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Bertone S, Denina M, Pagano M, Delmonaco AG, Castagno E, Bondone C. Red Code Management in a Pediatric Emergency Department: A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:462. [PMID: 38671679 PMCID: PMC11048913 DOI: 10.3390/children11040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
The "red code" (RC) represents the highest level of emergency in the emergency department (ED). This study retrospectively analyzed RCs in the Regina Margherita Children's Hospital ED, a regional referral center in north Italy, between 1 July 2020 and 30 June 2023. The aim was to describe RC characteristics and to identify significant correlations between presenting complaints and clinical management. The study includes 934 RCs (0.9% of overall ED admissions); 64% were assigned based on the Pediatric Assessment Triangle alteration. Most patients, 86.5%, followed the medical pathway, while 13.5% were surgical cases. Admission complaints were respiratory (46.9%), neuropsychiatric (26.7%), traumatic (11.8%), cardiologic (9.3%), metabolic (3.8%), and surgical (1.5%). Seventy-six percent of patients received vascular access, and intraosseous access was obtained in 2.2% of them. In one-third of RCs, an urgent critical care evaluation was necessary, and 19% of cases required admission to the intensive care unit. The overall mortality rate was 3.4% (0.4% in ED setting). The study identified six distinct diagnostic pathways, each associated with specific characteristics in clinical presentation, management, therapeutic interventions, and outcomes. Our findings underscore the need for a systematic approach in pediatric emergency settings, supported by international and national guidelines but also by clearly defined diagnostic pathways, aiming to enhance the quality of care and patient outcomes.
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Affiliation(s)
- Serena Bertone
- Paediatric Unit, Ospedale Regina Montis Regalis, 12084 Mondovì, Italy;
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Città della Salute e della Scienza, 10126 Turin, Italy
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Manuela Pagano
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Angelo Giovanni Delmonaco
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
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Olfat M, Hosseinzadeh R, Sharifzadeh M, Hassani SA, Goudarzi M, Mohammadpour M. Infant Intensive Care Unit: Is it Time to Change? Indian J Pediatr 2024:10.1007/s12098-024-05032-1. [PMID: 38358405 DOI: 10.1007/s12098-024-05032-1] [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: 08/04/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To assess the effect of the Infant intensive care unit (InICU), a specialized unit for critically ill infants established in 2016 in authors' hospital, on infant mortality and compare the outcome with the current Pediatric intensive care units (PICU). METHODS In this retrospective cross-sectional study, two groups were defined; the first included expired patients aged 1 mo to 2 y admitted to PICU before the establishment of the InICU (the PICU group). The second included age-matched expired patients admitted to the InICU (the InICU group). Data were recorded using a questionnaire. RESULTS The authors found that the age, sex, underlying diseases, the leading cause of admission to the ICU, time of death, hospital and ICU length of stay, and the pediatric index of mortality 2 (PIM 2) score were same between the two groups. The incidence of mortality in the PICU group was 10.66 in 1000 person-month. This value was 6.37 for the InICU group (P-value <0.001). The relative risk of mortality of patients admitted to the PICU group compared to the InICU group was 1.67 (P-value <0.001). CONCLUSIONS Establishment of age specific InICU for infants may be beneficial in reducing infant mortality.
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Affiliation(s)
- Mehrnaz Olfat
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | | | - Meisam Sharifzadeh
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Hassani
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Goudarzi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mohammadpour
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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3
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Horvat CM, Hamilton MF, Hall MW, McGuire JK, Mink RB. Child Health Needs and the Pediatric Critical Care Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678G. [PMID: 38300003 DOI: 10.1542/peds.2023-063678g] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
This article, focused on the current and future pediatric critical care medicine (PCCM) workforce, is part of a supplement in Pediatrics anticipating the future supply of the pediatric subspecialty workforce. It draws on information available in the literature, data from the American Board of Pediatrics, and findings from a model that estimates the future supply of pediatric subspecialists developed by the American Board of Pediatrics Foundation in collaboration with the Carolina Workforce Research Center at the University of North Carolina at Chapel Hill's Cecil G. Sheps Center for Health Services Research and Strategic Modeling and Analysis Ltd. A brief history of the field of PCCM is provided, followed by an in-depth examination of the current PCCM workforce and a subsequent evaluation of workforce forecasts from 2020 to 2040. Under baseline conditions, the PCCM workforce is expected to increase by 105% during the forecasted period, more than any other pediatric subspecialty. Forecasts are modeled under a variety of multifactorial conditions meant to simulate the effects of changes to the supply of PCCM subspecialists, with only modest changes observed. Future PCCM workforce demand is unclear, although some suggest an oversupply may exist and that market forces may correct this. The findings generate important questions regarding the future state of the PCCM workforce and should be used to guide trainees considering a PCCM career, subspecialty leaders responsible for hosting training programs, staffing ICUs, and governing bodies that oversee training program accreditation and subspecialist certification.
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Affiliation(s)
| | | | - Mark W Hall
- Nationwide Children's Hospital, Columbus, Ohio
| | | | - Richard B Mink
- The Lundquist Institute for Biomedical Innovation at Harbor, University of California Los Angeles Medical Center, Torrance, California
- David Geffen School of Medicine at UCLA, Torrance, CA
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4
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de Sonnaville ESV, Vermeule J, Oostra K, Knoester H, van Woensel JBM, Allouch SB, Oosterlaan J, Kӧnigs M. Predicting long-term neurocognitive outcome after pediatric intensive care unit admission for bronchiolitis-preliminary exploration of the potential of machine learning. Eur J Pediatr 2024; 183:471-482. [PMID: 37930398 PMCID: PMC10857960 DOI: 10.1007/s00431-023-05307-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/29/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE For successful prevention and intervention, it is important to unravel the complex constellation of factors that affect neurocognitive functioning after pediatric intensive care unit (PICU) admission. This study aims (1) to elucidate the potential relevance of patient and PICU-related characteristics for long-term adverse neurocognitive outcome after PICU admission for bronchiolitis, and (2) to perform a preliminary exploration of the potential of machine learning as compared to linear regression to improve neurocognitive outcome prediction in a relatively small sample of children after PICU admission. METHODS This cross-sectional observational study investigated 65 children aged 6-12 years with previous PICU admission for bronchiolitis (age ≤ 1 year). They were compared to demographically comparable healthy peers (n = 76) on neurocognitive functioning. Patient and PICU-related characteristics used for the prediction models were as follows: demographic characteristics, perinatal and disease parameters, laboratory results, and intervention characteristics, including hourly validated mechanical ventilation parameters. Neurocognitive outcome was measured by intelligence and computerized neurocognitive testing. Prediction models were developed for each of the neurocognitive outcomes using Regression Trees, k-Nearest Neighbors, and conventional linear regression analysis. RESULTS The patient group had lower intelligence than the control group (p < .001, d = -0.59) and poorer performance in neurocognitive functions, i.e., speed and attention (p = .03, d = -0.41) and verbal memory (p < .001, d = -0.60). Lower intelligence was predicted by lower birth weight and lower socioeconomic status (R2 = 25.9%). Poorer performance on the speed and attention domain was predicted by younger age at follow-up (R2 = 53.5%). Poorer verbal memory was predicted by lower birth weight, younger age at follow-up, and greater exposure to acidotic events (R2 = 50.6%). The machine learning models did not reveal added value in terms of model performance as compared to linear regression. CONCLUSION The findings of this study suggest that in children with previous PICU admission for bronchiolitis, (1) lower birth weight, younger age at follow-up, and lower socioeconomic status are associated with poorer neurocognitive outcome; and (2) greater exposure to acidotic events during PICU admission is associated with poorer verbal memory outcome. The findings of this study provide no evidence for the added value of machine learning models as compared to linear regression analysis in the prediction of long-term neurocognitive outcome in a relatively small sample of children. WHAT IS KNOWN • Adverse neurocognitive outcomes are described in PICU survivors, which are known to interfere with development in other major domains of functioning, such as mental health, academic achievement, and socioeconomic success, highlighting neurocognition as an important outcome after PICU admission. • Machine learning is a rapidly growing field of artificial intelligence that is increasingly applied in health care settings, with great potential to capture the complexity of outcome prediction. WHAT IS NEW • This study shows that lower birth weight, lower socioeconomic status, and greater exposure to acidotic events during PICU admission for bronchiolitis are associated with poorer long-term neurocognitive outcome after PICU admission. Results provide no evidence for the added value of machine learning models in a relatively small sample of children. • As bronchiolitis seldom manifests neurologically, the relation between acidotic events and neurocognitive outcome may reflect either potentially harmful effects of acidosis itself or related processes such as hypercapnia or hypoxic and/or ischemic events during PICU admission. This study further highlights the importance of structured follow-up to monitor long-term outcome of children after PICU admission.
