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Lin N, Lv M, Li S, Xiang Y, Li J, Xu H. A nomogram for predicting postoperative delirium in pediatric patients following cardiopulmonary bypass: A prospective observational study. Intensive Crit Care Nurs 2024; 83:103717. [PMID: 38692080 DOI: 10.1016/j.iccn.2024.103717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 04/17/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To create a nomogram for early delirium detection in pediatric patients following cardiopulmonary bypass. RESEARCH METHODOLOGY/DESIGN This prospective, observational study was conducted in the Cardiac Intensive Care Unit at a Children's Hospital, enrolling 501 pediatric patients from February 2022 to January 2023. Perioperative data were systematically collected through the hospital information system. Postoperative delirium was assessed using the Cornell Assessment of Pediatric Delirium (CAPD). For model development, Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed to identify the most relevant predictors. These selected predictors were then incorporated into a multivariable logistic regression model to construct the predictive nomogram. The performance of the model was evaluated by Harrell's concordance index, receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. External validity of the model was confirmed through the C-index and calibration plots. RESULTS Five independent predictors were identified: age, SpO2 levels, lymphocyte count, diuretic use, and midazolam administration, integrated into a predictive nomogram. This nomogram demonstrated strong predictive capacity (AUC 0.816, concordance index 0.815) with good model fit (Hosmer-Lemeshow test p = 0.826) and high accuracy. Decision curve analysis showed a significant net benefit, and external validation confirmed the nomogram's reliability. CONCLUSIONS The study successfully developed a precise and effective nomogram for identifying pediatric patients at high risk of post-cardiopulmonary bypass delirium, incorporating age, SpO2 levels, lymphocyte counts, diuretic use, and midazolam medication. IMPLICATIONS FOR CLINICAL PRACTICE This nomogram aids early delirium detection and prevention in critically ill children, improving clinical decisions and treatment optimization. It enables precise monitoring and tailored medication strategies, significantly contributes to reducing the incidence of delirium, thereby enhancing the overall quality of patient care.
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Affiliation(s)
- Nan Lin
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Meng Lv
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Shujun Li
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yujun Xiang
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Jiahuan Li
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Hongzhen Xu
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
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Hannan KE, Bourque SL, Ross E, Wymore EM, Kinsella JP, Mandell EW, Houin SS. Successful and Rapid Reduction in Neurosedative and Analgesic Medications in Complex Infants with Severe Bronchopulmonary Dysplasia After Tracheostomy Placement: Experience with 24-hour Propofol Infusions. J Pediatr 2024; 270:114040. [PMID: 38554746 DOI: 10.1016/j.jpeds.2024.114040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Infants with severe bronchopulmonary dysplasia may require high doses of neurosedative medications to ensure pain control and stability following tracheostomy placement. Subsequent weaning of these medications safely and rapidly is a challenge. We describe a 24-hour propofol infusion to reduce neurosedative medications in 3 high-risk infants following tracheostomy placement.
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Affiliation(s)
- Kathleen E Hannan
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
| | - Stephanie L Bourque
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Emma Ross
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Erica M Wymore
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - John P Kinsella
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Erica W Mandell
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Satya S Houin
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Savino T, Vergara FH, Ramos MD, Warzecha D. Bringing Delirium to Light: Impact of CAM-ICU Tool to Improve Care Coordination. Prof Case Manag 2024; 29:149-157. [PMID: 38421724 DOI: 10.1097/ncm.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Delirium is a serious complication in patients in the critical care unit (CCU) that may lead to prolonged hospitalization if left undetected. The CCU at our hospital does not have a framework for determining delirium that could affect patient outcomes and discharge planning. PRIMARY PRACTICE SETTING CCU in a community hospital. METHOD A posttest-only design was used for this study. We established a framework for the early assessment of delirium, educated and trained nurses to detect delirium, collaborated with the informatics department, intensivist, nursing, respiratory therapy and worked with case management to deploy the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We used a one-tailed independent t test to determine the impact of CAM-ICU on length of stay (LOS). Cross-tabulation and chi-square tests were used to examine the impact of CAM-ICU tool on home care utilization between the intervention and comparison groups. RESULTS There was a 3.12% reduction in LOS after implementing the CAM-ICU tool. Also, a reduction in home care service utilization demonstrated statistical significance ( p = .001) between the intervention group (62.5%; n = 177) and the comparison group (37.5%; n = 106). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Case managers are essential in improving care transitions. Case managers need to become competent in understanding the implications of the CAM-ICU tool because of their relevant role in the multidisciplinary rounds as advocates to improve care transitions across the continuum of care. Case managers need to have an understanding on how to escalate when changes in the Richmond Agitation-Sedation Scale scores occur during the multidisciplinary rounds because it can affect care coordination throughout the hospital. CONCLUSIONS Implementing the CAM-ICU decreased LOS, and reduced health care utilization. The early identification of patients with delirium can affect the outcomes of critically ill patients and entails multidisciplinary collaboration.
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Affiliation(s)
- Theresa Savino
- Theresa Savino, DNP, RN, CPHQ, CPXP, FNAHQ, is Director of Service Excellence and Patient Experience at Middlesex Health, Middletown, Connecticut. She is also an adjunct nursing faculty member at the University of Connecticut
- Franz H. Vergara, PhD, DNP, MAS, RN, CENP, CCM, ONC, is Senior Director of Nursing Operations and Patient Care Services at MedStar Harbor Hospital, Baltimore, Maryland. He served as the school capstone chairman and supervising faculty of Dr. Savino
- Mary Dioise Ramos, PhD, RN, CNE, is Associate Professor and Interim Director of Graduate Programs, Wellstar College of Health and Human Services, Kennesaw State University, Georgia
- Deborah Warzecha, DNP, RN, NEA-BC, CEN, is Director of Nursing at Middlesex Health, Middletown, Connecticut. She served as the preceptor for Dr. Savino during her doctorate program
| | - Franz H Vergara
- Theresa Savino, DNP, RN, CPHQ, CPXP, FNAHQ, is Director of Service Excellence and Patient Experience at Middlesex Health, Middletown, Connecticut. She is also an adjunct nursing faculty member at the University of Connecticut
- Franz H. Vergara, PhD, DNP, MAS, RN, CENP, CCM, ONC, is Senior Director of Nursing Operations and Patient Care Services at MedStar Harbor Hospital, Baltimore, Maryland. He served as the school capstone chairman and supervising faculty of Dr. Savino
- Mary Dioise Ramos, PhD, RN, CNE, is Associate Professor and Interim Director of Graduate Programs, Wellstar College of Health and Human Services, Kennesaw State University, Georgia
- Deborah Warzecha, DNP, RN, NEA-BC, CEN, is Director of Nursing at Middlesex Health, Middletown, Connecticut. She served as the preceptor for Dr. Savino during her doctorate program
| | - Mary Dioise Ramos
- Theresa Savino, DNP, RN, CPHQ, CPXP, FNAHQ, is Director of Service Excellence and Patient Experience at Middlesex Health, Middletown, Connecticut. She is also an adjunct nursing faculty member at the University of Connecticut
- Franz H. Vergara, PhD, DNP, MAS, RN, CENP, CCM, ONC, is Senior Director of Nursing Operations and Patient Care Services at MedStar Harbor Hospital, Baltimore, Maryland. He served as the school capstone chairman and supervising faculty of Dr. Savino
- Mary Dioise Ramos, PhD, RN, CNE, is Associate Professor and Interim Director of Graduate Programs, Wellstar College of Health and Human Services, Kennesaw State University, Georgia
- Deborah Warzecha, DNP, RN, NEA-BC, CEN, is Director of Nursing at Middlesex Health, Middletown, Connecticut. She served as the preceptor for Dr. Savino during her doctorate program
| | - Deborah Warzecha
- Theresa Savino, DNP, RN, CPHQ, CPXP, FNAHQ, is Director of Service Excellence and Patient Experience at Middlesex Health, Middletown, Connecticut. She is also an adjunct nursing faculty member at the University of Connecticut
- Franz H. Vergara, PhD, DNP, MAS, RN, CENP, CCM, ONC, is Senior Director of Nursing Operations and Patient Care Services at MedStar Harbor Hospital, Baltimore, Maryland. He served as the school capstone chairman and supervising faculty of Dr. Savino
- Mary Dioise Ramos, PhD, RN, CNE, is Associate Professor and Interim Director of Graduate Programs, Wellstar College of Health and Human Services, Kennesaw State University, Georgia
- Deborah Warzecha, DNP, RN, NEA-BC, CEN, is Director of Nursing at Middlesex Health, Middletown, Connecticut. She served as the preceptor for Dr. Savino during her doctorate program
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Åkerman S, Axelin A, Traube C, Frithiof R, Thernström Blomqvist Y. Adapting the Cornell assessment of pediatric delirium for Swedish context: translation, cultural validation and inter-rater reliability. BMC Pediatr 2024; 24:413. [PMID: 38926708 PMCID: PMC11202322 DOI: 10.1186/s12887-024-04886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Pediatric delirium causes prolonged hospital stays, increased costs, and distress for children and caregivers. Currently, there is no delirium screening tool available in Sweden that has been translated, culturally validated, and tested for reliability. This study aimed to translate, culturally adapt, and assess the suitability of the Cornell Assessment of Pediatric Delirium (CAPD) for implementation in Swedish healthcare settings. METHODS The CAPD was translated and culturally adapted to Swedish context following the ten-step process recommended by the International Society for Pharmacoeconomics and Outcomes Task Force for Translation and Cultural Adaptation. The Swedish CAPD was tested in the pediatric intensive care unit of Uppsala University Hospital, a tertiary hospital in Sweden. Inter-rater reliability was tested using intraclass correlation coefficient (ICC), with both Registered Nurses (RNs) and Assistant Nurses (ANs) conducting parallel measurements using the Swedish CAPD. A reliability score of ICC > 0.75 was considered indicative of good reliability. RESULTS After translation of the CAPD into Swedish, 10 RNs participated in the cultural adaptation process. Issues related to word choice, education, and instructions were addressed. Wording improvements were made to ensure accurate interpretation. Supplementary training sessions were organized to strengthen users' proficiency with the Swedish CAPD. Additional instructions were provided to enhance clarity and usability. Inter-rater reliability testing resulted in an ICC of 0.857 (95% CI: 0.708-0.930), indicating good reliability. CONCLUSION This study successfully translated and culturally adapted the CAPD to align with Swedish contextual parameters. The resulting Swedish CAPD demonstrated good inter-rater reliability, establishing its viability as a tool for measuring delirium among pediatric patients in Swedish pediatric intensive care units. TRAIL REGISTRATION Not applicable.
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Affiliation(s)
- Sara Åkerman
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
- Uppsala Centre for Paediatric Anaesthesia and Intensive Care Research, Uppsala, Sweden.
| | - Anna Axelin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Chani Traube
- Department of Pediatrics, Weill Cornell Medical Center, New York, NY, USA
| | - Robert Frithiof
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Centre for Paediatric Anaesthesia and Intensive Care Research, Uppsala, Sweden
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Wiencek C. Palliative Care in the Intensive Care Unit: The Standard of Care. AACN Adv Crit Care 2024; 35:112-124. [PMID: 38848570 DOI: 10.4037/aacnacc2024525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Intensive care unit-based palliative care has evolved over the past 30 years due to the efforts of clinicians, researchers, and advocates for patient-centered care. Although all critically ill patients inherently have palliative care needs, the path was not linear but rather filled with the challenges of blending the intensive care unit goals of aggressive treatment and cure with the palliative care goals of symptom management and quality of life. Today, palliative care is considered an essential component of high-quality critical care and a core competency of all critical care nurses, advanced practice nurses, and other intensive care unit clinicians. This article provides an overview of the current state of intensive care unit-based palliative care, examines how the barriers to such care have shifted, reviews primary and specialist palliative care, addresses the impact of COVID-19, and presents resources to help nurses and intensive care unit teams achieve optimal outcomes.
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Affiliation(s)
- Clareen Wiencek
- Clareen Wiencek is Professor of Nursing, University of Virginia School of Nursing, 202 Jeanette Lancaster Way, Charlottesville, VA 22908
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6
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Salotagi S, Jindal A. Beyond opioids: revisiting pain management in post cardiac surgery infants. Crit Care 2024; 28:193. [PMID: 38849911 PMCID: PMC11157770 DOI: 10.1186/s13054-024-04983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Siddannagoud Salotagi
- Division of Pediatric Pulmonology and Critical Care, Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India
| | - Atul Jindal
- Division of Pediatric Pulmonology and Critical Care, Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India.
