Implementation of the "awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility" bundle in the pediatric intensive care unit of tertiary hospitals in southwestern China: a cross-sectional survey

Blended teaching mode based on small private online course and case-based learning in analgesia and sedation education in China: a comparison with an offline mode

BACKGROUND

Standardized training for pain, agitation-sedation, and delirium (PAD) management is urgently needed for Chinese intensivists' continuing education. Since 2020, because of the COVID-19 pandemic, the Chinese Analgesia and Sedation Education and Research (CASER) group has used an online blended teaching mode based on a small private online course (SPOC) and case-based learning (CBL). This study evaluated whether an online blended teaching mode has similar effects on PAD management training when an offline mode cannot be used.

MATERIALS AND METHODS

Since 2020, the CASER group has provided offline training and online SPOC&CBL training three times each, targeting intensivists and ICU nurses in China. All participants were divided into an offline group and SPOC&CBL group. A final examination was offered in each training session to assess the students' mastery of professional knowledge. Teachers' and students' perceptions regarding the online SPOC&CBL mode were evaluated through questionnaires.

RESULTS

Of all participants (n = 117), 106 completed all examinations and questionnaires. Most participants were aged 31-40 years (53, 50.0%), had an academic degree (60, 56.6%), and worked in a tertiary hospital (100, 94.34%). We assessed the learning effect on participants from two aspects: theory and clinical practice. There was no significant difference between the SPOC&CBL and offline groups in terms of theoretical, case analysis, and total scores (p > 0.05). In terms of the participants' perceptions regarding the SPOC&CBL mode, 91.5% considered the online mode to be a useful and accessible alternative to improve knowledge and skills. A total of 95.7% of the participants believed that they could interact well with group members, and 87.2% believed that they had a good degree of participation. Of these participants, 76.6% believed that they had received valuable learning resources. All instructors believed that the SPOC&CBL mode was more flexible than the offline mode in terms of teaching time and location, and they were all willing to carry out training with the SPOC&CBL mode.

CONCLUSION

Compared to the offline mode, the SPOC&CBL mode can also enhance participants' knowledge and skills and meets their expectations. Therefore, an online mode can be considered a potential method in PAD management education in China.

Incidence, associated factors, and outcomes of delirium in critically ill children in china: a prospective cohort study

BACKGROUND

Delirium occurs frequently in critically ill children and has been reported in many countries, but delirium is not well-characterized in China. The aim of this study was to represent the incidence of delirium in critically ill children in China, its associated factors, and the influence of delirium on in-hospital outcomes.

METHODS

This observational prospective cohort study was set up in a large academic medical center with a 57-bed PICU in southwestern China. Critically ill children who required PICU stays over 24 h and were admitted between November 2019 and February 2022 were included in this study. The Cornell Assessment of Pediatric Delirium was used twice daily for delirium evaluation by bedside nurses, and twenty-four clinical features were collected from medical and nursing records during hospitalization.

RESULTS

The incidence of delirium was 26.0% (n = 410/1576). Multivariate analysis revealed that seven independent risk factors including days of mechanical ventilation and physical restraints, admission diagnosis (neurologic disorder), sleep deprivation, use of benzodiazepines and dexmedetomidine, liver failure/liver dysfunction associated with delirium in critically ill children. One potentially protective factor was the watching television /listening to music/playing with toys. Children with delirium had longer lengths of stay in the PICU (median 11 vs. 10 days, p < 0.001) and hospital (median 18 vs. 15 days, p < 0.001) compared to those without delirium. Additionally, the in-hospital mortality rates were 4.63% and 0.77% in patients with and without delirium (p < 0.05).

CONCLUSIONS

Delirium is common in critically ill children in China and related to poor outcomes. Interventional studies are warranted to determine the best practices to reduce delirium exposure in at-risk children.

Rol de enfermería frente al delirium en unidad de cuidado intensivo pediátrico: Scoping Review

Introducción: El manejo integral de delirium tiene componentes de diferente índole y el rol de enfermería frente a éste puede ser difuso. Objetivo: Identificar en la literatura disponible los cuidados de enfermería no farmacológicos para niños hospitalizados en Unidad de Cuidado Intensivo Pediátrica que presenten delirium. Materiales y métodos: Se realizó una búsqueda estratégica en Web Of Science, Medline, Science Direct, Scielo, Biblioteca Virtual en Salud, LILACS y Open Grey utilizando los términos “nursing care”, “child OR children”, “delirium”, y “Pediatric Intensive Care Unit”. La extracción y análisis de los datos se dio por medio de una matriz. Resultados: Se identificaron 12 artículos que cumplían con los criterios de inclusión y se clasificaron en 4 categorías según la intervención principal desarrollada en el estudio: Abordaje investigativo, intervenciones de confort, intervenciones integrales, e intervenciones educativas. Discusión: El cuidado de enfermería frente al delirium comprende medidas preventivas o curativas que parten del paciente como centro y se extienden hasta su entorno y su familia. Las intervenciones de enfermería pueden estar interrelacionadas de manera que se sustentan y complementan entre ellas. Algunas actividades de cuidado pueden considerarse un indicador de calidad de la atención en salud. Conclusiones: Para abordar integralmente el delirium pediátrico es necesario incidir sobre los factores individuales, ambientales y estructurales que contribuyen a su aparición. El cuidado de enfermería frente al delirium constituye una forma de proteger y promover el bienestar y el desarrollo inmediato y futuro de los niños.