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Affiliation(s)
- Eleonore S V de Sonnaville
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands.
| | - Jacob Vermeule
- University of Amsterdam, Informatics Institute, Science Park 904, Amsterdam, The Netherlands
| | - Kjeld Oostra
- University of Amsterdam, Informatics Institute, Science Park 904, Amsterdam, The Netherlands
| | - Hennie Knoester
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Somaya Ben Allouch
- University of Amsterdam, Informatics Institute, Science Park 904, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Marsh Kӧnigs
- Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
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Liu J, Jackson SS, Xie J, Rowland MJ, Michelson CD. National Survey of Combined Pediatrics-Anesthesiology Residents and Graduates: Factors Contributing to Changing Career Aspirations Over Time. Anesth Analg 2023; 137:1250-1256. [PMID: 36729970 DOI: 10.1213/ane.0000000000006308] [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: 02/03/2023]
Abstract
BACKGROUND The Dual Pathway for Certification in Pediatrics and Anesthesiology was created in 2011 to develop leaders in caring for children with complex medical and surgical conditions. While existing dual-trained practitioners report continued practice in both pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM), recent surveys of dual pathway trainees have shown that only one-quarter still currently plan to pursue training in PCCM, a change from their initial plans to complete training in both PA and PCCM. The aim of this study was to further characterize the motivations driving shifts in career trajectory during training as well as factors affecting the combined training experience. METHODS We conducted an online mixed-methods survey of all individuals who had matriculated at 1 of the 7 Accreditation Council for Graduate Medical Education-accredited combined pediatrics-anesthesiology residencies from 2011 to 2018. The survey consisted of a 30-item questionnaire addressing training experience, anticipated career trajectory, and respondent demographics. Descriptive statistics were used for closed-format questions. Responses to open-ended questions were systematically analyzed through inductive iterative review by 2 of the authors to elicit a set of overarching themes. RESULTS We achieved a response rate of 85% (n = 53/62) with respondents from 7 of 7 combined residency programs. When asked about career goals, the majority of respondents planned to pursue both PA and PCCM (60%, n = 32) at the start of residency. However, at the time of survey completion, the percentage of respondents who were still planning to (or had already completed) train in both PA and PCCM had decreased to 23% (n = 12). Factors such as lifestyle and length of training contributed more to career choices during/after training compared to before residency. Thematic analysis of open-ended questions regarding transition between specialties, impact of dual training, and general comments revealed 3 major themes: (1) challenges of transitioning between specialties, (2) dual training is mutually beneficial, and (3) the need for an established fellowship training pathway. CONCLUSIONS While there is continued interest in dual training in PA/PCCM for residents who enter the combined pediatrics-anesthesiology residency, factors such as duration of training and lifestyle become more important during residency and alter their career trajectories, often away from PCCM. Optimization of dual-subspecialty fellowship training will be critical to sustaining interest in dual-subspecialty training in PA/PCCM.
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Affiliation(s)
- Jia Liu
- From the Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shawn S Jackson
- From the Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Xie
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, California
| | - Matthew J Rowland
- Division of Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Catherine D Michelson
- Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
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Critical Care and Occupational Therapy Practice Across the Lifespan. Am J Occup Ther 2023; 77:7713410220. [PMID: 38166053 DOI: 10.5014/ajot.2023.77s3003] [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: 01/04/2024] Open
Abstract
This AOTA Position Statement defines the distinct role and value of occupational therapy practitioners in critical care settings across the lifespan. Occupational therapy practitioners are essential interprofessional team members who address the needs of critically ill individuals by implementing evidence-based critical care guidelines that aim to improve the quality of survivorship.
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de Sonnaville ESV, Kӧnigs M, Aarnoudse-Moens CSH, van Woensel JBM, Oosterlaan J, Knoester H. Long-Term Follow-Up of Daily Life Functioning After Pediatric Intensive Care Unit Admission. J Pediatr 2023; 260:113477. [PMID: 37187287 DOI: 10.1016/j.jpeds.2023.113477] [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: 10/14/2022] [Revised: 03/29/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate the long-term impact of pediatric intensive care unit (PICU) admission on daily life functioning while exploring the potential mediating role of neurocognitive outcome. STUDY DESIGN This cross-sectional observational study compared children aged 6-12 years with previous PICU admission (age ≤1 year) for bronchiolitis requiring mechanical ventilation ("patient group," n = 65) to demographically comparable healthy peers ("control group," n = 76). The patient group was selected because bronchiolitis is not expected to affect neurocognitive functioning in itself. Assessed daily life outcome domains were behavioral and emotional functioning, academic performance, and health-related quality of life (QoL). The role of neurocognitive outcomes in the relationship between PICU admission and daily life functioning was assessed by mediation analysis. RESULTS The patient group did not differ from the control group regarding behavioral and emotional functioning but performed poorer on academic performance and school-related QoL (Ps ≤ .04, d = -0.48 to -0.26). Within the patient group, lower full-scale IQ (FSIQ) was associated with poorer academic performance and school-related QoL (Ps ≤ .02). Poorer verbal memory was associated with poorer spelling performance (P = .002). FSIQ mediated the observed effects of PICU admission on reading comprehension and arithmetic performance. CONCLUSIONS Children admitted to the PICU are at risk for long-term adverse daily life outcomes in terms of academic performance and school-related QoL. Findings suggest that lower intelligence may contribute to academic difficulties after PICU admission. Findings underline the importance of monitoring daily life and neurocognitive functioning after PICU admission.
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Affiliation(s)
- Eleonore S V de Sonnaville
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - Marsh Kӧnigs
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Hennie Knoester
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Calhoun J, Kline-Tilford A, Verger J. Evolution of Pediatric Critical Care Nursing. Crit Care Nurs Clin North Am 2023; 35:265-274. [PMID: 37532380 DOI: 10.1016/j.cnc.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pediatric critical care nursing is a key pillar in patient care and outcomes for children who are ill and injured. Tremendous advances have occurred in pediatric critical care and nursing. This article provides an overview of the key advances in pediatric critical care nursing through the decades.
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Affiliation(s)
- Jackie Calhoun
- UPMC Children's Hospital of Pittsburgh, The University of Pittsburgh, School of Nursing, 3500 Victoria Street, 440 Victoria Building, Pittsburgh, PA 15261, USA
| | | | - Judy Verger
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Hill K, McCabe C, Brenner M. Impact of adapting paediatric intensive care units for adult care during the COVID-19 pandemic: a scoping review. BMJ Open 2023; 13:e068174. [PMID: 37640456 PMCID: PMC10462976 DOI: 10.1136/bmjopen-2022-068174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES The objectives were to categorise the evidence, map out the existing studies and explore what was known about the organisation of paediatric intensive care units (PICUs) during the first 18 months of the COVID-19 pandemic. Additionally, this review set out to identify any knowledge gaps in the literature and recommend areas for future research. DESIGN Scoping review. METHODS This study used Arksey and O'Malley's six-stage scoping review framework. A comprehensive search was conducted using the following databases, CINAHL Complete; MEDLINE; PsycINFO; PsycARTICLES and EMBASE and grey literature search engines. A search strategy with predefined inclusion criteria was used to uncover relevant research in this area. Screening and data collection were done in duplicate. RESULTS 47 631 articles were obtained through searching. However, only 25 articles met the inclusion criteria and were included in the analysis. Three dominant themes emerged from the literature: (1) the reorganisation of space for managing increased capacity; (2) increased staffing and support; and (3) the resulting challenges. CONCLUSION COVID-19 has strained institutional resources across the globe. To relieve the burden on intensive care units (ICUs), some PICUs adjusted their units to care for critically ill adults, with other PICUs making significant changes, including the redeployment of staff to adult ICUs to provide extra care for adults. Overall, PICUs were collectively well equipped to care for adult patients, with care enhanced by implementing elements of holistic, family-centred PICU practices. The pandemic fostered a collaborative approach among PICU teams and wider hospital communities. However, specific healthcare guidelines had to be created to safely care for adult patients.