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Azamfirei R, Behrens D, Padilla S, Madden K, Goldberg S, Geno M, Manning MJ, Piole M, Madsen E, Maue D, Abu-Sultaneh S, Awojoodu R, Wang NY, Needham DM, Neufeld K, Kudchadkar SR. Delirium Screening in Critically Ill Children: Secondary Analysis of the Multicenter PICU Up! Pilot Trial Dataset, 2019-2020. Pediatr Crit Care Med 2024:00130478-990000000-00350. [PMID: 38832837 DOI: 10.1097/pcc.0000000000003555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVES To determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices. DESIGN A secondary analysis of 2019-2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168). SETTING Six PICUs in the United States. PATIENTS One thousand sixty-four patients who were admitted to a PICU for 3 or more days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 1064 patients, 74% (95% CI, 71-76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1-3 days (aOR 3.36 [95% CI, 2.62-4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32-2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04-1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08-2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63-0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63-0.90]) or ketamine (aOR 0.48 [95% CI, 0.29-0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates. CONCLUSIONS In the 2019-2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.
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Affiliation(s)
- Razvan Azamfirei
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania
| | - Deanna Behrens
- Pediatric Critical Care, Advocate Children's Hospital, Park Ridge, IL
| | - Sofia Padilla
- Pediatric Critical Care, Advocate Children's Hospital, Park Ridge, IL
| | - Kate Madden
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Sarah Goldberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Megan Geno
- Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, MA
| | | | - Michelle Piole
- Division of Pediatric Critical Care, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Erik Madsen
- Division of Pediatric Critical Care, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Danielle Maue
- Division of Pediatric Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Samer Abu-Sultaneh
- Division of Pediatric Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Ronke Awojoodu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Departments of Biostatistics and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Dale M Needham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Departments of Biostatistics and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
- Outcomes after Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karin Neufeld
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
- Outcomes after Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD
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Shah S, Kaul A, Nagarkar R, Thorat A. Comparison of invasive blood pressure monitoring vs. non-invasive blood pressure monitoring in critically ill children receiving vasoactive agents-a prospective observational study. Front Pediatr 2024; 12:1376327. [PMID: 38887566 PMCID: PMC11181160 DOI: 10.3389/fped.2024.1376327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
Objective The primary aim of this study was to compare non-invasive blood pressure (NIBP) measurement using the automated oscillometric method with invasive blood pressure (IBP) measurement using peripheral arterial line insertion in critically ill children receiving vasoactive agents. Design Single-centre, prospective cohort study. Setting Tertiary care 15 bedded Pediatric ICU in Urban Indian city. Subjects All critically ill children between the ages of 1 month to 16 years with shock on vasoactive medications and with IBP monitoring. Results Forty children with 1,072 paired BP measurements were incorporated in the final analysis. Among all normotensive children (Total number of paired measurements = 623) receiving vasoactive agents, Bland-Altman analysis revealed an acceptable agreement between Invasive mean blood pressure (MBP) and non-invasive MBP with a bias of -2.10 mmHg (SD 11.35). The 95% limits of agreement were from -24.34 to 20.14 mmHg. In children with hypotension (Total number of paired measurements = 449), Bland-Altman analysis showed disagreement between Invasive MBP and non-invasive MBP i.e., a bias of -8.44 mmHg (SD 9.62). The 95% limits of agreement were from -27.29 to 10.41 mmHg. Conclusion A limited agreement exists between invasive blood pressure (IBP) and non-invasive blood pressure (NIBP) measurements in critically ill children requiring vasoactive agents. This discrepancy can lead to either an underestimation or an overestimation of blood pressure. While NIBP can serve as a screening tool for hemodynamically stable children, those who are hemodynamically unstable and necessitate the initiation of vasoactive agents should undergo IBP monitoring.
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Affiliation(s)
- Sachin Shah
- Department of Neonatal and Pediatric Intensive Care Services, Surya Mother and Child Superspecialty Hospital, Pune, India
| | - Amita Kaul
- Department of Neonatal and Pediatric Intensive Care Services, Surya Mother and Child Superspecialty Hospital, Pune, India
| | - Rohini Nagarkar
- Department of Pediatrics, Surya Mother and Child Superspecialty Hospital, Pune, India
| | - Amol Thorat
- Department of Pediatrics, Surya Mother and Child Superspecialty Hospital, Pune, India
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Castro REVD, Medeiros DNM, Murupudi N, de Magalhães-Barbosa MC, Prata-Barbosa A, Kawai Y. About Acute Disorders of Consciousness in Pediatric Severe Sepsis and Organ Failure. Pediatr Crit Care Med 2024; 25:e310-e311. [PMID: 38836716 DOI: 10.1097/pcc.0000000000003443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Roberta Esteves Vieira de Castro
- Pediatric Intensive Care Unit, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
- Department of Pediatrics, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | | | - Neelima Murupudi
- Pediatric Intensive Care Unit, University of Chicago, Chicago, IL
| | | | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Yu Kawai
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Critical Care, Mayo Clinic, Rochester, MN
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10
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Choong K, Fraser DD, Cameron S, Cuello C, Debigaré S, Ewusie J, Kho ME, Krasevich K, Martin CM, Thabane L, Todt A, Cupido C. Post-Intensive Care Sequelae in Pediatrics-Results of an Early Rehabilitation Implementation Study. Pediatr Crit Care Med 2024; 25:563-568. [PMID: 38305699 DOI: 10.1097/pcc.0000000000003467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To compare post-PICU discharge functioning, health-related quality of life (HRQL), and parental stress before and after the implementation of an early rehabilitation bundle. DESIGN AND SETTING Prospective cohort substudy within an early rehabilitation implementation program, conducted at the PICUs at McMaster Children's Hospital and London Health Sciences, London, Ontario, Canada. INTERVENTIONS A bundle consisting of: 1) analgesia-first sedation; 2) delirium monitoring and prevention; and 3) early mobilization. Patients with an anticipated 48-hour PICU length of stay were approached for consent to participate. PATIENTS Critically ill children with an anticipated 48-hour PICU length of stay were approached for consent to participate. MEASUREMENTS AND MAIN RESULTS Patient-/proxy-reported outcome measures were assessed at baseline, PICU discharge, and 1 and 3 months post-PICU discharge using: 1) Pediatric Evaluation of Disability Inventory Computer Adaptive Test to assess physical, social, cognitive, and responsibility/caregiver domains of functioning; 2) KIDSCREEN to assess HRQL; and 3) the Pediatric Inventory for Parents to assess caregiver stress. A total of 117 participants were enrolled. Patient demographic characteristics were similar in the pre- and post-intervention groups. Following bundle implementation, 30 of 47 respondents (63.8%) experienced functional decline and 18 of 45 (40%) experienced low HRQL at PICU discharge. Eighteen of 36 (50%) at 1 month and 14 of 38 (36.8%) at 3 months experienced either persistent functional decline and/or low HRQL; 2.8% and 2.6% at 1- and 3-month follow-up, respectively, experienced both persistent functional decline and low HRQL. There were no significant differences in the rates of persistent functional decline, low HRQL, or caregiver stress scores post-bundle compared with pre-rehabilitation bundle implementation. CONCLUSIONS We were unable to adequately determine the efficacy of a rehabilitation bundle on patient-centered outcomes as this substudy was not powered for these outcomes. Our results did reveal that persistent low functioning is common in PICU survivors, more common than low HRQL, while experiencing both functional decline and low HRQL was uncommon.
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Affiliation(s)
- Karen Choong
- Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Douglas D Fraser
- Division of Critical Care, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Saoirse Cameron
- Lawson Health Research Institute, Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Carlos Cuello
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sylvie Debigaré
- Family Partner, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Joycelyne Ewusie
- The Research Institute, Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Kimberley Krasevich
- Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Claudio M Martin
- Division of Critical Care, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Ashley Todt
- Family Partner, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Cynthia Cupido
- Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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11
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Rohmah I, Chen YC, Lin CJ, Tsao NH, Chiu HY. Diagnostic accuracy of the pediatric CAM-ICU, pre-school CAM-ICU, Pediatric Anesthesia Emergence Delirium and Cornell Assessment of Pediatric Delirium for detecting delirium in the pediatric intensive care unit: A systematic review and meta-analysis. Intensive Crit Care Nurs 2024; 82:103606. [PMID: 38158251 DOI: 10.1016/j.iccn.2023.103606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Delirium is a frequent complication of critical illness, affecting 34% of children admitted to pediatric intensive care units. The commonly used tools for detecting delirium in the pediatric intensive care unit include the Pediatric Confusion Assessment Method for the intensive care unit (ICU, pCAM-ICU), Preschool Confusion Assessment Method for the ICU (psCAM-ICU), Pediatric Anesthesia Emergence Delirium and the Cornell Assessment of Pediatric Delirium. DATA SOURCES We searched four electronic databases for relevant articles from inception to March 1, 2023. STUDY SELECTION All full-text observational studies examining the sensitivity and specificity of the four tools for screening delirium in the pediatric intensive care units were included. DATA EXTRACTION Two researchers independently identified articles, extracted data, and retrieved the diagnostic accuracy parameters of the pediatric CAM-ICU, pre-school CAM-ICU, Pediatric Anesthesia Emergence Delirium, and Cornell Assessment of Pediatric Delirium relative to standard references. A bivariate diagnostic statistical analysis with a random-effects model was performed. DATA SYNTHESIS Four, five, three and seven studies on the pediatric CAM-ICU, pre-school CAM-ICU, Pediatric Anesthesia Emergence Delirium, and Cornell Assessment of Pediatric Delirium, respectively, were identified. Due to the limited number of Pediatric Anesthesia Emergence Delirium articles included, no pooled diagnostic accuracy was produced. The pooled sensitivity was 0.73, 0.84, and 0.95 for the pediatric CAM-ICU, pre-school CAM-ICU, and Cornell Assessment of Pediatric Delirium, respectively, whereas the pooled specificity was 0.98, 0.90, and 0.81, respectively. The Cornell Assessment of Pediatric Delirium had greater sensitivity compared to both the pediatric CAM-ICU and pre-school CAM-ICU (both p = 0.04) and lower specificity than the pediatric CAM-ICU did (p < 0.001). Age, sample size, and mechanical ventilation use were significant moderators of the specificity of the pediatric CAM-ICU (p < 0.001, <0.001, and = 0.001, respectively). CONCLUSIONS Our data indicate that the Cornell Assessment of Pediatric Delirium is a more dependable instrument than the pediatric CAM-ICU and pre-school CAM-ICU for detecting pediatric intensive care delirium occurrence. More studies on the Pediatric Anesthesia Emergence Delirium are warranted. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare providers are suggested adopting the Cornell Assessment of Pediatric Delirium into daily routine for the early detection of delirium in pediatric intensive care units.
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Affiliation(s)
| | - Yi-Chen Chen
- School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chia-Jou Lin
- School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Nan-Hsuan Tsao
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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12
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Groman A, Spyhalsky A, Michienzi K, Breuer R. Impact of Intravenous Methadone Dosing Schedule on Iatrogenic Withdrawal Syndrome in a Pediatric Intensive Care Unit. J Pediatr Pharmacol Ther 2024; 29:266-272. [PMID: 38863852 PMCID: PMC11163900 DOI: 10.5863/1551-6776-29.3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/14/2023] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To compare median Sophia Observation withdrawal Symptoms scale (SOS) scores between -intravenous methadone dosing scheduled every 6 hours or every 8 hours for iatrogenic withdrawal -syndrome (IWS). METHODS This single-center, retrospective chart review evaluated patients aged 4 weeks through 18 years treated with intravenous methadone for IWS. Children admitted to the pediatric intensive care unit (PICU) of a tertiary care children's hospital between August 2017 and July 2021 and treated for IWS for at least 48 hours were eligible for inclusion. Methadone dosing schedules were compared, with a primary outcome of median Sophia Observation withdrawal Symptoms (SOS) score during the first 24 hours after cessation of continuous fentanyl infusion. Secondary outcomes included PICU and general pediatric unit lengths of stay, extubation failure rates, and mortality. RESULTS Twenty patients met inclusion criteria, with 9 in the 6-hour dosing group. There was no difference in median SOS score, extubation failure, length of stay, or mortality between the 2 groups. CONCLUSIONS During the first 24 hours after cessation of continuous fentanyl, there appears to be no -difference in IWS severity, as determined by bedside nurse scoring, between patients treated with -intravenous methadone every 6 hours compared with every 8 hours.
