studied the effect of structured medication audit and feedback by a clinical pharmacist as part of the multidisciplinary team, on MEs in critically ill children. Method: We performed an interrupted time series analysis with 6 preintervention and 6 postintervention data collection points, in a tertiary pediatric intensive care unit...
March 2018: Health science reports
Shaodong Zhao, Xuhua Ge, Penghong Xu, Yong Liu, Jun Shi, Hongjun Miao
OBJECTIVE: To explore the clinical application value of the continuous blood purification (CBP) technology in pediatric intensive care unit (ICU). METHODS: A retrospective study was conducted. All CBP patients admitted to pediatric ICU of Children's Hospital of Nanjing Medical University from 2015 to 2017 were enrolled. The disease diagnosis, CBP treatment mode, catheter placement, anticoagulation way, treatment time and adverse reactions were summarized and analyzed...
December 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Holly L Spraker-Perlman, Reena P Tam, Tyler Bardsley, Jacob Wilkes, Leah Farley, Dominic Moore, Joan Sheetz, Justin N Baker
BACKGROUND: The impact of pediatric palliative care (PPC) is well established for children with chronic complex diseases. However, PPC likely also benefits previously healthy children with acute life-threatening conditions. OBJECTIVE: To determine the incidence and impact of PPC for previously healthy patients who died in a pediatric hospital. DESIGN: Retrospective chart review of all pediatric deaths over four years. SETTING/SUBJECTS: Patients were 0 to 25 years old, died during an inpatient stay at an academic pediatric hospital ≥48 hours after admission, and had no complex chronic conditions (CCCs) before admission...
December 27, 2018: Journal of Palliative Medicine
Sukla Samaddar, Jhuma Sankar, Sushil Kumar Kabra, Rakesh Lodha
OBJECTIVE: To study the association of fluid overload with mortality and morbidity in critically-ill mechanically ventilated children. DESIGN: Prospective observational study. SETTING: Pediatric Intensive Care Unit (PICU) of a tertiary care hospital, New Delhi, India. PARTICIPANTS: 118 children (age 1 mo - 15 y) requiring mechanical ventilation. OUTCOME MEASURES: Primary: Association of fluid overload with mortality...
November 15, 2018: Indian Pediatrics
Charlotte Z Woods-Hill, Laura Lee, Anping Xie, Anne F King, Annie Voskertchian, Sybil A Klaus, Michelle M Smith, Marlene R Miller, Elizabeth A Colantuoni, James C Fackler, Aaron M Milstone
Introduction: Single center work demonstrated a safe reduction in unnecessary blood culture use in critically ill children. Our objective was to develop and implement a customizable quality improvement framework to reduce unnecessary blood culture testing in critically ill children across diverse clinical settings and various institutions. Methods: Three pediatric intensive care units (14 bed medical/cardiac; 28 bed medical; 22 bed cardiac) in 2 institutions adapted and implemented a 5-part Blood Culture Improvement Framework, supported by a coordinating multidisciplinary team...
September 2018: Pediatric Quality & Safety
Marshall A Ahearn, Danielle E Soranno, Timothy Stidham, Jennifer Lusk, Katja M Gist
Background: Fluid is central to the resuscitation of critically ill children. However, many pay limited attention to continued fluid accumulation. Fluid overload (FO) is associated with significant morbidity and mortality. The Volume Status Awareness Program (VSAP) is a multi-phase quality improvement initiative aimed at reducing iatrogenic FO. For baseline data, the authors examined a retrospective cohort of patients admitted to the pediatric intensive care unit. Methods: Cohort included diuretic-naive patients admitted to the pediatric intensive care unit at a tertiary care children's hospital in 2014...
September 2018: Pediatric Quality & Safety
Margaret J Kihlstrom, Ashley P Edge, Kelly M Cherry, Paul J Zarick, Shawna D Beck, Jenny M Boyd
Introduction: The Richmond Agitation-sedation Scale (RASS) is a reliable and valid scale for assessing sedation in critically ill pediatric patients. This investigation evaluates the inter-rater reliability of the RASS in mechanically ventilated pediatric patients before and after an educational intervention. Methods: This prospective, interventional quality improvement study was completed in a 20-bed pediatric intensive care unit from July 2013 to July 2014. Children 0-18 years of age requiring mechanical ventilation and receiving sedative or analgesic medications were eligible...
September 2018: Pediatric Quality & Safety
Jennifer M Lavin, Craig Smith, Zena Leah Harris, Dana M Thompson
OBJECTIVE: Children at high risk for respiratory complication after adenotonsillectomy are often admitted to a pediatric intensive care unit (PICU) postoperatively. Although many patients receive care in such units, it is unknown how many utilize critical care resources. METHODS: A review was conducted to audit intensive care needs of postadenotonsillectomy patients admitted to the PICU at a tertiary, academic, pediatric hospital between July 2013, and March 2017...
December 24, 2018: Laryngoscope
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