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Affiliation(s)
- Katie Hill
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Catherine McCabe
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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10
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de Sonnaville ESV, van Woensel JBM, van Goudoever JB, Otten MH, Teela L, Aarnoudse-Moens CSH, Terheggen-Lagro SWJ, van der Hulst AE, Engelen M, Kӧnigs M, Oosterlaan J, Knoester H. Structured Multidisciplinary Follow-Up After Pediatric Intensive Care: A Model for Continuous Data-Driven Health Care Innovation. Pediatr Crit Care Med 2023; 24:484-498. [PMID: 36807306 PMCID: PMC10226472 DOI: 10.1097/pcc.0000000000003213] [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] [Indexed: 02/22/2023]
Abstract
OBJECTIVES Morbidity after PICU admission for critical illness is a growing concern. Sequelae may occur in various domains of functioning and can only appropriately be determined through structured follow-up. Here, we describe the process of designing and implementing a structured multidisciplinary follow-up program for patients and their parents after PICU admission and show the first results illustrating the significance of our program. DESIGN Prospective observational cohort study. SETTING Outpatient PICU follow-up clinic. PATIENTS Patients 0-18 years old admitted to our PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In our structured multidisciplinary follow-up program, follow-up care is provided by a pediatric intensivist and psychologist and in addition, depending on patient's critical illness and received PICU treatment(s), by a pediatric pulmonologist, cardiologist, neurologist, and/or neuropsychologist. All consultations are scheduled consecutively. Collected data are stored in a hospital-wide data warehouse and used for yearly health care evaluation sessions as well as scientific research. Challenges in organizing this follow-up program include technological challenges, providing time-efficient care, participation rate, and completeness of questionnaires. In our experience, a dedicated team is essential to tackle these challenges. Our first results, obtained in 307 of 388 referred patients (79.1%), showed the diversity of problems arising after PICU discharge, including physical, neurocognitive, and psychosocial sequelae. In addition, our data also reflected the risk of psychosocial problems among parents. Within the limited operation time of our follow-up program, the program has evolved based on our experiences and the data collected. CONCLUSIONS We successfully developed and implemented a structured multidisciplinary follow-up program for patients and their parents after PICU admission. This program may help to timely initiate appropriate interventions, improve the standard of care during and after PICU admission, and facilitate scientific research on outcome and prognosis after PICU admission.
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Affiliation(s)
- Eleonore S V de Sonnaville
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam & Vrije Universiteit, Emma Children's Hospital, Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marieke H Otten
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lorynn Teela
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development & Amsterdam Public Health Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development & Amsterdam Public Health Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Suzanne W J Terheggen-Lagro
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Pulmonology and Allergy, Amsterdam Reproduction and Development & Infection and Immunity Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Annelies E van der Hulst
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marc Engelen
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Amsterdam Neuroscience & Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marsh Kӧnigs
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hennie Knoester
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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11
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Chiarastelli TDC, de Sá CDSC, Garcia CSNB, Cabó SL, Carvalho RDP. Translation and cross-cultural adaptation of the pediatric cerebral performance category (PCPC) and pediatric overall performance category (POPC) to Brazilian Portuguese. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022030. [PMID: 37255106 DOI: 10.1590/1984-0462/2023/41/2022030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/30/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To translate and culturally adapt the scales Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) to the Brazilian population. METHODS Two English language proficient professionals independently translated the original version of the scales into Brazilian Portuguese. After consensus, it was generated a translated version of each scale. These were back translated into English by two native English translators. A new consensus process resulted in an English version of each scale, which were compared with the originals and approved by the author. A committee of experts with clinical and academic experience in intensive care checked the validity of the content and produced the pre-final versions of the scales, which were tested by 25 professionals from a Pediatric Intensive Care Unit. An audit was conducted to verify the consistency of the methodological process. RESULTS The pre-final versions were approved by 96% of the Brazilian professionals. No significant changes were made to the content of the instrument; however, it was identified the need of a guide with instructions on how to use the scales. CONCLUSIONS The process of translation and cross-cultural adaptation of the scales was completed and resulted in PCPC-BR and POPC-BR scales.
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12
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Deschenes S, Scott SD, Kunyk D. Mitigating Moral Distress: Pediatric Critical Care Nurses' Recommendations. HEC Forum 2023:10.1007/s10730-023-09506-1. [PMID: 37140806 PMCID: PMC10158695 DOI: 10.1007/s10730-023-09506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) "I'm sorry, there's nothing else": increasing supports for patients and families; (2) "someone will commit suicide": improving supports for nurses: (3) "Everyone needs to be heard": improving patient care communication; and (4) "I didn't see it coming": providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions.
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Affiliation(s)
- Sadie Deschenes
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
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13
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Abstract
Children who survive the pediatric intensive care unit (PICU) are at risk of developing post-intensive care syndrome in pediatrics (PICS-p). PICS-p, defined as new physical, cognitive, emotional, and/or social health dysfunction following critical illness, can affect the child and family. Historically, synthesizing PICU outcomes research has been challenging due to inconsistency in study design and in outcomes measurement. PICS-p risk may be mitigated by implementing intensive care unit best practices that limit iatrogenic injury and by supporting the resiliency of critically ill children and their families.
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14
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Macias CG, Remy KE, Barda AJ. Utilizing big data from electronic health records in pediatric clinical care. Pediatr Res 2023; 93:382-389. [PMID: 36434202 PMCID: PMC9702658 DOI: 10.1038/s41390-022-02343-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/25/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
Big data has the capacity to transform both pediatric healthcare delivery and research, but its potential has yet to be fully realized. Curation of large multi-institutional datasets of high-quality data has allowed for significant advances in the timeliness of quality improvement efforts. Improved access to large datasets and computational power have also paved the way for the development of high-performing, data-driven decision support tools and precision medicine approaches. However, implementation of these approaches and tools into pediatric practice has been hindered by challenges in our ability to adequately capture the heterogeneity of the pediatric population as well as the nuanced complexities of pediatric diseases such as sepsis. Moreover, there are large gaps in knowledge and definitive evidence demonstrating the utility, usability, and effectiveness of these types of tools in pediatric practice, which presents significant challenges to provider willingness to leverage these solutions. The next wave of transformation for pediatric healthcare delivery and research through big data and sophisticated analytics will require focusing efforts on strategies to overcome cultural barriers to adoption and acceptance. IMPACT: Big data from EHRs can be used to drive improvement in pediatric clinical care. Clinical decision support, artificial intelligence, machine learning, and precision medicine can transform pediatric care using big data from the EHR. This article provides a review of barriers and enablers for the effective use of data analytics in pediatric clinical care using pediatric sepsis as a use case. The impact of this review is that it will inform influencers of pediatric care about the importance of current trends in data analytics and its use in improving outcomes of care through EHR-based strategies.