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Affiliation(s)
- Aleah Groman
- Department of Pharmacy (AG, AS, KM), Kaleida Health John R. Oishei Children’s Hospital, Buffalo, NY
| | - Autumn Spyhalsky
- Department of Pharmacy (AG, AS, KM), Kaleida Health John R. Oishei Children’s Hospital, Buffalo, NY
- PharmD Candidate (AS), State University of New York at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, anticipated graduation 2024
| | - Kelly Michienzi
- Department of Pharmacy (AG, AS, KM), Kaleida Health John R. Oishei Children’s Hospital, Buffalo, NY
| | - Ryan Breuer
- Department of Pediatrics (RB), UBMD Physicians Group, Buffalo, NY
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13
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Gargadennec T, Le Bot S, Caillard A. Unveiling clarity: Assessing tools for delirium in the pediatric intensive care unit. Intensive Crit Care Nurs 2024; 82:103641. [PMID: 38354547 DOI: 10.1016/j.iccn.2024.103641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Thomas Gargadennec
- Département d'Anesthésie et Réanimation Chirurgicale, Centre Hospitalier Universitaire de, Brest, Brest, France.
| | - Sophie Le Bot
- Département d'Anesthésie et Réanimation Chirurgicale, Centre Hospitalier Universitaire de, Brest, Brest, France
| | - Anaïs Caillard
- Département d'Anesthésie et Réanimation Chirurgicale, Centre Hospitalier Universitaire de, Brest, Brest, France; Université de Bretagne Occidentale, Laboratoire ORPHY EA 4324, Brest, France
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14
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McCudden A, Valdivia HR, Di Gennaro JL, Berika L, Zimmerman J, Dervan LA. Barriers to Implementing the ICU Liberation Bundle in a Single-center Pediatric and Cardiac ICUs. J Intensive Care Med 2024; 39:558-566. [PMID: 38105529 DOI: 10.1177/08850666231220558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Objectives: The intensive care unit (ICU) Liberation "ABCDEF" Bundle improves outcomes in critically ill adults. We aimed to identify common barriers to Pediatric ICU Liberation Bundle element implementation, to describe differences in barrier perception by ICU staff role, and to describe changes in reported barriers over time. Study Design: A 91-item survey was developed based on existing literature, iteratively revised, and tested by the PICU Liberation Committee at Seattle Children's Hospital, a tertiary free-standing academic children's hospital. Voluntary surveys were administered electronically to all ICU staff twice over 4-week periods in 2017 and 2020. Survey Respondents: 119 (2017) and 163 (2020) pediatric and cardiac ICU staff, including nurses (n = 142, 50%), respiratory therapists (RTs) (n = 46, 16%), attending and fellow physicians, hospitalists, and advanced practice providers (APPs) (n = 62, 22%), physical, occupational, and speech-language pathology therapists (n = 25, 9%), and pharmacists (n = 7, 2%). Measurements and Main Results: Respondents widely agreed that increased workload (78%-100% across roles), communication (53%-84%), and lack of RT-directed ventilator weaning (68%-88%) are barriers to implementation. Other barriers differed by role. In 2020, nurses reported liability (59%) and personal injury (68%) concerns, patient severity of illness (24%), and family discomfort with ICU liberation practices (41%) more frequently than physicians and APPs (16%, 6%, 8%, and 19%, respectively; P < .01 for all). Between 2017 and 2020, some barriers changed: RTs endorsed discomfort with early mobilization less frequently (50% vs 11%, P = .028) and nurses reported concern for patient harm less frequently (51% vs 24%, P = .004). Conclusions: Implementation efforts aimed at addressing known barriers, including educating staff on the safety of early mobility, considering respiratory therapist-directed ventilator weaning, and standardizing interdisciplinary discussion of Pediatric ICU Liberation Bundle elements, will be needed to overcome barriers and improve ICU Liberation Bundle implementation.
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Affiliation(s)
- Anna McCudden
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Hector R Valdivia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Jane L Di Gennaro
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Lina Berika
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Jerry Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Leslie A Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
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15
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Mondardini MC, Pezzato S, Meneghini L, Agostiniani R, De Cassai A, D'Errico I, Minardi C, Sagredini R, Sbaraglia F, Testoni C, Toni F, Vason M, Amigoni A. Procedural sedation and analgesia in pediatric diagnostic and interventional radiology: An expert DELPHI consensus document developed by the ITALIAN scientific society of anesthesia, analgesia, resuscitation and intensive care (SIAARTI). Paediatr Anaesth 2024. [PMID: 38808388 DOI: 10.1111/pan.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Children undergoing diagnostic and interventional radiology procedures often require sedation to achieve immobility and analgesia if the procedure is painful. In the past decades, leading scientific organizations have developed evidence-based guidelines for procedural sedation and analgesia in children outside of the operating room. Their recommendations are being applied to procedural sedation in radiology. However, some questions remain open regarding specific aspects contextualized to the radiology setting, such as elective prone sedation, the urgency of the procedure, when venous access or airway protection is required, and others. AIMS To address the unresolved issues of procedural sedation and analgesia in pediatric diagnostic and interventional radiology. METHODS An expert panel of pediatricians, pediatric anesthesiologists, intensivists, and neuroradiologists selected topics representative of current controversies and formulated research questions. Statements were developed by reviewing the literature for new evidence, comparing expertise and experience, and expressing opinions. Panelists' agreement with the statements was collected anonymously using the DELPHI method. RESULTS Twelve evidence-based or expert opinion incorporate are presented, considering risks, benefits, and applicability. CONCLUSIONS This consensus document, developed by a multidisciplinary panel of experts involved in the field, provides statements to improve the quality of decision-making practice in procedural sedation and analgesia in pediatric radiology.
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Affiliation(s)
| | - Stefano Pezzato
- Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luisa Meneghini
- Department of Pediatric Surgery, University Hospital of Padova, Padova, Italy
| | | | - Alessandro De Cassai
- Department of Medicine, Anaesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Ignazio D'Errico
- Department of Neuroradiology, University Hospital of Padova, Padova, Italy
| | - Carmelo Minardi
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Raffaella Sagredini
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Fabio Sbaraglia
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Gemelli IRCCS, Sacro Cuore Catholic University, Rome, Italy
| | - Caterina Testoni
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Toni
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Milo Vason
- Department of Emergency, Anaesthesiology and Intensive Care Unit, Arcispedale Sant'Anna, University of Ferrara, Cona, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, University Hospital of Padova, Padova, Italy
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Patel S, Pfeiffer B, Haddock De Jesus R, Garcia J, Chandar J, Alladin A. Postoperative Delirium Screening Characteristics in Pediatric Intestinal, Liver, and Renal Transplant Recipients: Single-Center Retrospective Cohort Study. Pediatr Crit Care Med 2024:00130478-990000000-00348. [PMID: 38801303 DOI: 10.1097/pcc.0000000000003540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To describe and compare the results of delirium screening in the immediate post-transplant PICU admission for pediatric intestinal, liver, and renal transplant recipients. We also examined associations with known and suspected risk factors for pediatric delirium (PD). DESIGN Retrospective analysis of a single-center cohort, 2016-2022. SETTING Twenty-four-bed PICU in a high-volume transplant center. PATIENTS All intestinal, liver, and renal transplant recipients under 23 years old admitted between July 2016 and August 2022. MEASUREMENTS AND MAIN RESULTS We identified 211 pediatric transplant recipients: intestinal (n = 36), liver (n = 78), and renal (n = 97). Results of the Cornell Assessment for PD during the immediate post-transplant PICU admission were reviewed and patients were categorized into screen positive, screen negative, and unscreened. Corresponding data on known and suspected risk factors for PD were also collected. Data on delirium subtypes were not collected. Screens were available for 156 of 211 patients (74%) who were included in the final analysis. The prevalence of a positive screen by transplant category was: intestine 80% (24/30), liver 75% (47/63), and renal 14% (9/63). A positive screen was associated with younger age, greater duration of mechanical ventilation, and greater PICU length of stay (LOS) in bivariate analysis. In multivariable analysis, age and PICU LOS remained strongly correlated with a positive screen (p < 0.05). Deep sedation and agitation as categorized by the State Behavioral Scale was associated with a positive screen, as was significant iatrogenic withdrawal symptoms (p < 0.05). Most patients screened positive by post-transplant days 2 and 3 (58/80 [72%] and 64/80 [80%], respectively). CONCLUSIONS In our 2016 to 2022 experience, we found a high prevalence of positive PD screens in pediatric intestinal and liver transplant recipients in the immediate post-transplant PICU admission. A positive screen was associated with younger age and greater PICU LOS.
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Affiliation(s)
- Sagar Patel
- Pediatric Critical Care Fellowship Program, Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Brent Pfeiffer
- Division of Pediatric Critical Care, Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Rosa Haddock De Jesus
- Pediatric Critical Care Fellowship Program, Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Jennifer Garcia
- Department of Pediatrics, Miami Transplant Institute, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Jayanthi Chandar
- Division of Pediatric Nephrology, Department of Pediatrics, Miami Transplant Institute, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Amanda Alladin
- Division of Pediatric Critical Care, Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL
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17
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Lu H, Jin L. Knowledge, attitudes and practices of critical care unit personnel regarding pediatric palliative care: a cross-sectional study. BMC Palliat Care 2024; 23:125. [PMID: 38769557 PMCID: PMC11106871 DOI: 10.1186/s12904-024-01456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Few studies have evaluated the perceptions of healthcare providers in China regarding pediatric palliative care, particularly in critical care units (PICUs), where many children receive palliative care. To evaluate the knowledge, attitudes and practices of PICU personnel in China regarding pediatric palliative care. METHODS This cross-sectional study was conducted in five cities in China (Shanghai, Suzhou, Chongqing, Chengdu and Yunnan) between November 2022 and December 2022. RESULTS The analysis included 204 participants (122 females), with 158 nurses and 46 physicians. The average knowledge, attitude and practice scores were 9.75 ± 2.90 points (possible range, 0-13 points), 38.30 ± 3.80 points (possible range, 12-60 points) and 35.48 ± 5.72 points (possible range, 9-45 points), respectively. Knowledge score was higher for physicians than for nurses (P < 0.001) and for personnel with previous training in pediatric palliative care (P = 0.005). According to structural equation modelling knowledge had a direct positive effect on attitude (β = 0.69 [0.28-1.10], p = 0.001), and indirect on practice (β = 0.82 [0.36-1.28], p < 0.001); attitude had significant effect on practice as well (β = 1.18 [0.81-1.56], p < 0.001). CONCLUSIONS There is room for improvement in the knowledge, attitudes and practices of PICU personnel in China regarding pediatric palliative care. The findings of this study may facilitate the design and implementation of targeted education/training programs to better inform physicians and nurses in China about pediatric palliative care.
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Affiliation(s)
- Hua Lu
- Department of Peadiatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Linfei Jin
- Department of Peadiatric Intensive Care Unit, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
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da Silva PSL, Kubo EY, da Motta Ramos Siqueira R, Fonseca MCM. Impact of Prolonged Continuous Ketamine Infusions in Critically Ill Children: A Prospective Cohort Study. Paediatr Drugs 2024:10.1007/s40272-024-00635-9. [PMID: 38762850 DOI: 10.1007/s40272-024-00635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Ketamine has been considered as an adjunct for children who do not reach their predefined target sedation depth. However, there is limited evidence regarding the use of ketamine as a prolonged infusion (i.e., >24 hours) in the pediatric intensive care unit (PICU). OBJECTIVE We sought to evaluate the safety and effectiveness of continuous ketamine infusion for >24 hours in mechanically ventilated children. METHODS We conducted a prospective cohort study in a tertiary PICU from January 2020 to December 2022. The primary outcome was the incidence of adverse events (AEs) after ketamine initiation. The secondary outcome included assessing the median proportion of time the patient spent on the Richmond Agitation-Sedation Scale (RASS) goal after ketamine infusion. Patients were also divided into two groups based on the sedative regimen, ketamine-based or non-ketamine-based, to assess the incidence of delirium. RESULTS A total of 269 patients were enrolled: 73 in the ketamine group and 196 in the non-ketamine group. The median infusion rate of ketamine was 1.4 mg/kg/h. Delirium occurred in 16 (22%) patients with ketamine and 15 (7.6%) patients without ketamine (p = 0.006). After adjusting for covariates, logistic regression showed that delirium was associated with comorbidities (odds ratio [OR] 4.2), neurodevelopmental delay (OR 0.23), fentanyl use (OR 7.35), and ketamine use (OR 4.17). Thirty-one (42%) of the patients experienced at least one AE following ketamine infusion. Other AEs likely related to ketamine were hypertension (n = 4), hypersecretion (n = 14), tachycardia (n = 6), and nystagmus (n = 2). There were no significant changes in hemodynamic variables 24 h after the initiation of ketamine. Regarding the secondary outcomes, patients were at their goal RASS level for a median of 76% (range 68-80.5%) of the time in the 24 hours before ketamine initiation, compared with 84% (range 74.5-90%) of the time during the 24 h after ketamine initiation (p < 0.001). The infusion rate of ketamine did not significantly affect concomitant analgesic and sedative infusions. The ketamine group experienced a longer duration of mechanical ventilation and a longer length of stay in the PICU and hospital than the non-ketamine group. CONCLUSION The use of ketamine infusion in PICU patients may be associated with an increased rate of adverse events, especially delirium. High-quality studies are needed before ketamine can be broadly recommended or adopted earlier in the sedation protocol.
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Affiliation(s)
- Paulo Sérgio Lucas da Silva
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Estadual de Diadema, Rua José Bonifácio 1641, São Paulo, 09980-150, Brazil.
| | - Emerson Yukio Kubo
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Estadual de Diadema, Rua José Bonifácio 1641, São Paulo, 09980-150, Brazil
| | - Rafael da Motta Ramos Siqueira
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Estadual de Diadema, Rua José Bonifácio 1641, São Paulo, 09980-150, Brazil
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Dornette S, Deptola S, Hemmann B, Venkatesan C, Cortezzo DE. Recognition and Management of Delirium in the Neonatal Intensive Care Unit: Case Series From a Single-Center Level IV Intensive Care Unit. J Child Neurol 2024; 39:171-177. [PMID: 38629166 DOI: 10.1177/08830738241246693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Delirium often goes unrecognized in neonates and children because of lack of experience in evaluating behavior and cognition, insufficient awareness of the prevalence, and nondistinctive symptoms in this population. Although there are increasing reports of the presence of delirium in neonates, there are little data to guide the pharmacologic treatment in this population. In this retrospective single-center case series, we present our experience using quetiapine to treat delirium in 9 medically complex neonates. Based on an extensive literature review, expert opinion, and institutional experience, we propose an approach for monitoring and treating delirium in neonates and infants.
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Affiliation(s)
- Stacey Dornette
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Stephen Deptola
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brianna Hemmann
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charu Venkatesan
- Division of Neurology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - DonnaMaria E Cortezzo
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pain and Palliative Medicine, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Anesthesia, Cincinnati, University of Cincinnati College of Medicine, OH, USA
- Division of Neonatology Pain & Palliative Care, Connecticut Children's Medical Center, Hartford, CT, USA
- Division of Pain & Palliative Care, Connecticut Children's Medical Center, Hartford, CT, USA
- Fetal Care Program, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, Hartford, University of Connecticut School of Medicine, CT, USA
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Stenkjaer RL, Egerod I, Moszkowicz M, Ista E, Greisen G, Weis J, Pagsberg AK, Herling SF. Prospective validation of Sophia observation withdrawal symptoms: A paediatric delirium scale in critically ill children in Denmark. Aust Crit Care 2024; 37:400-406. [PMID: 37164889 DOI: 10.1016/j.aucc.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Paediatric delirium (PD) is increasingly recognised as a common disorder in critically ill children with a reported prevalence ranging from 9% to 66%. We validated the PD component of the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale in a Danish setting to provide increased awareness and reliable identification of this critical condition, thereby paving the way for improved pathways to targeted delirium care. OBJECTIVE The objectives of this study were to criterion validate the PD component of the SOS-PD screening tool by comparing blinded psychiatric and nurse assessments and to estimate the prevalence of delirium in critically ill children in a Danish context. METHODS A prospective observational study was performed on critically ill children aged between 3 m and 18 y, admitted to an intensive care unit, with a hospital stay of 48 h or more. Assessments took place on a fixed weekday over an 18-month period. To test accuracy and criterion validity, bedside nurses' SOS-PD assessments were compared to the reference standard, a diagnostic assessment performed by a child psychiatrist according to the Diagnostic and Statistical Manual-V criteria by use of the Vanderbilt Assessment of Delirium in Infants and Children. RESULTS We included 141 children in the study, 30 (21%) of whom were diagnosed with delirium by the child psychiatrist. The accuracy of the delirium diagnosis was 93.6% (95% confidence interval [CI]: 88.3-97.1) among the nurses' SOS-PD assessments compared to the reference standard. The SOS-PD demonstrated a high sensitivity of 83.3% (95% CI: 65.3-94.4) and a high specificity of 96.4% (95% CI: 91.0-99.0) with five false-negative and four false-positive cases. CONCLUSION The PD component of the SOS-PD tool has good accuracy and validity for assessments performed by nurses compared to a child psychiatrist's diagnosis in critically ill children in a Danish setting. We recommend the use of the SOS-PD instrument in clinical practice.
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Affiliation(s)
- Rikke Louise Stenkjaer
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
| | - Mala Moszkowicz
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, Copenhagen 2900 Hellerup, Denmark.
| | - Erwin Ista
- Department of paediatric Surgery, paediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
| | - Janne Weis
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, Copenhagen 2900 Hellerup, Denmark.
| | - Suzanne Forsyth Herling
- The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
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Moas D, Aydin EY, Irazuzta J, Filipp S, Guthrie KK, Manasco K, Pringle C. Safety of Extended Propofol Infusions in Critically Ill Pediatric Patients. Cureus 2024; 16:e59948. [PMID: 38854299 PMCID: PMC11162280 DOI: 10.7759/cureus.59948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Propofol is a phenol agent with sedative and anesthetic properties that has been in use for decades, but with controversy in critically ill pediatric patients, given the concern for developing propofol-related infusion syndrome (PRIS). Our aim was to assess the risk of propofol infusions in the pediatric intensive care unit (PICU) at doses and durations greater than the described safety data and its associated covariables. Methods Retrospective cohort analysis of 173 patients receiving propofol in the PICU. Patients were categorized as receiving greater or less than 48-hour infusions. Demographic data and daily clinical variables were recorded for up to seven days post-infusion initiation or until infusion was stopped. Results In this descriptive analysis, patients' demographics were similar, but admission diagnosis was not. Both groups received high mean doses of propofol (>67 mcg/kg/min), with no cases of PRIS observed. The illness severity scores and the need for vasoactive infusion support varied between the cohorts, with higher illness scores and a higher percentage of subjects requiring vasoactive agents in the >48-hour cohort. Finally, there were no major differences in lactate levels or biochemical characteristics between the two groups. Conclusions This study provides pilot data in relation to the feasibility of propofol infusion in critically ill pediatric patients and underscores the need for a larger multicenter study to draw clinical recommendations.
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Affiliation(s)
- Daniel Moas
- Pediatric Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Elber Y Aydin
- Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Jose Irazuzta
- Pediatric Critical Care, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Stephanie Filipp
- Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, USA
| | - Kourtney K Guthrie
- Pediatrics, Shands Hospital at the University of Florida, Gainesville, USA
| | - Kalen Manasco
- Pharmacology and Therapeutics, University of Florida College of Medicine, Gainesville, USA
| | - Charlene Pringle
- Pediatrics, University of Florida College of Medicine, Gainesville, USA
- Critical Care Medicine, University of Florida College of Medicine, Gainesville, USA
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22
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Zeilmaker-Roest G, de Vries-Rink C, van Rosmalen J, van Dijk M, de Wildt SN, Knibbe CAJ, Koomen E, Jansen NJG, Kneyber MCJ, Maebe S, Van den Berghe G, Haghedooren R, Vlasselaers D, Bogers AJJC, Tibboel D, Wildschut ED. Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial. Crit Care 2024; 28:143. [PMID: 38689310 PMCID: PMC11061924 DOI: 10.1186/s13054-024-04905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND To determine whether intermittent intravenous (IV) paracetamol as primary analgesic would significantly reduce morphine consumption in children aged 0-3 years after cardiac surgery with cardiopulmonary bypass. METHODS Multi-center, randomized, double-blinded, controlled trial in four level-3 Pediatric Intensive Care Units (PICU) in the Netherlands and Belgium. Inclusion period; March 2016-July 2020. Children aged 0-3 years, undergoing cardiac surgery with cardiopulmonary bypass were eligible. Patients were randomized to continuous morphine or intermittent IV paracetamol as primary analgesic after a loading dose of 100 mcg/kg morphine was administered at the end of surgery. Rescue morphine was given if numeric rating scale (NRS) pain scores exceeded predetermined cutoff values. Primary outcome was median weight-adjusted cumulative morphine dose in mcg/kg in the first 48 h postoperative. For the comparison of the primary outcome between groups, the nonparametric Van Elteren test with stratification by center was used. For comparison of the proportion of patients with one or more NRS pain scores of 4 and higher between the two groups, a non-inferiority analysis was performed using a non-inferiority margin of 20%. RESULTS In total, 828 were screened and finally 208 patients were included; parents of 315 patients did not give consent and 305 were excluded for various reasons. Fourteen of the enrolled 208 children were withdrawn from the study before start of study medication leaving 194 patients for final analysis. One hundred and two patients received intermittent IV paracetamol, 106 received continuous morphine. The median weight-adjusted cumulative morphine consumption in the first 48 h postoperative in the IV paracetamol group was 5 times lower (79%) than that in the morphine group (median, 145.0 (IQR, 115.0-432.5) mcg/kg vs 692.6 (IQR, 532.7-856.1) mcg/kg; P < 0.001). The rescue morphine consumption was similar between the groups (p = 0.38). Non-inferiority of IV paracetamol administration in terms of NRS pain scores was proven; difference in proportion - 3.1% (95% CI - 16.6-10.3%). CONCLUSIONS In children aged 0-3 years undergoing cardiac surgery, use of intermittent IV paracetamol reduces the median weight-adjusted cumulative morphine consumption in the first 48 h after surgery by 79% with equal pain relief showing equipoise for IV paracetamol as primary analgesic. Trial Registration Clinicaltrials.gov, Identifier: NCT05853263; EudraCT Number: 2015-001835-20.
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MESH Headings
- Humans
- Morphine/therapeutic use
- Morphine/administration & dosage
- Acetaminophen/therapeutic use
- Acetaminophen/administration & dosage
- Male
- Female
- Infant
- Double-Blind Method
- Pain, Postoperative/drug therapy
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Belgium
- Netherlands
- Infant, Newborn
- Administration, Intravenous
- Cardiac Surgical Procedures/methods
- Child, Preschool
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/therapeutic use
- Intensive Care Units, Pediatric/organization & administration
- Intensive Care Units, Pediatric/statistics & numerical data
- Pain Measurement/methods
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Affiliation(s)
- Gerdien Zeilmaker-Roest
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
| | - Christine de Vries-Rink
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Monique van Dijk
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Saskia N de Wildt
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catherijne A J Knibbe
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
- Department of Clinical Pharmacy, St. Antonius Hospital Nieuwegein/Utrecht, Utrecht, The Netherlands
| | - Erik Koomen
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolaas J G Jansen
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin C J Kneyber
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Sofie Maebe
- Department of Pediatrics, Maastricht University Medical Center+, MosaKids Children's Hospital, Maastricht, The Netherlands
| | | | | | - Dirk Vlasselaers
- Department of Intensive Care Medicine, UZ Leuven, Louvain, Belgium
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Enno D Wildschut
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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23
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Zhang Y, Xie J, Tang M. Attitudes, knowledge and practices concerning delirium among paediatric intensive care unit nurses: a multisite cross-sectional study in Sichuan, China. BMC Nurs 2024; 23:289. [PMID: 38684972 PMCID: PMC11057075 DOI: 10.1186/s12912-024-01956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Delirium is an acute mental state associated with poor outcomes. The incidence of delirium is high, especially in the paediatric intensive care unit (PICU). It is important for staff, particularly nurses, to understand delirium and implement interventions to prevent it. We performed a survey with the aim of evaluating and analysing the factors influencing the knowledge, attitudes and behaviour of PICU nurses towards delirium. METHODS This cross-sectional descriptive study included 215 PICU nurses in 6 PICUs from five teaching hospitals in Sichuan Province, China. An online survey about the knowledge, attitudes and practices related to delirium care was conducted among PICU nurses used a self-made and validated questionnaire. The data were analysed using descriptive statistics; differences between groups were compared using t tests, ANOVA and rank-sum tests. Variables with a significance level of 0.05 in the univariate analysis were entered into the multivariable regression analysis to identify predictors. RESULTS Only 14.4% of the nurses had a good understanding of delirium, and 40.9% had received relevant training. The mean knowledge score was 9.01 ± 3.86, and the overall passing rate of knowledge was 49.8%. The mean attitude and behaviour scores were 40.95 ± 5.62 and 40.33 ± 8.01, respectively. Among the hospitals, different delirium assessments for children and specific training were performed, explaining approximately 10% of the variability in knowledge scores (F = 6.152), approximately 10% of the variability in attitude/belief scores (F = 5.908), and approximately 17% of the variability in practice scores (F = 10.767). CONCLUSIONS PICU nurses have poor knowledge of delirium, particularly regarding its clinical manifestations, influencing factors and medications used, and they have adequate attitudes and confidence and good behaviour regarding delirium in children. To better prevent delirium, we suggest that PICU departments routinely assess delirium and conduct delirium training for nurses. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- YueEr Zhang
- Department of Pain Management, West China Hospital ,Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - JingYing Xie
- West China Hospital of Stomatology,Sichuan University, Chengdu, 610041, China
| | - MengLin Tang
- Department of cardiovascular surgery,West China Hospital,Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China.