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Affiliation(s)
- Charles G. Macias
- grid.67105.350000 0001 2164 3847Department of Pediatrics, Division of Pediatric Emergency Medicine, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH USA
| | - Kenneth E. Remy
- grid.415629.d0000 0004 0418 9947Department of Pediatrics, Division of Pediatric Critical Care Medicine, Rainbow Babies and Children’s Hospital, Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University Hospital of Cleveland, Case Western University School of Medicine, Cleveland, OH USA
| | - Amie J. Barda
- grid.189504.10000 0004 1936 7558Department of Population and Quantitative Health Sciences, Case Western Reserve, University School of Medicine, Cleveland, OH USA
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15
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Stark RJ, Yildizdas D. Editorial: Case reports in pediatric critical care 2022. Front Pediatr 2023; 11:1176704. [PMID: 37009277 PMCID: PMC10064131 DOI: 10.3389/fped.2023.1176704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 04/04/2023] Open
Affiliation(s)
- Ryan J. Stark
- Department of Pediatrics, Division of Pediatric Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States
- Correspondence: Ryan J. Stark
| | - Dinçer Yildizdas
- Department of Pediatrics, Division of Pediatric Critical Care, Çukurova University School of Medicine, Adana, Türkiye
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16
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The use of machine learning and artificial intelligence within pediatric critical care. Pediatr Res 2023; 93:405-412. [PMID: 36376506 PMCID: PMC9660024 DOI: 10.1038/s41390-022-02380-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/15/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
The field of pediatric critical care has been hampered in the era of precision medicine by our inability to accurately define and subclassify disease phenotypes. This has been caused by heterogeneity across age groups that further challenges the ability to perform randomized controlled trials in pediatrics. One approach to overcome these inherent challenges include the use of machine learning algorithms that can assist in generating more meaningful interpretations from clinical data. This review summarizes machine learning and artificial intelligence techniques that are currently in use for clinical data modeling with relevance to pediatric critical care. Focus has been placed on the differences between techniques and the role of each in the clinical arena. The various forms of clinical decision support that utilize machine learning are also described. We review the applications and limitations of machine learning techniques to empower clinicians to make informed decisions at the bedside. IMPACT: Critical care units generate large amounts of under-utilized data that can be processed through artificial intelligence. This review summarizes the machine learning and artificial intelligence techniques currently being used to process clinical data. The review highlights the applications and limitations of these techniques within a clinical context to aid providers in making more informed decisions at the bedside.
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17
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Dendir G, Awoke N, Alemu A, Sintayhu A, Eanga S, Teshome M, Zerfu M, Tila M, Dessu BK, Efa AG, Gashaw A. Factors Associated with the Outcome of a Pediatric Patients Admitted to Intensive Care Unit in Resource-Limited Setup: Cross-Sectional Study. Pediatric Health Med Ther 2023; 14:71-79. [PMID: 36890923 PMCID: PMC9987449 DOI: 10.2147/phmt.s389404] [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: 09/22/2022] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Background Critical care is a multidisciplinary and interprofessional specialty devoted to treating patients who already have or are at danger of developing acute, life-threatening organ dysfunction. Due to the higher disease load and mortality from preventable illness, patient outcomes in intensive care units are challenging in settings with inadequate resources. This study aimed to determine factors associated with outcomes of pediatric patients admitted to intensive care units. Methods A cross-sectional study was conducted at Wolaita Sodo and Hawassa University teaching hospitals in southern Ethiopia. Data were entered and analyzed using SPSS version 25. Normality tests using the Shapiro-Wilk and Kolmogorov-Smirnov data were normally distributed. The frequency, percentage, and cross-tabulation of the different variables were then determined. Finally, the magnitude and associated factors were first analyzed using binary logistic regression and then multivariate logistic regression. Statistical significance was set at P < 0.05. Results A total of 396 Pediatric ICU patients were included in this study, and 165 (41.7%) deaths were recorded. The odds of patients from urban areas (AOR = 45%, CI 95%: 8%, 67% p-value = 0.025) were less likely to die than those in rural areas. Patients with co morbidities (AOR = 9.4, CI 95%: 4.5, 19.7, p = 0.000) were more likely to die than pediatric patients with no co-morbidities. Patients admitted with Acute respiratory distress syndrome (AOR = 12.86, CI 95%: 4.3, 39.2, p = 0.000) were more likely to die than those with not. Pediatric patients on mechanical ventilation (AOR = 3, CI 95%: 1.7, 5.9, p = 0.000) more likely to die than not mechanically ventilated. Conclusion Mortality of paediatric ICU patients was high (40.7%) in this study. Co-morbid disease, residency, the use of inotropes, and the length of ICU stay were all statistically significant predictors of death.
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Affiliation(s)
- Getahun Dendir
- School of Anesthesia, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Nefsu Awoke
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Afework Alemu
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Ashagrie Sintayhu
- School of Anesthesia, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Shamill Eanga
- College of Health Science and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Mistire Teshome
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mahlet Zerfu
- School of Medicine, College of Health Science and Medicine, Yekatit 12 Medical College, Addis Ababa, Ethiopia
| | - Mebratu Tila
- School of Anesthesia, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Blen Kassahun Dessu
- School of Anesthesia, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amelework Gonfa Efa
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanu Gashaw
- Department of Anesthesia, College of Health Science and Medicine, Hawassa University, Hawassa, Ethiopia
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Argent AC, Ranjit S, Peters MJ, Andre-von Arnim AVS, Chisti MJ, Jabornisky R, Musa NL, Kissoon N. Factors to be Considered in Advancing Pediatric Critical Care Across the World. Crit Care Clin 2022; 38:707-720. [PMID: 36162906 DOI: 10.1016/j.ccc.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article reviews the many factors that have to be taken into account as we consider the advancement of pediatric critical care (PCC) in multiple settings across the world. The extent of PCC and the range of patients who are cared for in this environment are considered. Along with a review of the ongoing treatment and technology advances in the PCC setting, the structures and systems required to support these services are also considered. Finally the question of how PCC can be made sustainable in a volatile world with the impacts of global crises such as climate change is addressed.
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Affiliation(s)
- Andrew C Argent
- Department of Paediatrics and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Suchitra Ranjit
- Pediatric ICU, Apollo Children's Hospital, 15, Shafee Mhd Road, Chennai 600006, India
| | - Mark J Peters
- University College London Great Ormond Street Institute of Child Health, London, WC1N 3JH, UK; Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, WC1N 1EH, UK
| | - Amelie von Saint Andre-von Arnim
- Department of Pediatrics, Division of Pediatric Critical Care, University of Washington, Seattle Children's, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA; Department of Global Health, University of Washington, Seattle Children's, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA
| | - Md Jobayer Chisti
- ARI Ward, Dhaka Hospital, Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Roberto Jabornisky
- Universidad Nacional Del Nordeste, Argentina. Pediatric Intensive Care Unit (Hospital Juan Pablo II and Hospital Olga Stuky) Argentina, Sociedad Latinoamericana de Cuidados Intensivos Pediátricos, LARed Network, Universidad Nacional Del Nordeste, 1420 Mariano Moreno, Corrientes 3400, Argentina
| | - Ndidiamaka L Musa
- Paediatric Critical Care, University of Washington, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA
| | - Niranjan Kissoon
- British Columbia Children's Hospital and The University of British Columbia, Vancouver, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
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19
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Affiliation(s)
- Matthew P Kirschen
- Both authors: Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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20
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Perkowski C, Eldridge B, Zurca AD, Demartini TKM, Ceneviva GD, Williams D, Fang X, Zhou S, Thomas NJ, Krawiec C. Impact of Pediatric Intensive Care Unit Preadmission Huddle on Perceptions of Interprofessional Communication About Patient Safety. Crit Care Nurse 2022; 42:55-67. [PMID: 35908765 DOI: 10.4037/ccn2022307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Preadmission discussions in the study institution's pediatric intensive care unit are not standardized and admission plans were thought to be disjointed, leading to a perceived lack of organization and preparation for the arrival of a critically ill child. OBJECTIVE To evaluate the impact of a new, formalized preadmission pediatric intensive care unit interdisciplinary huddle on clinician perceptions of interprofessional communication. The hypothesis was that preadmission huddles would improve unit clinicians' perceptions of interprofessional communication. METHODS Interprofessional pediatric intensive care unit clinicians (physicians, advanced practice providers, nurses, and respiratory therapists) completed surveys before and 7 months after preadmission interdisciplinary huddle implementation. Huddle compliance and perceptions of interprofessional communication in the unit were evaluated. RESULTS Of 265 eligible pediatric intensive care unit admissions, 69 huddles (26.0%) occurred. The postintervention survey revealed increased odds (odds ratio [95% CI]) of responding "strongly agree" or "agree" to questions about the opportunity to "communicate effectively with health care team members" (2.42 [1.10-5.34]), "respond to feedback from health care team members" (2.54 [1.23-5.24]), and "convey knowledge to other health care team members" (2.71 [1.31-5.61]) before an admission. DISCUSSION This study introduced a formalized huddle that improved pediatric intensive care unit clinicians' perceived communication with other health care team members in the preadmission period. CONCLUSIONS Future studies are needed to determine if this perceived improvement in communication significantly affects health care outcomes of critically ill children or if these results are generalizable to other pediatric intensive care unit settings.