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24
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Ismail A, Alsumali S, Eltohamy N. Nurses' Assessment of Pain in Saudi Neonatal Intensive Care Units. Pain Manag Nurs 2024:S1524-9042(24)00103-6. [PMID: 38641446 DOI: 10.1016/j.pmn.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 02/18/2024] [Accepted: 03/09/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Research reveals that neonatal pain management in Neonatal Intensive Care Units (NICUs) is suboptimal. There is limited research that assessed NICU nurses' pain assessment practices in Saudi Arabia. AIM To assess the nurses' pain assessment practices in the NICU in Saudi Arabia. DESIGN This study used a descriptive cross-sectional design. SETTINGS Research was conducted using an online survey. PARTICIPANTS/SUBJECTS This study was carried out on 65 NICU nurses. The participants were recruited from one governmental and one private hospital in Saudi Arabia. METHODS Data on pain assessment practices were collected, including the frequency of pain assessment, pain assessment scales used for preterm and term neonates, and pain assessment documentation. Data were analyzed using frequencies and percentages. RESULTS The majority of the participants (94%) routinely assessed pain and documented pain assessment (97%). One-third of the participants assessed pain regularly every hour (32%). The most used pain assessment scales for term neonates were the neonatal infant pain scale (40%) and the cry, required oxygen, increased vital signs, expression, and sleeplessness scale (23%). The most used pain assessment scales for preterm neonates were the neonatal infant pain scale (31%), the cry, required oxygen, increased vital signs, expression, sleeplessness scale (19%), and the premature infant pain profile (17%). CONCLUSIONS NICU nurses in Saudi Arabia consistently assessed for and documented pain; however, the tools chosen were sometimes suboptimal. A substantial number of NICU nurses used invalid tools to assess pain in term and preterm neonates. An interventional program is needed to enhance the use of evidence-based practice recommendations regarding neonatal pain assessment by nurses in the Neonatal Intensive Care Units in Saudi Arabia.
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Affiliation(s)
- Ahmad Ismail
- Nursing Department, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia.
| | - Samah Alsumali
- Nursing Department, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Nadia Eltohamy
- Nursing Department, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia; Faculty of Nursing, Helwan University, Egypt
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25
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Chen Y, Zhou L, Tan Y. The effect of maternal voice and non-nutritional sucking on repeated procedural pain of heel prick in neonates: a quasi-experimental study. BMC Pediatr 2024; 24:256. [PMID: 38627645 PMCID: PMC11020345 DOI: 10.1186/s12887-024-04738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Neonates in the neonatal intensive care unit undergo frequent painful procedures. It is essential to reduce pain using safe and feasible methods. PURPOSE To evaluate the effects of non-nutritional sucking, mother's voice, or non-nutritional sucking combined with mother's voice on repeated procedural pain in hospitalized neonates. METHODS A quasi-experimental study was conducted in which 141 neonates were selected in a hospital in Changsha, China. Newborns were divided into four groups: non-nutritional sucking (NNS) (n = 35), maternal voice (MV) (n = 35), NNS + MV (n = 34), and control (n = 37) groups. The Preterm Infant Pain Profile-Revised Scale (PIPP-R) was used to assess pain. RESULTS During the heel prick, the heart rate value and blood oxygen saturation were significantly different between the groups (P < 0.05). Both non-nutritional sucking and maternal voice significantly reduced PIPP-R pain scores of hospitalized newborns (P < 0.05). The pain-relief effect was more robust in the combined group than in other groups. CONCLUSIONS This study showed that both non-nutritional sucking and the mother's voice alleviated repeated procedural pain in neonates. Therefore, these interventions can be used as alternatives to reduce repeated procedural pain.
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Affiliation(s)
- Yushuang Chen
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Leshan Zhou
- Xiangya Nursing School, Yuelu District, Central South University, No 172, Tongzipo Road, Changsha City, 410013, China.
| | - Yanjuan Tan
- Xiangya Thrid Hospital, Central South University, Changsha, China
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26
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Drury KM, Hall TA, Orwoll B, Adhikary S, Kirby A, Williams CN. Exposure to Sedation and Analgesia Medications: Short-term Cognitive Outcomes in Pediatric Critical Care Survivors With Acquired Brain Injury. J Intensive Care Med 2024; 39:374-386. [PMID: 37885235 PMCID: PMC11132562 DOI: 10.1177/08850666231210261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background/Objective: Pediatric intensive care unit (PICU) survivors risk significant cognitive morbidity, particularly those with acquired brain injury (ABI) diagnoses. Studies show sedative and analgesic medication may potentiate neurologic injury, but few studies evaluate impact on survivor outcomes. This study aimed to evaluate whether exposures to analgesic and sedative medications are associated with worse neurocognitive outcome. Methods: A retrospective cohort study was conducted of 91 patients aged 8 to 18 years, undergoing clinical neurocognitive evaluation approximately 1 to 3 months after PICU discharge. Electronic health data was queried for sedative and analgesic medication exposures, including opioids, benzodiazepines, propofol, ketamine, and dexmedetomidine. Doses were converted to class equivalents, evaluated by any exposure and cumulative dose exposure per patient weight. Cognitive outcome was derived from 8 objective cognitive assessments with an emphasis on executive function skills using Principal Components Analysis. Then, linear regression was used to control for baseline cognitive function estimates to calculate a standardized residualized neurocognitive index (rNCI) z-score. Multivariable linear regression evaluated the association between rNCI and medication exposure controlling for covariates. Significance was defined as P < .05. Results: Most (n = 80; 88%) patients received 1 or more study medications. Any exposure and higher cumulative doses of benzodiazepine and ketamine were significantly associated with worse rNCI in bivariate analyses. When controlling for Medicaid, preadmission comorbid conditions, length of stay, delirium, and receipt of other medication classes, receipt of benzodiazepine was associated with significantly worse rNCI (β-coefficient = -0.48, 95% confidence interval = -0.88, -0.08). Conclusions: Exposure to benzodiazepines was independently associated with worse acute phase cognitive outcome using objective assessments focused on executive function skills when controlling for demographic and illness characteristics. Clinician decisions regarding medication regimens in the PICU may serve as a modifiable factor to improve outcomes. Additional inquiry into associations with long-term cognitive outcome and optimal medication regimens is needed.
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Affiliation(s)
- Kurt M. Drury
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University
| | - Benjamin Orwoll
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
| | - Sweta Adhikary
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
- School of Medicine, Oregon Health and Science University
| | - Aileen Kirby
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
| | - Cydni N. Williams
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
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27
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Marraro GA, Chen YF, Spada C. So, What About Acute Respiratory Distress Syndrome in Immunocompromised Pediatric Patients? Pediatr Crit Care Med 2024; 25:375-377. [PMID: 38573039 DOI: 10.1097/pcc.0000000000003448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Giuseppe A Marraro
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
- Healthcare Accountability Lab, University of Milan, Milan, Italy
| | - Yun-Feng Chen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Claudio Spada
- Healthcare Accountability Lab, University of Milan, Milan, Italy
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28
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Jackson SS, Lee JJ, Jackson WM, Price JC, Beers SR, Berkenbosch JW, Biagas KV, Dworkin RH, Houck CS, Li G, Smith HAB, Ward DS, Zimmerman KO, Curley MAQ, Horvat CM, Huang DT, Pinto NP, Salorio CF, Slater R, Slomine BS, West LL, Wypij D, Yeates KO, Sun LS. Sedation Research in Critically Ill Pediatric Patients: Proposals for Future Study Design From the Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research IV Workshop. Pediatr Crit Care Med 2024; 25:e193-e204. [PMID: 38059739 DOI: 10.1097/pcc.0000000000003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVES Sedation and analgesia for infants and children requiring mechanical ventilation in the PICU is uniquely challenging due to the wide spectrum of ages, developmental stages, and pathophysiological processes encountered. Studies evaluating the safety and efficacy of sedative and analgesic management in pediatric patients have used heterogeneous methodologies. The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research (SCEPTER) IV hosted a series of multidisciplinary meetings to establish consensus statements for future clinical study design and implementation as a guide for investigators studying PICU sedation and analgesia. DESIGN Twenty-five key elements framed as consensus statements were developed in five domains: study design, enrollment, protocol, outcomes and measurement instruments, and future directions. SETTING A virtual meeting was held on March 2-3, 2022, followed by an in-person meeting in Washington, DC, on June 15-16, 2022. Subsequent iterative online meetings were held to achieve consensus. SUBJECTS Fifty-one multidisciplinary, international participants from academia, industry, the U.S. Food and Drug Administration, and family members of PICU patients attended the virtual and in-person meetings. Participants were invited based on their background and experience. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Common themes throughout the SCEPTER IV consensus statements included using coordinated multidisciplinary and interprofessional teams to ensure culturally appropriate study design and diverse patient enrollment, obtaining input from PICU survivors and their families, engaging community members, and using developmentally appropriate and validated instruments for assessments of sedation, pain, iatrogenic withdrawal, and ICU delirium. CONCLUSIONS These SCEPTER IV consensus statements are comprehensive and may assist investigators in the design, enrollment, implementation, and dissemination of studies involving sedation and analgesia of PICU patients requiring mechanical ventilation. Implementation may strengthen the rigor and reproducibility of research studies on PICU sedation and analgesia and facilitate the synthesis of evidence across studies to improve the safety and quality of care for PICU patients.
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Affiliation(s)
- Shawn S Jackson
- Departments of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Jennifer J Lee
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - William M Jackson
- Department of Anesthesiology, Montefiore Medical Center, New York, NY
| | - Jerri C Price
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Sue R Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - John W Berkenbosch
- Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, KY
| | - Katherine V Biagas
- Department of Pediatrics, The Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Robert H Dworkin
- Departments of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY
| | - Constance S Houck
- Departments of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Heidi A B Smith
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Denham S Ward
- Departments of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY
| | | | - Martha A Q Curley
- School of Nursing, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christopher M Horvat
- Departments of Critical Care Medicine, Pediatrics and Biomedical Informatics, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - David T Huang
- Departments of Critical Care Medicine, Emergency Medicine, Clinical and Translational Science, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Neethi P Pinto
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Cynthia F Salorio
- Department of Neuropsychology, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebeccah Slater
- Department of Paediatric Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Beth S Slomine
- Center for Brain Injury Recovery, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leanne L West
- International Children's Advisory Network, Atlanta, GA
| | - David Wypij
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Keith O Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Lena S Sun
- Departments of Pediatrics and Anesthesiology, Columbia University Irving Medical Center, New York, NY
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29
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Abarintos HML, Kapuscinski CA, Wheaton T, Stauber SD, Swartz MF, Grossman M, Masri S, Hutchinson DJ. Effect of Dexmedetomidine on Incidence of Hypertension Following Repair of Coarctation of the Aorta. J Pediatr Pharmacol Ther 2024; 29:144-150. [PMID: 38596424 PMCID: PMC11001214 DOI: 10.5863/1551-6776-29.2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/21/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Recent literature suggests a potential role for dexmedetomidine in reducing the incidence and severity of hypertension following repair of coarctation of the aorta (CoA). The primary aim of this study was to assess the association between dexmedetomidine use and the incidence of hypertension following repair of CoA in pediatric patients. METHODS This was a single-center, retrospective cohort study in patients younger than 19 years who underwent surgical repair of CoA between January 1, 2016, and September 30, 2021. Patients were divided into 2 groups: dexmedetomidine initiation within the first 3 hours after surgery or no dexmedetomidine. The primary outcome was incidence of hypertension within the first 4 to 24 hours after repair. Secondary outcomes included the incidence of hypotension and bradycardia. RESULTS A total of 80 patients were included, 25 (31.25%) received dexmedetomidine. Median age at the time of procedure was 26 days (IQR, 13-241) in the dexmedetomidine group and 14 days (IQR, 8-53) in the no dexmedetomidine group (p = 0.014). The primary outcome of hypertension was met in 7 patients (28%) in the dexmedetomidine group and 12 patients (21.8%) in the no dexmedetomidine group, p = 0.547. The only variable found to be associated with the incidence of hypertension was age greater than 30 days at the time of procedure. More patients who received dexmedetomidine experienced bradycardia. There was no difference in the incidence of hypotension. CONCLUSIONS There was no association between the use of dexmedetomidine and the incidence of -hypertension following repair of CoA in pediatric patients.
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Affiliation(s)
- Hope Mae L. Abarintos
- Department of Pharmacy (HLA, CAK, SS, DJH), University of Rochester Medical Center, Rochester, NY
| | - Christine A. Kapuscinski
- Department of Pharmacy (HLA, CAK, SS, DJH), University of Rochester Medical Center, Rochester, NY
| | - Taylor Wheaton
- Department of Pediatrics (TW), University of Rochester Medical Center, Rochester, NY
| | - Sierra D. Stauber
- Department of Pharmacy (HLA, CAK, SS, DJH), University of Rochester Medical Center, Rochester, NY
| | - Michael F. Swartz
- Department of Surgery (MFS), University of Rochester Medical Center, Rochester, NY
| | - Madeline Grossman
- Department of Pharmacy Practice and Education (MG, SM, DJH), Wegmans School of Pharmacy, St John Fisher College, Rochester, NY
| | - Sarah Masri
- Department of Pharmacy Practice and Education (MG, SM, DJH), Wegmans School of Pharmacy, St John Fisher College, Rochester, NY
| | - David J. Hutchinson
- Department of Pharmacy (HLA, CAK, SS, DJH), University of Rochester Medical Center, Rochester, NY
- Department of Pharmacy Practice and Education (MG, SM, DJH), Wegmans School of Pharmacy, St John Fisher College, Rochester, NY
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Tasker RC. Editor's Choice Articles for April. Pediatr Crit Care Med 2024; 25:285-287. [PMID: 38573038 DOI: 10.1097/pcc.0000000000003501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Robert C Tasker
- orcid.org/0000-0003-3647-8113
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Selwyn College, Cambridge University, Cambridge, United Kingdom
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Thibault C, Pont-Thibodeau GD, MacDonald S, Jutras C, Metras MÉ, Harrington K, Toledano B, Roumeliotis N, Farrell C, Lacroix J, Ducharme-Crevier L. Two months outcomes following delirium in the pediatric intensive care unit. Eur J Pediatr 2024:10.1007/s00431-024-05491-w. [PMID: 38520519 DOI: 10.1007/s00431-024-05491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 03/25/2024]
Abstract
The lasting consequences of delirium in children are not well characterized. This study aimed to compare the two-month outcomes in pediatric intensive care unit (PICU) survivors according to the presence of delirium. Post-hoc analysis of a single-center prospective study of mechanically ventilated (invasive ventilation or non-invasive ventilation) children followed at the CHU Sainte-Justine PICU follow-up clinic two months after PICU discharge, between October 2018 and August 2022. Delirium was defined as one or more Cornell Assessment of Pediatric Delirium (CAPD) scores ≥ 9. Primary outcome was survivors' quality of life and secondary outcomes were sleep and posttraumatic stress and anxiety and depression in parents. Multivariable linear and logistic regression models assessed the independent associations between delirium and outcomes while adjusting for age, sex, comorbidity, diagnosis, severity of illness, PICU length of stay, and invasive mechanical ventilation. Of the 179 children included over a 47 month-period, 117 (65.4%) had delirium. Children with delirium were more commonly intubated (91.5% vs. 30.7%, p < 0.001) and had higher PELOD-2 scores (10 vs. 4, p < 0.001). On multivariable analysis, delirium was associated with a decreased quality of life at 2.3 months post discharge (p = 0.03). The severity of the delirium episode (higher scores of CAPD) was associated with a higher likelihood of sleep disturbances (OR 1.13, p = 0.01) and parental anxiety (OR 1.16, p = 0.01), in addition to lower quality of life (p = 0.03).Conclusions: Two months following their PICU stay, children with delirium had a lower quality of life, suggesting a lasting effect of delirium on children and their families.
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Affiliation(s)
- Celine Thibault
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
| | - Geneviève Du Pont-Thibodeau
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
| | - Simon MacDonald
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
| | - Camille Jutras
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
| | - Marie-Élaine Metras
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Karen Harrington
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
| | - Baruch Toledano
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
| | - Nadia Roumeliotis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
| | - Catherine Farrell
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada
| | - Laurence Ducharme-Crevier
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.
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Canavera K, Marik P, Schneider NM, Smith J. The Role of Pediatric Psychologists in Critical Care: Lessons Learned and Future Directions in Integrating Mental Health Care Into PICUs. Chest 2024:S0012-3692(24)00398-2. [PMID: 38513964 DOI: 10.1016/j.chest.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024] Open
Abstract
Pediatric psychologists are essential staff in the PICU. Their role in caring for critically ill children aligns with clinical practice guidelines for the mental health care needs of this population of patients. This article highlights the role of pediatric psychology in the PICU through illustrative case examples. We discuss lessons learned and future directions for the development and provision of mental health services in PICUs. We address relevant ways for critical care providers to understand the importance of evidence-based psychological care and advocate for the inclusion of psychologists on multidisciplinary PICU teams. As the critical care field continues to focus on an improved understanding of post-intensive care syndrome in pediatrics and the psychological needs of critical care patients, it will be important to consider the vital roles of psychologists and to advocate for improved integration of mental health care in PICUs.
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Affiliation(s)
- Kristin Canavera
- Department of Pediatrics, Ochsner Hospital for Children, New Orleans, LA.
| | - Patricia Marik
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
| | - Nicole M Schneider
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Jacquelyn Smith
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
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Warren JD, Hughes KM. Pharmacologic Management of Pediatric Burns. J Burn Care Res 2024; 45:277-291. [PMID: 37948608 DOI: 10.1093/jbcr/irad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Indexed: 11/12/2023]
Abstract
Many pediatric patients with burn injuries may be initially treated in a hospital where pediatric specialized care, including resources and trained personnel may be limited. This includes resuscitation in adult emergency departments and inpatient care in mixed adult-pediatric burn units. The intent of this review is to provide a compilation of topics for the adult trained pharmacist or another healthcare practitioner on the management of pediatric patients with burn injuries. This article focuses on several key areas of pharmacologic burn management in the pediatric patient that may differ from the adult patient, including pain and sedation, fluid resuscitation, nutrition support, antimicrobial selection, anticoagulation, and inhalation injury. It is important that all clinicians have resources to help optimize the management of burn injuries in the pediatric population as, in addition to burn injury itself, pediatric patients have different pharmacokinetics and pharmacodynamics affecting which medications are used and how they are dosed. This article highlights several key differences between pediatric and adult patients, providing an additional resource to assist adult-trained pharmacists or other healthcare practitioners with making clinical decisions in the pediatric burn population.
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Affiliation(s)
- Jontae D Warren
- Ochsner Baptist-A Campus of Ochsner Medical Center, Pharmacy Department, New Orleans, LA, 70115, USA
| | - Kaitlin M Hughes
- Riley Hospital for Children, Pharmacy Department, Indianapolis, IN, 46202, USA
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Fu M, Yuan Q, Yang Q, Song W, Yu Y, Luo Y, Xiong X, Yu G. Risk factors and incidence of postoperative delirium after cardiac surgery in children: a systematic review and meta-analysis. Ital J Pediatr 2024; 50:24. [PMID: 38331831 PMCID: PMC10854157 DOI: 10.1186/s13052-024-01603-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
Delirium, a form of acute cerebral dysfunction, is a common complication of postoperative cardiac surgery in children. It is strongly associated with adverse outcomes, including prolonged hospitalization, increased mortality, and cognitive dysfunction. This study aimed to identify risk factors and incidence of delirium after cardiac surgery in children to facilitate early identification of delirium risk and provide a reference for the implementation of effective prevention and management. A systematic literature search was conducted in PubMed, Web of Science, Embase, Cochrane Library, Scopus, CNKI, Sinomed, and Wanfang for studies published in English or Chinese from the inception of each database to November 2023. The PRISMA guidelines were followed in all phases of this systematic review. The Risk of Bias Assessment for Nonrandomized Studies tool was used to assess methodological quality. A total of twelve studies were included in the analysis, with four studies classified as overall low risk of bias, seven studies as moderate risk of bias, and one study as high risk of bias. The studies reported 39 possible predictors of delirium, categorized into four broad groups: intrinsic and parent-related factors, disease-related factors, surgery and treatment-related factors, and clinical scores and laboratory parameters. By conducting qualitative synthesis and quantitative meta-analysis, we identified two definite factors, four possible factors, and 32 unclear factors related to delirium. Definite risk factors included age and mechanical ventilation duration. Possible factors included developmental delay, cyanotic heart disease, cardiopulmonary bypass time, and pain score. With only a few high-quality studies currently available, well-designed and more extensive prospective studies are still needed to investigate the risk factors affecting delirium and explore delirium prevention strategies in high-risk children.
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Affiliation(s)
- Maoling Fu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Qiaokou District, Wuhan, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Quan Yuan
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Qiaokou District, Wuhan, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiaoyue Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Qiaokou District, Wuhan, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenshuai Song
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Qiaokou District, Wuhan, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yaqi Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Qiaokou District, Wuhan, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying Luo
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Qiaokou District, Wuhan, Hubei, China
| | - Xiaoju Xiong
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Qiaokou District, Wuhan, Hubei, China
| | - Genzhen Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Qiaokou District, Wuhan, Hubei, China.
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35
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Casten M, Miller JL, Neely SB, Harkin M, Johnson PN. Variability in opioid conversion calculators in critically ill children transitioned from fentanyl to hydromorphone. Am J Health Syst Pharm 2024; 81:153-158. [PMID: 37880811 DOI: 10.1093/ajhp/zxad270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE Opioid conversion calculators (OCCs) are used to convert between opioids. The purpose of this study was to describe the variability in OCC results in critically ill children transitioned from fentanyl to hydromorphone infusions. METHODS This was a descriptive, retrospective study. Seventeen OCCs were identified and grouped into 6 groups (groups 1-6) based on the equianalgesic conversions. The OCCs were used to calculate the hydromorphone rate in critically ill children (<18 years) converted from fentanyl to hydromorphone. Information from a previous study on children stabilized on hydromorphone (defined as the first 24-hour period with no change in the hydromorphone rates, <3 hydromorphone boluses administered, and 80% of State Behavior Scale scores between 0 and -1) were utilized. The primary objective was to compare the median hydromorphone rates calculated using the 17 OCCs. The secondary objective was to compare the percent variability of the OCC-calculated hydromorphone rates to the stabilization rate. RESULTS Seventeen OCCs were applied to data on 28 children with a median age and hydromorphone rate of 2.4 years and 0.08 mg/kg/h, respectively. The median hydromorphone rate calculated using the 17 OCCs ranged from 0.06 to 0.12 mg/kg/h. Group 3 and group 6 OCCs resulted in a calculated hydromorphone rate that was higher than the stabilization rate in 96% and 75% of patients, respectively. Use of group 4 and group 5 OCCs resulted in a calculated hydromorphone rate that was lower than the stabilization rate in 64% and 75% of patients, respectively. CONCLUSION Given the considerable variability of OCCs, caution should be used when applying OCCs to critically ill children.