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Affiliation(s)
- Caroline Perkowski
- Caroline Perkowski was a pediatric intensive care unit fellow, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania, at the time the study was conducted
| | - Barbara Eldridge
- Barbara Eldridge is a critical care nurse in the pediatric intensive care unit, Department of Nursing, Penn State Health Children's Hospital
| | - Adrian D Zurca
- Adrian D. Zurca is a pediatric intensivist and pediatric critical care fellowship director, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital
| | - Theodore K M Demartini
- Theodore K. M. Demartini is a pediatric intensivist and medical director of quality and safety, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital
| | - Gary D Ceneviva
- Gary D. Ceneviva is a pediatric intensivist, Division Chief, and Vice Chair of Clinical Affairs, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital
| | - Duane Williams
- Duane Williams is a pediatric intensivist, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, and the Medical Director of patient throughput at Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Xinying Fang
- Xinying Fang is a graduate research assistant of statistics, Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Shouhao Zhou
- Shouhao Zhou is a biostatistician, Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University College of Medicine
| | - Neal J Thomas
- Neal J. Thomas is a pediatric intensivist, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, and Associate Dean for clinical research at Pennsylvania State University College of Medicine
| | - Conrad Krawiec
- Conrad Krawiec is a pediatric intensivist, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, and Pediatric Clerkship Director at Pennsylvania State University College of Medicine
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21
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Fakhory N, Lee LA, Seabrook JA, Ryan M, Miller L, Foster JR. Outcomes associated with family presence at the bedside of critically ill children in the pediatric intensive care unit: a scoping review protocol. JBI Evid Synth 2022; 20:2040-2047. [DOI: 10.11124/jbies-21-00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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22
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Cardiovascular Critical Care in Children. Pediatr Clin North Am 2022; 69:403-413. [PMID: 35667753 DOI: 10.1016/j.pcl.2022.02.002] [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] [Indexed: 11/22/2022]
Abstract
Pediatric cardiac critical care has evolved with advances in congenital heart surgery, interventional cardiac catheterization, and diagnostic advances. Debate remains over the optimal location of care and training background despite data showing that systems established in collaboration with multidisciplinary experts in the care of children with congenital heart disease are associated with the best outcomes. Operative mortality is low, and preventing morbidity is the new focus of the future. Advances in screening and fetal diagnosis, mechanical circulatory support, and collaborative research and quality improvement initiatives are reviewed in this article.
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23
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Abstract
Brain injury in children is a major public health problem, causing substantial morbidity and mortality. Cause of pediatric brain injury varies widely and can be from a primary neurologic cause or as a sequela of multisystem illness. This review discusses the emerging field of pediatric neurocritical care (PNCC), including current techniques of imaging, treatment, and monitoring. Future directions of PNCC include further expansion of evidence-based practice guidelines and establishment of multidisciplinary PNCC services within institutions.
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Affiliation(s)
- Ajit A Sarnaik
- Central Michigan University College of Medicine, Carls Building, Pediatric Critical Care, Children's Hospital of Michigan, 3901 Beaubien Avenue, Detroit, MI 48201, USA.
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24
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de Sonnaville ESV, Kӧnigs M, van Leijden O, Knoester H, van Woensel JBM, Oosterlaan J. Intelligence outcome of pediatric intensive care unit survivors: a systematic meta-analysis and meta-regression. BMC Med 2022; 20:198. [PMID: 35642037 PMCID: PMC9158152 DOI: 10.1186/s12916-022-02390-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term morbidity after pediatric intensive care unit (PICU) admission is a growing concern. Both critical illness and accompanying PICU treatments may impact neurocognitive development as assessed by its gold standard measure; intelligence. This meta-analysis and meta-regression quantifies intelligence outcome after PICU admission and explores risk factors for poor intelligence outcome. METHODS PubMed, Embase, CINAHL and PsycINFO were searched for relevant studies, published from database inception until September 7, 2021. Using random-effects meta-analysis, we calculated the standardized mean difference in full-scale intelligence quotient (FSIQ) between PICU survivors and controls across all included studies and additionally distinguishing between PICU subgroups based on indications for admission. Relation between demographic and clinical risk factors and study's FSIQ effect sizes was investigated using random-effects meta-regression analysis. RESULTS A total of 123 articles was included, published between 1973 and 2021, including 8,119 PICU survivors and 1,757 controls. We found 0.47 SD (7.1 IQ-points) lower FSIQ scores in PICU survivors compared to controls (95%CI -0.55 to -0.40, p < .001). All studied PICU subgroups had lower FSIQ compared to controls (range 0.38-0.88 SD). Later year of PICU admission (range 1972-2016) and longer PICU stay were related to greater FSIQ impairment (R2 = 21%, 95%CI -0.021 to -0.007, p < .001 and R2 = 2%, 95%CI -0.027 to -0.002, p = .03, respectively), whereas male sex and higher rate of survivors were related to smaller FSIQ impairment (R2 = 5%, 95%CI 0.001 to 0.014, p = .03 and R2 = 11%, 95%CI 0.006 to 0.022, p < .001, respectively). Meta-regression in PICU subgroups showed that later year of PICU admission was related to greater FSIQ impairment in children admitted after cardiac surgery and heart- or heart-lung transplantation. Male sex was related to smaller FSIQ impairment in children admitted after cardiac surgery. Older age at PICU admission and older age at follow-up were related to smaller FSIQ impairment in children admitted after heart- or heart-lung transplantation. CONCLUSIONS PICU survivors, distinguished in a wide range of subgroups, are at risk of intelligence impairment. Length of PICU stay, female sex and lower rate of survivors were related to greater intelligence impairment. Intelligence outcome has worsened over the years, potentially reflecting the increasing percentage of children surviving PICU admission.
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Affiliation(s)
- Eleonore S V de Sonnaville
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development research institute, Meibergdreef 9, Amsterdam, The Netherlands. .,Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development research institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Marsh Kӧnigs
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development research institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ouke van Leijden
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development research institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hennie Knoester
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development research institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development research institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development research institute, Meibergdreef 9, Amsterdam, The Netherlands
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25
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Hill K, McCabe C, Brenner M. Organisation of care in paediatric intensive care units during the first 18 months of the COVID-19 pandemic: a scoping review protocol. BMJ Open 2022; 12:e054398. [PMID: 35613808 PMCID: PMC9133726 DOI: 10.1136/bmjopen-2021-054398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The emergence of COVID-19 has had a significant impact on hospital services, particularly care delivered to those in intensive care units (ICUs) and paediatric ICUs (PICUs) across the world. Although much has been written about healthcare delivery and the healthcare setting since COVID-19 began, to the authors' knowledge, this is the first scoping review to investigate the organisation of care and changes implemented in PICUs during the COVID-19 pandemic. The aim is to conduct a scoping review of the literature to map out the existing studies about care delivery in PICUs during the COVID-19 pandemic and the changes made to the organisation of care in these units during the first 18 months of the pandemic. This review will also identify gaps in current knowledge in this area. METHODS AND ANALYSIS This study will be guided by the Joanna Briggs Institute's methodology for scoping reviews, using Arksey and O'Malley's six-stage scoping review framework: (1) identifying the research question; (2) identifying relevant studies; (3) selecting the studies; (4) data charting; (5) collating, summarising and reporting results; and (6) consulting with experts. A comprehensive search will be conducted using the following databases: CINAHL Complete; MEDLINE; PsycINFO; PsycARTICLES and EMBASE. A search strategy with predefined inclusion and exclusion criteria will be used to uncover relevant research in this area. This study will include quantitative, qualitative and mixed research methods studies published in English from 2019 to May 2021. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review. The results from this study will be disseminated through conferences and in peer-reviewed academic journals for those working in the healthcare arena.
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Affiliation(s)
- Katie Hill
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Catherine McCabe
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Matsuishi Y, Mathis BJ, Hoshino H, Enomoto Y, Shimojo N, Kawano S, Sakuramoto H, Inoue Y. PERSonality, Ehical, and PROfessional quality of life in Pediatric/Adult Intensive Nurses study: PERSEPRO PAIN study. PLoS One 2022; 17:e0259721. [PMID: 35255088 PMCID: PMC8901072 DOI: 10.1371/journal.pone.0259721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The World Health Organization included burnout syndrome criteria that reduce both professional quality of life and work satisfaction in its 11th Revision of the International Classification of Diseases in 2019 while nursing bodies have issued action calls to prevent burnout syndrome. Despite this, the effect of social factors, personality traits and cross-interaction on professional quality of life is still unclear. AIM To reveal the association between ethical climate, personal trait and professional quality of life. METHOD An online survey of registered nurses working in adult, pediatric or both ICUs. We used the ten-item personality measure based on The Big Five theory and Type-D personality Scale-14 then measured the ethical climate with the Hospital Ethical Climate Survey and the professional domains of burnout syndrome, secondary traumatic stress and compassion satisfaction by the Professional Quality of Life Scale Version 5 simultaneously. Multivariate analysis confirmed the triangular association of hospital ethical climate, personality traits and professional quality of life. RESULT We enrolled 310 participants from September 2019 to February 2020. Mean age was 33.1 years (± 5.9) and about 70% were female. In the multivariate analysis, neuroticism (p = 0.03, p = 0.01) and Type D personality (both of p<0.01) were associated with burnout syndrome and secondary traumatic stress while agreeableness (p<0.01) was associated with secondary traumatic stress. Conversely, extraversion (p = 0.01), agreeableness (p<0.01) and openness (p<0.01) were associated with compassion satisfaction. We also observed interactions between hospital ethical climate and conscientiousness (p = 0.01) for burnout syndrome and secondary traumatic stress. Neuroticism was related to (p<0.01) BOS and compassion satisfaction while Type D personality (p<0.01) correlated with burnout syndrome and secondary traumatic stress. CONCLUSION Hospital ethical climate strongly affects professional quality of life in nurses with specific personality traits. Therefore, it is important to maintain an ethical hospital climate, considering individual personalities to prevent burnout syndrome.
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Affiliation(s)
- Yujiro Matsuishi
- Neuroscience Nursing, St. Luke’s International University, Tokyo, Japan
| | - Bryan J. Mathis
- International Medical Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Haruhiko Hoshino
- Adult Health Nursing, Department of Nursing, International University of Health and Welfare, Narita, Japan
| | - Yuki Enomoto
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Satoru Kawano
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideaki Sakuramoto
- Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Ibaraki, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Implementing structured follow-up of neonatal and paediatric patients: an evaluation of three university hospital case studies using the functional resonance analysis method. BMC Health Serv Res 2022; 22:191. [PMID: 35152890 PMCID: PMC8842913 DOI: 10.1186/s12913-022-07537-x] [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: 05/22/2021] [Accepted: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background In complex critical neonatal and paediatric clinical practice, little is known about long-term patient outcomes and what follow-up care is most valuable for patients. Emma Children’s Hospital, Amsterdam UMC (Netherlands), implemented a follow-up programme called Follow Me for neonatal and paediatric patient groups, to gain more insight into long-term outcomes and to use such outcomes to implement a learning cycle for clinical practice, improve follow-up care and facilitate research. Three departments initiated re-engineering and change processes. Each introduced multidisciplinary approaches to long-term follow-up, including regular standardised check-ups for defined age groups, based on medical indicators, developmental progress, and psychosocial outcomes in patients and their families. This research evaluates the implementation of the three follow-up programmes, comparing predefined procedures (work-as-imagined) with how the programmes were implemented in practice (work-as-done). Methods This study was conducted in 2019–2020 in the outpatient settings of the neonatal intensive care, paediatric intensive care and paediatric surgery departments of Emma Children’s Hospital. It focused on the organisational structure of the follow-up care. The functional resonance analysis method (FRAM) was applied, using documentary analysis, semi-structured interviews, observations and feedback sessions. Results One work-as-imagined model and four work-as-done models were described. The results showed vast data collection on medical, developmental and psychosocial indicators in all work-as-done models; however, process indicators for programme effectiveness and performance were missing. In practice there was a diverse allocation of roles and responsibilities and their interrelations to create a multidisciplinary team; there was no one-size-fits-all across the different departments. Although control and feedback loops for long-term outcomes were specified with respect to the follow-up groups within the programmes, they were found to overlap and misalign with other internal and external long-term outcome monitoring practices. Conclusion Implementing structured long-term follow-up may provide insights for improving daily practice and follow-up care, with the precondition of standardised measurements. Lessons learned from practice are (1) to address fragmentation in data collection and storage, (2) to incorporate the diverse ways to create a multidisciplinary team in practice, and (3) to include timely actionable indicators on programme effectiveness and performance, alongside medical, developmental and psychosocial indicators. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07537-x.
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de Castro REV, Rodríguez-Rubio M, de Magalhães-Barbosa MC, Prata-Barbosa A, Holbrook J, Kamat P, Stormorken A. A review of key strategies to address the shortage of analgesics and sedatives in pediatric intensive care. Front Pediatr 2022; 10:895541. [PMID: 36110118 PMCID: PMC9468272 DOI: 10.3389/fped.2022.895541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/21/2022] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Targeted analgosedation is a challenge in critically ill children, and this challenge becomes even more significant with drug shortages. OBSERVATIONS Published guidelines inform the provision of analgosedation in critically ill children. This review provides insights into general approaches using these guidelines during drug shortages in Pediatric Intensive Care Units as well as strategies to optimize both pharmacological and non-pharmacological approaches in these situations. CONCLUSIONS AND RELEVANCE Considering that drug shortages are a recurrent worldwide problem, this review may guide managing these drugs in critically ill children in situations of scarcity, such as in pandemics or disasters.
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Affiliation(s)
- Roberta Esteves Vieira de Castro
- Pediatric Intensive Care Unit, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.,Department of Pediatrics, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.,Department of Pediatrics, Souza Marques School of Medicine, Rio de Janeiro, RJ, Brazil
| | - Miguel Rodríguez-Rubio
- Pediatric Intensive Care Department, Hospital Universitario La Paz, Madrid, Spain.,Department of Pediatrics, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Jaimee Holbrook
- Department of Pediatrics, University of Chicago Medicine, Chicago, IL, United States
| | - Pradip Kamat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Anne Stormorken
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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Alexander D, Eustace-Cook J, Brenner M. Approaches to the initiation of life-sustaining technology in children: A scoping review of changes over time. J Child Health Care 2021; 25:509-522. [PMID: 32966106 DOI: 10.1177/1367493520961884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is understood about the dynamic circumstances within which the initiation of technology dependence takes place in children. The aim of this scoping review was to identify the influences on the initiation of technology dependence and the issues that require further exploration and consideration. Scientific literature that directly or indirectly discussed the initiation of technology dependence in children was identified. A three-stage screening process of title and abstract scrutiny, full-text scanning and in-depth full-text reading resulted in 63 relevant articles from 1133 initially reviewed. These were then subjected to descriptive and thematic analysis. Articles ranged from the 1970s to the present, reflecting the evolution of ethical debates around the approaches to clinical practice and changes in cultural and societal attitudes. Three themes emerged: how technology alters the meaning of futile care, dissonance in the perspectives of decision makers and increasing support for joint decision-making. Only articles in English and predominantly from the clinician's rather than the patient's perspective were included. Societal and cultural factors as well as the structural, financial and cultural environment influence the initiation of technology dependence in children. However, to what extent these overt and implicit influences guide decision-makers in this field remains largely unknown.