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Affiliation(s)
- Madison Casten
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Jamie L Miller
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Stephen B Neely
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Maura Harkin
- Oklahoma Children's Hospital at OU Health, Oklahoma City, OK, USA
| | - Peter N Johnson
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
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Volanaki A, Briassoulis G, Gerostergios G, Samiotakis G, Soumaki E, Traube C, Ilia S. Adaptation and Validation of the Cornell Assessment of Pediatric Delirium Tool in the Greek Language. Pediatr Crit Care Med 2024; 25:e105-e107. [PMID: 37882634 DOI: 10.1097/pcc.0000000000003369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Aikaterini Volanaki
- Pediatric Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, Crete, Greece
| | - George Briassoulis
- Pediatric Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, Crete, Greece
- Postgraduate Program "Emergency and Intensive Care in Children, Adolescents and Young Adults," School of Medicine, University of Crete, Crete, Greece
| | - George Gerostergios
- Pediatric Psychiatric Department, University Hospital of Heraklion, Crete, Greece
| | - George Samiotakis
- Pediatric Psychiatric Department, University Hospital of Heraklion, Crete, Greece
| | - Evgenia Soumaki
- Pediatric Psychiatric Department, University Hospital of Heraklion, Crete, Greece
| | - Chani Traube
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Stavroula Ilia
- Pediatric Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, Crete, Greece
- Postgraduate Program "Emergency and Intensive Care in Children, Adolescents and Young Adults," School of Medicine, University of Crete, Crete, Greece
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Kolmar AR, Paton AM, Kramer MA, Guilliams KP. Differences in Delirium Evaluation and Pharmacologic Management in Children With Developmental Delay: A Retrospective Case-Control Study. J Intensive Care Med 2024; 39:170-175. [PMID: 37563949 PMCID: PMC10938448 DOI: 10.1177/08850666231194534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Delirium is associated with increased mortality and cost, decreased neurocognition, and decreased quality of life in the pediatric intensive care unit (PICU) population. The Cornell Assessment for Pediatric Delirium (CAPD) is used in PICUs for delirium screening but lacks specificity in children with developmental delay (DD). Within a cohort of children receiving pharmacologic treatment for intensive care unit (ICU) delirium, we compared delirium scoring and medication management between children with and without DD. We hypothesized that CAPD scores and treatment decisions would differ between DD and neurotypical (NT) patients. In this retrospective case-control study, we queried the medical record of patients admitted to our PICU with respiratory failure from June 2018 to March 2022 who received antipsychotics typically used for ICU delirium. Antipsychotics prescribed for home use were excluded. Nonparametric statistics compared demographics, CAPD scores, medication choice, dosing (mg/kg), and medication continuation after discharge between those with and without DD based on the ICD-10 codes. Twenty-one DD admissions and 59 NT admissions were included. Groups did not significantly differ by demographics, LOS, drug, or initial dosage. DD patients had higher median CAPD scores at admission (17 vs 13; P = .02) and treatment initiation (18 vs 16.5; P = .05). Providers more frequently escalated doses in DD patients (13/21 vs 21/59; P = .04) and discharged them home on new antipsychotics (7/21 vs 5/59; P = .01). DD patients experience delirium screening and management differently than NT counterparts. Providers should be aware of baseline elevated scores in DD patients and carefully attend to indications for dosage escalation. Further work is needed to understand if prolonged duration, even after hospital discharge, benefits patients, or represents potential disparity in care.
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Affiliation(s)
- Amanda R Kolmar
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Anneliese M Paton
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Michael A Kramer
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Mallinckrodt Institution of Radiology, Division of Neuroradiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Ista E, van Dijk M. Moving Away From Randomized Controlled Trials to Hybrid Implementation Studies for Complex Interventions in the PICU. Pediatr Crit Care Med 2024; 25:177-180. [PMID: 38240539 DOI: 10.1097/pcc.0000000000003400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Erwin Ista
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique van Dijk
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Huang T, Liu Y, Tang M. About Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis. Pediatr Crit Care Med 2024; 25:e108-e109. [PMID: 38240543 DOI: 10.1097/pcc.0000000000003382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Tao Huang
- All authors: Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
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Castro REVD, de Almeida JPC, Monteiro Medeiros DN, Cheniaux E, Colleti Júnior J, de Magalhães-Barbosa MC, Prata-Barbosa A, Ista E. Brazilian Portuguese Translation and Cross-Cultural Adaptation of the Sophia Observation Withdrawal Symptoms Pediatric Delirium Tool for the Diagnosis of Withdrawal Syndrome and Delirium in Children. Pediatr Crit Care Med 2024; 25:e103-e104. [PMID: 37889093 DOI: 10.1097/pcc.0000000000003364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Roberta Esteves Vieira de Castro
- Pediatric Intensive Care Unit (PICU), Department of Pediatrics, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
- Department of Pediatrics, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Juliana Patrícia Chaves de Almeida
- Department of Pediatrics, Souza Marques School of Medicine, Rio de Janeiro, Brazil
- PICU, Department of Pediatrics, Federal Hospital of Lagoa, Rio de Janeiro, Brazil
| | | | - Elie Cheniaux
- Department of Psychiatry, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
- Department of Psychiatry, Institute of Psychiatry of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Erwin Ista
- PICU, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Choong K, Fraser DD, Al-Farsi A, Awlad Thani S, Cameron S, Clark H, Cuello C, Debigaré S, Ewusie J, Kennedy K, Kho ME, Krasevich K, Martin CM, Thabane L, Nanji J, Watts C, Simpson A, Todt A, Wong J, Xie F, Vu M, Cupido C. Early Rehabilitation in Critically ill Children: A Two Center Implementation Study. Pediatr Crit Care Med 2024; 25:92-105. [PMID: 38240534 DOI: 10.1097/pcc.0000000000003343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES To implement an early rehabilitation bundle in two Canadian PICUs. DESIGN AND SETTING Implementation study in the PICUs at McMaster Children's Hospital (site 1) and London Health Sciences (site 2). PATIENTS All children under 18 years old admitted to the PICU were eligible for the intervention. INTERVENTIONS A bundle consisting of: 1) analgesia-first sedation; 2) delirium monitoring and prevention; and 3) early mobilization. MEASUREMENTS AND MAIN RESULTS Primary outcomes were the duration of implementation, bundle compliance, process of care, safety, and the factors influencing implementation. Secondary endpoints were the impact of the bundle on clinical outcomes such as pain, delirium, iatrogenic withdrawal, ventilator-free days, length of stay, and mortality. Implementation occurred over 26 months (August 2018 to October 2020). Data were collected on 1,036 patients representing 4,065 patient days. Bundle compliance was optimized within 6 months of roll-out. Goal setting for mobilization and level of arousal improved significantly (p < 0.01). Benzodiazepine, opioid, and dexmedetomidine use decreased in site 1 by 23.2% (95% CI, 30.8-15.5%), 26.1% (95% CI, 34.8-17.4%), and 9.2% (95% CI, 18.2-0.2%) patient exposure days, respectively, while at site 2, only dexmedetomidine exposure decreased significantly by 10.5% patient days (95% CI, 19.8-1.1%). Patient comfort, safety, and nursing workload were not adversely affected. There was no significant impact of the bundle on the rate of delirium, ventilator-free days, length of PICU stay, or mortality. Key facilitators to implementation included institutional support, unit-wide practice guidelines, dedicated PICU educators, easily accessible resources, and family engagement. CONCLUSIONS A rehabilitation bundle can improve processes of care and reduce patient sedative exposure without increasing patient discomfort, nursing workload, or harm. We did not observe an impact on short-term clinical outcomes. The efficacy of a PICU-rehabilitation bundle requires ongoing study. Lessons learned in this study provide evidence to inform rehabilitation implementation in the PICU setting.
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Affiliation(s)
- Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Douglas D Fraser
- Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ahmed Al-Farsi
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Saif Awlad Thani
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Saoirse Cameron
- Lawson Health Research Institute, Children's Hospital at London Health Sciences Center, London, ON, Canada
| | | | - Carlos Cuello
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Joycelyne Ewusie
- The Research Institute, Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Kevin Kennedy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Claudio M Martin
- Department of Pediatrics, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lehana Thabane
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute, Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Jasmine Nanji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Vu
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Cynthia Cupido
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Ista E, Traube C, de Neef M, Schieveld J, Knoester H, Molag M, Kudchadkar SR, Strik J. The authors reply. Pediatr Crit Care Med 2024; 25:e109-e110. [PMID: 38240544 DOI: 10.1097/pcc.0000000000003402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Erwin Ista
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Nursing Science, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Chani Traube
- Department of Pediatric Critical Care, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Marjorie de Neef
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Jan Schieveld
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Nursing Science, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Critical Care, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Department of Psychiatry and Psychology, Division of Child and Adolescent Psychiatry and Psychology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- European Graduate School For Neuroscience (EURON), South Limburg Mental Health Research & Teaching Network (SEARCH), Maastricht, The Netherlands
- Mutsaers Stichting, Pediatric Mental Health Care, Venlo, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hennie Knoester
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Marja Molag
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Sapna R Kudchadkar
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Nursing Science, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Critical Care, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Department of Psychiatry and Psychology, Division of Child and Adolescent Psychiatry and Psychology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- European Graduate School For Neuroscience (EURON), South Limburg Mental Health Research & Teaching Network (SEARCH), Maastricht, The Netherlands
- Mutsaers Stichting, Pediatric Mental Health Care, Venlo, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jacqueline Strik
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Nursing Science, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Critical Care, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Department of Psychiatry and Psychology, Division of Child and Adolescent Psychiatry and Psychology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
- European Graduate School For Neuroscience (EURON), South Limburg Mental Health Research & Teaching Network (SEARCH), Maastricht, The Netherlands
- Mutsaers Stichting, Pediatric Mental Health Care, Venlo, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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Tasker RC. Editor's Choice Articles for February. Pediatr Crit Care Med 2024; 25:88-91. [PMID: 38240533 DOI: 10.1097/pcc.0000000000003431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Robert C Tasker
- orcid.org/0000-0003-3647-8113
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Selwyn College, Cambridge University, Cambridge, United Kingdom
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Goldstein M, Jergel A, Karpen S, He Z, Austin TM, Hall M, Deep A, Gilbertson L, Kamat P. Trends in sedation-analgesia practices in pediatric liver transplant patients admitted postoperatively to the pediatric intensive care unit: An analysis of data from the pediatric health information system (PHIS) database. Pediatr Transplant 2024; 28:e14660. [PMID: 38017659 DOI: 10.1111/petr.14660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/26/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Children admitted to the pediatric intensive care unit (PICU), after liver transplantation, frequently require analgesia and sedation in the immediate postoperative period. Our objective was to assess trends and variations in sedation and analgesia used in this cohort. METHODS Multicenter retrospective cohort study using the Pediatric Health Information System from 2012 to 2022. RESULTS During the study period, 3963 patients with liver transplantation were admitted to the PICU from 32 US children's hospitals with a median age of 2 years [IQR: 0.00, 10.00]. 54 percent of patients received mechanical ventilation (MV). Compared with patients without MV, those with MV were more likely to receive morphine (57% vs 49%, p < .001), fentanyl (57% vs 44%), midazolam (45% vs 31%), lorazepam (39% vs. 24%), dexmedetomidine (38% vs 30%), and ketamine (25% vs 12%), all p < .001. Vasopressor usage was also higher in MV patients (22% vs. 35%, p < .001). During the study period, there was an increasing trend in the utilization of dexmedetomidine and ketamine, but the use of benzodiazepine decreased (p < .001). CONCLUSION About 50% of patients who undergo liver transplant are placed on MV in the PICU postoperatively and receive a greater amount of benzodiazepines in comparison with those without MV. The overall utilization of dexmedetomidine and ketamine was more frequent, whereas the administration of benzodiazepines was less during the study period. Pediatric intensivists have a distinctive opportunity to collaborate with the liver transplant team to develop comprehensive guidelines for sedation and analgesia, aimed at enhancing the quality of care provided to these patients.
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Affiliation(s)
- Matthew Goldstein
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
| | - Andrew Jergel
- Department of Pediatrics, Pediatric Biostatistics Core at Emory University School of Medicine, Atlanta, Georgia, USA
| | - Saul Karpen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zhulin He
- Department of Pediatrics, Pediatric Biostatistics Core at Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas M Austin
- Department of Anesthesiology, Shands Children's Hospital, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Akash Deep
- Paediatric Intensive Care Unit (PICU), King's College Hospital, London, UK
| | - Laura Gilbertson
- Department of Anesthesiology and Pain Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pradip Kamat
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
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Stenkjaer RL, Egerod I, Moszkowicz M, Collet MO, Weis J, Ista E, Greisen G, Herling SF. The parent perspective on paediatric delirium and an associated care bundle: A qualitative study. J Adv Nurs 2024. [PMID: 38186225 DOI: 10.1111/jan.16048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIMS To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle. DESIGN We conducted a qualitative exploratory descriptive study using semi-structured individual or dyad interviews. METHODS Twelve semi-structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis. FINDINGS We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long-term consequences, (4) adding insight to the bundle, and (5) family engagement. CONCLUSION The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium. IMPACT This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit. REPORTING METHOD The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution to the research design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL COMMUNITY?: - It increases awareness of the parent's perspective on PD in critically ill children. - It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage. - It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child.