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Affiliation(s)
- Denise Alexander
- School of Nursing and Midwifery, 8809Trinity College Dublin, Ireland
| | | | - Maria Brenner
- School of Nursing and Midwifery, 8809Trinity College Dublin, Ireland
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Lee JH, Long D, Srinivasan V. Translating scientific evidence into the art of caring for critically ill children across the globe. Transl Pediatr 2021; 10:2643-2645. [PMID: 34765490 PMCID: PMC8578783 DOI: 10.21037/tp-21-429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Debbie Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia.,Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Australia
| | - Vijay Srinivasan
- Department of Anesthesiology, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Matsuishi Y, Mathis BJ, Masuzawa Y, Okubo N, Shimojo N, Hoshino H, Enomoto Y, Inoue Y. Severity and prevalence of burnout syndrome in paediatric intensive care nurses: A systematic review. Intensive Crit Care Nurs 2021; 67:103082. [PMID: 34340889 DOI: 10.1016/j.iccn.2021.103082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study is to identify burnout syndrome severity and prevalence in paediatric intensive care unit nurses. DESIGN Systematic review. SETTING Paediatric intensive care unit. MAIN OUTCOME MEASURES A librarian was consulted on methodology before the search process. MEDLINE (via PubMed), EMBASE, the Cochrane Library, CINAHL, and PsycINFO were searched for full-text studies published before September 2019 in any language. Only those observational studies exploring burnout syndrome, including paediatric intensive care unit nurses, were included. Two authors independently screened studies. We assessed the risk of bias within each study based on the Office of Health Assessment and Translation tool. RESULT After screening 1238 articles, we identified six studies which met the systematic review criteria. All studies included were published after 2012 and participant sample sizes were between 35 and 195 nurses. Three studies were conducted in the United States of America while the others were from the United Kingdom, Turkey and Taiwan. Prevalence of burnout syndrome in pediatric intensive care unit nurses was reported in these studies as between 42% and 77%. The assessment tools used in these studies were the (abbreviated) Maslach Burnout Inventory, Abbreviated Maslach Burnout Inventory, Occupational Burnout Inventory, and Professional Quality of Life Scale Version 5. We could not conduct a meta-analysis due to the lack of studies. CONCLUSION Our systematic review identifies that a low number (6 total) of relevant studies focused on burnout syndrome for pediatric intensive care unit nurses with a prevalence of burnout syndrome in paediatric intensive care unit nurses of between 42% and 77%.
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Affiliation(s)
- Yujiro Matsuishi
- Neuroscience Nursing, St. Luke's International University, Tokyo, Japan
| | - Bryan J Mathis
- International Medical Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yuko Masuzawa
- Department of Health Informatics, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuko Okubo
- Neuroscience Nursing, St. Luke's International University, Tokyo, Japan
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Haruhiko Hoshino
- Adult Health Nursing, Department of Nursing, International University of Health and Welfare, Narita, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Current situation of pediatric intensive care specialty and pediatric intensive care units in Turkey: Results of a national survey. Turk Arch Pediatr 2021; 56:141-146. [PMID: 34286324 DOI: 10.14744/turkpediatriars.2020.26937] [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: 04/03/2020] [Accepted: 09/29/2020] [Indexed: 11/20/2022]
Abstract
Objective In this study, we have planned to present the results of a national survey performed to evaluate the last situation of pediatric intensive care specialty and pediatric intensive care units in Turkey. Material and Methods We have sent an electronic survey which includes 47 questions about the characteristics of pediatric intensive care units, staff, and equipment to members of the Turkish Society of Pediatric Emergency and Intensive Care via email. Results A total of 58 participant units responded to our survey. 93.2% of the centers have tertiary level pediatric intensive care units. There were 841 tertiary level pediatric intensive care beds. There were 35 pediatric intensive care faculty members, 44 pediatric intensive care specialists, and 53 pediatric intensive care fellows. In the participant units, the total number of invasive mechanical ventilators in the units was 806, the number of specific non-invasive mechanical ventilators was 126. It was learned that 79.3% of the centers could apply continuous renal replacement therapy, 84.4% of therapeutic plasma exchange, 46.5% of extracorporeal membrane oxygenation. Conclusion We see that the way we have traveled in the 20 years since the establishment of the first units is very important and proud. The number of educated new generation pediatric intensive care specialists and the well-equipped pediatric intensive care units established by these specialists in every region of our country together with the fellowship education applied in many centers make a great contribution to the treatment of the critically ill pediatric patient population in our country.
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Sánchez-Rubio L, Cleveland LM, Durán de Villalobos MM, McGrath JM. Parental Decision-Making in Pediatric Intensive Care: A Concept Analysis. J Pediatr Nurs 2021; 59:115-124. [PMID: 33848782 DOI: 10.1016/j.pedn.2021.03.018] [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: 07/09/2020] [Revised: 02/23/2021] [Accepted: 03/18/2021] [Indexed: 11/15/2022]
Abstract
The development of nursing knowledge requires a close relationship between theory, research, and practice. The purpose of the analysis of the concept of "parental decision-making in pediatric critical care" is to facilitate nurses' therapeutic care of critically ill children and their families. To construct, structure, and give meaning to the concept, we use our experience in the field, critical reading of the literature, and careful analysis of data that have emerged about parental decision-making in pediatric intensive care. Several factors affect parent's ability to act as decision-makers: the psychosocial and physical disorders they develop, the subordination of their parental roles by the health care team, and the child's critical state of health. While different disciplines, including nursing, have well described the decision-making concept, parental decision-making in the context of pediatric intensive care has not been as well delineated. Nursing science recognizes the importance of decision-making and has incorporated the concept as an essential domain of its philosophical and disciplinary interests. Following the method proposed by Walker and Avant, the concept was analyzed, attributes, background, and consequences described. A model case was presented and discussed. An operational definition emerges, providing knowledge for professional nursing practice and will be the basis for an essential theoretical development around this phenomenon. Parents' recognition, the promotion of family-centered care, and shared decisions are ideal for encouraging parental participation.
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Affiliation(s)
- Lorena Sánchez-Rubio
- Programa de Enfermería, Facultad de Ciencias de la Salud, Universidad del Tolima, Ibagué, Colombia.
| | - Lisa M Cleveland
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | | | - Jacqueline M McGrath
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX.
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Serra JA, Díaz F, Cruces P, Carvajal C, Nuñez MJ, Donoso A, Bravo-Serrano J, Carbonell M, Courtie C, Fernández A, Martínez-Arroyo L, Martínez J, Menta S, Pedrozo-Ortiz L, Wegner A, Monteverde-Fernández N, Jaramillo-Bustamante JC, Jabornisky R, González-Dambrauskas S, Kudchadkar SR, Vásquez-Hoyos P. Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes. J Pediatr Intensive Care 2021; 11:201-208. [DOI: 10.1055/s-0040-1722204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/20/2020] [Indexed: 10/21/2022] Open
Abstract
AbstractSeveral challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4–36.3).
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Affiliation(s)
- Jesus A. Serra
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Casa de Galicia, Montevideo, Uruguay
| | - Franco Díaz
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
- Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Pablo Cruces
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
- Departamento de Pediatría, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Cristobal Carvajal
- Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo, Santiago, Chile
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Facultad de Medicina, Clínica Alemana, Santiago, Chile
| | - Maria J. Nuñez
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Clínico La Florida Dra. Eloísa Díaz Insunza, Santiago, Chile
| | - A Donoso
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Clínico La Florida Dra. Eloísa Díaz Insunza, Santiago, Chile
| | - J.A Bravo-Serrano
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Caja Nacional de Salud, La Paz, Bolivia
| | - M Carbonell
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Médica Uruguaya, Montevideo, Uruguay
| | - C Courtie
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital de Sanidad Militar, Montevideo, Uruguay
| | - A Fernández
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Asociación Española, Montevideo, Uruguay
| | - L Martínez-Arroyo
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, COMEPA, Paysandú, Uruguay
| | - J Martínez
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital de Sanidad Militar, Montevideo, Uruguay
| | - S Menta
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Regional de Tacuarembó, Tacuarembó, Uruguay
| | - Luis Pedrozo-Ortiz
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Regional de Salto, Salto, Uruguay
| | - A Wegner
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | | | - Juan C. Jaramillo-Bustamante
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital General de Medellín, Colombia
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquía, Colombia
| | - Roberto Jabornisky
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Juan Pablo II, Corrientes, Argentina
| | | | - Sapna R. Kudchadkar
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Pablo Vásquez-Hoyos
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Departamento de Pediatría, Sociedad de Cirugía Hospital de San José, Bogotá, Colombia
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Universidad Nacional de Colombia, Bogotá, Colombia
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Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective. CHILDREN-BASEL 2021; 8:children8040254. [PMID: 33805106 PMCID: PMC8064072 DOI: 10.3390/children8040254] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022]
Abstract
Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and social impairments, collectively known as the “post-intensive care syndrome in pediatrics” (PICs-P). The spectrum of PICs-P manifestations within each domain are heterogeneous. This is attributed to the wide age and developmental diversity of children admitted to PICUs and the high prevalence of chronic complex conditions. PICs-P recovery follows variable trajectories based on numerous patient, family, and environmental factors. Those who improve tend to do so within less than a year of discharge. A small proportion, however, may actually worsen over time. There are many gaps in our current understanding of PICs-P. A unified approach to screening, preventing, and treating PICs-P-related morbidity has been hindered by disparate research methodology. Initiatives are underway to harmonize clinical and research priorities, validate new and existing epidemiologic and patient-specific tools for the prediction or monitoring of outcomes, and define research priorities for investigators interested in long-term outcomes.