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Affiliation(s)
- Rikke Louise Stenkjaer
- Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mala Moszkowicz
- Child and Adolescent Mental Health, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marie Oxenbøll Collet
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Janne Weis
- Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Erwin Ista
- Division of Pediatric Intensive Care, Department of Neonatal and Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gorm Greisen
- Department of Intensive Care for Infants and Toddlers, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Suzanne Forsyth Herling
- Department of Neuroanaesthesiology, Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Oschman A, Rao K. Challenges in management of refractory pain and sedation in infants. Front Pharmacol 2024; 14:1259064. [PMID: 38235119 PMCID: PMC10791862 DOI: 10.3389/fphar.2023.1259064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
The survival of preterm infants continues to improve, along with an increased in neonatal intensive care unit (NICU) management of chronic infants who are medically complex infants who have prolonged hospital stays, sometimes up until 2 years of age. Despite advances in neonatal and infant care, the management of pain and sedation in chronic NICU patients continues to be a challenge. Challenges such as development of appropriate pain, sedation, and withdrawal scales along with unfamiliarity of the NICU care team with pediatric disease states and pharmacotherapy complicate management of these patients. Opioid induced hyperalgesia (OIH) and delirium may play a large role in these refractory cases, yet are often not considered in the NICU population. Drug therapy interventions such as gabapentin, ketamine, risperidone, and others have limited data for safety and efficacy in this population. This article summarizes the available literature regarding the evidence for diagnosis and management of infants with refractory pain and sedation along with the challenges that clinicians face when managing these patients.
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Affiliation(s)
- Alexandra Oschman
- Department of Pharmacy, Children’s Mercy Hospital, Kansas City, MO, United States
| | - Karishma Rao
- Division of Neonatology, Children’s Mercy Hospital, Kansas City, MO, United States
- University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
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Mounier S, Cambonie G, Baleine J, Le Roux M, Bringuier S, Milési C. Music Therapy During Basic Daily Care in Critically Ill Children: A Randomized Crossover Clinical Trial. J Pediatr 2024; 264:113736. [PMID: 37722559 DOI: 10.1016/j.jpeds.2023.113736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To assess whether music therapy (MT) is effective to reduce pain during daily personal hygiene care (DPHC), a procedure performed in all patients in a pediatric intensive care unit. METHODS Fifty critically ill children were enrolled in a crossover controlled clinical trial with random ordering of the intervention, that is, passive MT, and standard conditions, and blind assessment of pain on film recordings. The primary outcome was variation of the Face Legs Activity Cry Consolability (FLACC) score (range, 0-10) comparing before and during DPHC. Secondary outcomes were changes in heart rate, respiratory rate, and mean arterial blood pressure, and administration of analgesic or sedative drugs during DPHC. Mixed-effects linear model analysis was used to assess effect size (95% CI). RESULTS The median (Q25-Q75) age and weight of the patients were 3.5 years (1.0-7.6 years) and 15.0 kg (10.0-26.8 kg). Consecutive DPHC were assessed on days 3 (2-5) and 4 (3-7) of hospitalization. In standard conditions, FLACC score was 0.0 (0.0-3.0) at baseline and 3.0 (1.0-5.5) during DPHC. With MT, these values were, respectively, 0.0 (0.0-1.0) and 2.0 (0.5-4.0). Rates of FLACC scores of >4 during DPHC, which indicates severe pain, were 42% in standard conditions and 17% with MT (P = .013). Mixed-effects model analysis found smaller increases in FLACC scores (-0.54 [-1.08 to -0.01]; P = .04) and heart rate (-9.00; [-14.53; -3.40]; P = .001) with MT. CONCLUSIONS MT is effective to improve analgesia in critically ill children exposed to DPHC. TRIAL REGISTRATION This study was recorded (April 16, 2019) before patient recruitment on the National Library of Medicine registry (NCT03916835; https://clinicaltrials.gov/ct2/show/NCT03916835).
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Affiliation(s)
- Sophie Mounier
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France; Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France.
| | - Julien Baleine
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Manon Le Roux
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Sophie Bringuier
- Department of Medical Statistics and Epidemiology, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Christophe Milési
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
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Tabone L, El-Tannoury J, Levy M, Sauthier M, Joram N, Du Pont-Thibodeau G, Bourgoin P, Al-Omar S, Poirier N, Emeriaud G, Thibault C. Determining Optimal Mean Arterial Blood Pressure Based on Cerebral Autoregulation in Children after Cardiac Surgery. Pediatr Cardiol 2024; 45:81-91. [PMID: 37945783 DOI: 10.1007/s00246-023-03326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Abstract
To evaluate the feasibility of continuous determination of the optimal mean arterial blood pressure (opt-MAP) according to cerebral autoregulation and to describe the opt-MAP, the autoregulation limits, and the time spent outside these limits in children within 48 h of cardiac surgery. Cerebral autoregulation was assessed using the correlation coefficient (COx) between cerebral oxygenation and MAP in children following cardiac surgery. Plots depicting the COx according to the MAP were used to determine the opt-MAP using weighted multiple time windows. For each patient, we estimated (1) the time spent with MAP outside the autoregulation limits and (2) the burden of deviation, defined as the area between the MAP curve and the autoregulation limits when the MAP was outside these limits. Fifty-one patients with a median age of 7.1 (IQR 0.7-52.0) months old were included. The opt-MAP was calculated for 94% (IQR 90-96) of the monitored time. The opt-MAP was significantly lower in neonates < 1 month old. The patients spent 24% (18-31) of the time outside of the autoregulation limits, with no significant differences between age groups. Continuous determination of the opt-MAP is feasible in children within the first 48 h following cardiac surgery.
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Affiliation(s)
- Laurence Tabone
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Pediatric Intensive Care Unit and Pediatric Emergency Department, CHU Clocheville, Tours, France
| | - Jihad El-Tannoury
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Michael Levy
- Pediatric Intensive Care Unit, CHU Robert Debré, Paris, France
| | - Michael Sauthier
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Nicolas Joram
- Pediatric Intensive Care Unit, CHU de Nantes, Nantes, France
| | - Geneviève Du Pont-Thibodeau
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit, CHU de Nantes, Nantes, France
| | - Sally Al-Omar
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Nancy Poirier
- Department of Cardiac Surgery, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Guillaume Emeriaud
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Céline Thibault
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
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Knapp T, DiLeonardo O, Maul T, Hochwald A, Li Z, Hossain J, Lowry A, Parker J, Baker K, Wearden P, Nelson J. Dexmedetomidine Withdrawal Syndrome in Children in the PICU: Systematic Review and Meta-Analysis. Pediatr Crit Care Med 2024; 25:62-71. [PMID: 37855676 DOI: 10.1097/pcc.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To systematically review literature describing the clinical presentation, risk factors, and treatment for dexmedetomidine withdrawal in the PICU (PROSPERO: CRD42022307178). DATA SOURCES MEDLINE/PubMed, Cochrane, Web of Science, and Scopus databases were searched. STUDY SELECTION Eligible studies were published from January 2000 to January 2022 and reported clinical data for patients younger than 21 years old following discontinuation of dexmedetomidine after greater than or equal to 24 hours of infusion. DATA EXTRACTION Abstracts identified during an initial search were screened and data were manually abstracted after full-text review of eligible articles. The Newcastle-Ottawa Scale was used to assess study quality. Summary statistics were provided and Spearman rank correlation coefficient was used to identify relationships between covariates and withdrawal signs. A weighted prevalence for each withdrawal sign was generated using a random-effects model. DATA SYNTHESIS Twenty-three studies (22 of which were retrospective cohort studies) containing 28 distinct cohorts were included. Median cumulative dexmedetomidine exposure by dose was 105.95 μg/kg (range, 30-232.7 μg/kg), median dexmedetomidine infusion duration was 131.75 hours (range, 20.5-525.6 hr). Weighted estimates for proportion (95% CI) of subjects experiencing withdrawal signs across all cohorts were: hypertension 0.34 (range, 0.0-0.92), tachycardia 0.26 (range, 0.0-0.87), and agitation 0.26 (range, 0.09-0.77). Meta-analysis revealed no correlation between dexmedetomidine exposure variables and withdrawal signs. A moderate negative monotonic relationship existed between the proportion of patients who had undergone cardiac surgery and the proportion experiencing hypertension (correlation coefficient, -0.47; p = 0.048) and tachycardia (correlation coefficient, -0.57; p = 0.008), indicating that in cohorts with a higher proportion of patients who were postcardiac surgery, there were fewer occurrences of hypertension and or tachycardia. CONCLUSIONS On review of the 2000-2022 literature, dexmedetomidine withdrawal may be characterized by tachycardia, hypertension, or agitation, particularly with higher cumulative doses or prolonged durations. Since most studies included in the review were retrospective, prospective studies are needed to further clarify risk factors, establish diagnostic criteria, and identify optimal management strategies.
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Affiliation(s)
- Thomas Knapp
- University of Central Florida, College of Medicine, Orlando, FL
| | - Olivia DiLeonardo
- Department of Medical Education, Nemours Children's Health, Orlando, FL
| | - Tim Maul
- Department of Cardiovascular Services, Nemours Children's Health, Florida, Orlando, FL
| | - Alexander Hochwald
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Zhuo Li
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Jobayer Hossain
- Department of Biomedical Research, Nemours Children's Health, Wilmington, DE
| | - Adam Lowry
- Department of Cardiovascular Services, Nemours Children's Health, Florida, Orlando, FL
| | - Jason Parker
- Department of Cardiovascular Services, Nemours Children's Health, Florida, Orlando, FL
| | - Kimberly Baker
- Department of Cardiovascular Services, Nemours Children's Health, Florida, Orlando, FL
| | - Peter Wearden
- Department of Cardiovascular Services, Nemours Children's Health, Florida, Orlando, FL
| | - Jennifer Nelson
- Department of Cardiovascular Services, Nemours Children's Health, Florida, Orlando, FL
- Department of Surgery, University of Central Florida College of Medicine, Orlando, FL
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50
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Inoue S, Nakanishi N, Amaya F, Fujinami Y, Hatakeyama J, Hifumi T, Iida Y, Kawakami D, Kawai Y, Kondo Y, Liu K, Nakamura K, Nishida T, Sumita H, Taito S, Takaki S, Tsuboi N, Unoki T, Yoshino Y, Nishida O. Post-intensive care syndrome: Recent advances and future directions. Acute Med Surg 2024; 11:e929. [PMID: 38385144 PMCID: PMC10879727 DOI: 10.1002/ams2.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 12/23/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
Post-intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU). It occurs either during the ICU stay or following ICU discharge and is related to the patients' long-term prognosis. The same concept also applies to pediatric patients, and it can greatly affect the mental status of family members. In the 10 years since post-intensive care syndrome was first proposed, research has greatly expanded. Here, we summarize the recent evidence on post-intensive care syndrome regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatments. We highlight new topics, future directions, and strategies to overcome post-intensive care syndrome among people treated in an ICU. Clinical and basic research are still needed to elucidate the mechanistic insights and to discover therapeutic targets and new interventions for post-intensive care syndrome.
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Affiliation(s)
- Shigeaki Inoue
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Yoshihisa Fujinami
- Department of Emergency MedicineKakogawa Central City HospitalKakogawaJapan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care MedicineOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
| | - Yuki Iida
- Faculty of Physical Therapy, School of Health SciencesToyohashi Sozo UniversityToyohashiJapan
| | - Daisuke Kawakami
- Department of Intensive Care MedicineAso Iizuka HospitalFukuokaJapan
| | - Yusuke Kawai
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Yutaka Kondo
- Department of Emergency and Critical Care MedicineJuntendo University Urayasu HospitalUrayasuJapan
| | - Keibun Liu
- Critical Care Research GroupThe Prince Charles HospitalChermsideQueenslandAustralia
- Faculty of MedicineThe University of Queensland, Mayne Medical SchoolHerstonQueenslandAustralia
- Non‐Profit Organization ICU Collaboration Network (ICON)TokyoJapan
| | - Kensuke Nakamura
- Department of Critical Care MedicineYokohama City University School of MedicineYokohamaJapan
| | - Takeshi Nishida
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
| | | | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and SupportHiroshima University HospitalHiroshimaJapan
| | - Shunsuke Takaki
- Department of Critical Care MedicineYokohama City University School of MedicineYokohamaJapan
| | - Norihiko Tsuboi
- Division of Critical Care Medicine, Department of Critical Care and AnesthesiaNational Center for Child Health and DevelopmentSetagayaJapan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of NursingSapporo City UniversitySapporoJapan
- Teine Keijinkai HospitalSapporoJapan
| | - Yasuyo Yoshino
- Department of Nursing, Faculty of NursingKomazawa Women's UniversityTokyoJapan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care MedicineFujita Health University School of MedicineToyoakeJapan
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