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Welch TP, Kilbaugh TJ, McCloskey JJ, Juriga LL, Abdallah AB, Fehr JJ. The Current State of Combined Pediatric Anesthesiology-Critical Care Practice: A Survey of Dual-Trained Practitioners in the United States. Anesth Analg 2021; 132:194-201. [PMID: 32665467 DOI: 10.1213/ane.0000000000005024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Combined practice in pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM) was historically common but has declined markedly with time. The reasons for this temporal shift are unclear, but existing evidence suggests that length of training is a barrier to contemporary trainees. Among current practitioners, restriction in dual-specialty practice also occurs, for reasons that are unknown at present. We sought to describe the demographics of this population, investigate their perceptions about the field, and consider factors that lead to attrition. METHODS We conducted a cross-sectional, observational study of physicians in the United States with a combined practice in PA and PCCM. The survey was distributed electronically and anonymously to the distribution list of the Pediatric Anesthesia Leadership Council (PALC) of the Society for Pediatric Anesthesia (SPA), directing the recipients to forward the link to their faculty meeting our inclusion criteria. Attending-level respondents (n = 62) completed an anonymous, 40-question multidomain survey. RESULTS Forty-seven men and 15 women, with a median age of 51, completed the survey. Major leadership positions are held by 44%, and 55% are externally funded investigators. A minority (26%) have given up one or both specialties, citing time constraints and politics as the dominant reasons. Duration of training was cited as the major barrier to entry by 77%. Increasing age and faculty rank and lack of a comparably trained institutional colleague were associated with attrition from dual-specialty practice. The majority (88%) reported that they would do it all again. CONCLUSIONS The current cohort of pediatric anesthesiologist-intensivists in the United States is a small but accomplished group of physicians. Efforts to train, recruit, and retain such providers must address systematic barriers to completion of the requisite training and continued practice.
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Affiliation(s)
- Timothy P Welch
- From the Departments of Anesthesiology.,Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John J McCloskey
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | - James J Fehr
- From the Departments of Anesthesiology.,Pediatrics, Washington University School of Medicine, St Louis, Missouri
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Establishing the Knowledge and Skills Necessary in Pediatric Critical Care Medicine: A Systematic Approach to Practice Analysis. Pediatr Crit Care Med 2020; 21:667-671. [PMID: 32195904 DOI: 10.1097/pcc.0000000000002312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the practice analysis undertaken by a task force convened by the American Board of Pediatrics Pediatric Critical Care Medicine Sub-board to create a comprehensive document to guide learning and assessment within Pediatric Critical Care Medicine. DESIGN An in-depth practice analysis with a mixed-methods design involving a descriptive review of practice, a modified Delphi process, and a survey. SETTING Not applicable. SUBJECTS Seventy-five Pediatric Critical Care Medicine program directors and 2,535 American Board of Pediatrics Pediatric Critical Care Medicine diplomates. INTERVENTIONS A practice analysis document, which identifies the full breadth of knowledge and skill required for the practice of Pediatric Critical Care Medicine, was developed by a task force made up of seven pediatric intensivists and a psychometrician. The document was circulated to all 75 Pediatric Critical Care Medicine fellowship program directors for review and comment and their feedback informed modifications to the draft document. Concurrently, data from creation of the practice analysis draft document were also used to update the Pediatric Critical Care Medicine, was developed by a task force made up of seven pediatric intensivists and a psychometrician. The document was circulated to all 75 Pediatrics Pediatric Critical Care Medicine fellowship program directors for review and comment and their feedback informed modifications to the draft document. Concurrently, data from creation of the practice analysis draft document were also used to update the Pediatric Critical Care Medicine content outline, which was sent to all 2,535 American Board of Pediatrics Pediatric Critical Care Medicine diplomates for review during an open-comment period between January 2019 and February 2019, and diplomate feedback was used to make updates to both the content outline and the practice analysis document. MEASUREMENTS AND MAIN RESULTS After review and comment by 25 Pediatric Critical Care Medicine program directors (33.3%) and 619 board-certified diplomates (24.4%), a comprehensive practice analysis document was created through a two-stage process. The final practice analysis includes 10 performance domains which parallel previously published Entrustable Professional Activities in Pediatric Critical Care Medicine. These performance domains are made up of between three and eight specific tasks, with each task including the critical knowledge and skills that are necessary for successful completion. The final practice analysis document was also used by the American Board of Pediatrics Pediatric Critical Care Medicine Sub-board to update the Pediatric Critical Care Medicine content outline. CONCLUSIONS A systematic approach to practice analysis, with stakeholder engagement, is essential for an accurate definition of Pediatric Critical Care Medicine practice in its totality. This collaborative process resulted in a dynamic document useful in guiding curriculum development for training programs, maintenance of certification, and lifetime professional development to enable safe and efficient patient care.
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Paediatric and adult critical care medicine: joining forces against Covid-19. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:350. [PMID: 32546204 PMCID: PMC7296896 DOI: 10.1186/s13054-020-03074-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
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The economics of a pediatric surgical ICU. Curr Opin Pediatr 2020; 32:424-427. [PMID: 32332332 DOI: 10.1097/mop.0000000000000893] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe quality and financial economic principles that form the foundation for complex care delivery systems for the critically ill pediatric surgical population. RECENT FINDINGS Advances in neonatology along with innovation in surgical techniques in children led to the need to care for more complex postoperative surgical patients. Several studies have demonstrated improved outcomes in specialized pediatric centers. Furthermore, there is some evidence to suggest that there is overall financial benefit with decreased costs and more efficient resource use to pediatric subspecialty critical care. SUMMARY As more becomes known regarding the impact of specialized ICU environments, pediatric surgical critical care, and pediatric surgical ICUs have the potential to improve the value of care delivered to these complex patients. Well-designed, prospective, observational studies are needed to assist in defining appropriate outcome and quality measures to inform the development of these specialized units. Currently, there are a variety of models used in children's hospitals to care for critically ill surgical patients. This represents a tremendous opportunity for a collaborative, multidisciplinary effort amongst pediatric medical and surgical intensivists.
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Focused Subspecialty Critical Care Training Is Superior for Trainees and Patients. Crit Care Med 2020; 47:1645-1647. [PMID: 31393322 DOI: 10.1097/ccm.0000000000003962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Purpose of Review We briefly review post-intensive care syndrome (PICS) and the morbidities associated with critical illness that led to the intensive care unit (ICU) liberation movement. We review each element of the ICU liberation bundle, including pediatric support data, as well as tips and strategies for implementation in a pediatric ICU (PICU) setting. Recent Findings Numerous studies have found children have cognitive, physical, and psychiatric deficits after a PICU stay. The effects of the full ICU liberation bundle in children have not been published, but in adults, bundle implementation (even partial) resulted in significant improvement in survival, mechanical ventilation use, coma, delirium, restraint-free care, ICU readmissions, and post-ICU discharge disposition. Summary Although initially described in adults, children also suffer from PICS. The ICU liberation bundle is feasible in children and may ameliorate the effects of a PICU stay. Further studies are needed to characterize the benefits of the ICU liberation bundle in children.
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Affiliation(s)
- Alice Walz
- 1Department of Pediatrics, Medical University of South Carolina, Charleston, SC USA
| | - Marguerite Orsi Canter
- Department of Pediatrics, NYU Winthrop Hospital, Long Island School of Medicine, Mineola, NY USA
| | - Kristina Betters
- 3Department of Pediatrics, Vanderbilt University School of Medicine, Doctors Office Tower 5114, 2200 Children's Way, Nashville, TN 37232 USA
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Not Just Little ARDS?: Pediatric Critical Care and Biomarkers for Pediatric Acute Respiratory Distress Syndrome. Chest 2020; 158:850-851. [PMID: 32416160 DOI: 10.1016/j.chest.2020.05.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/02/2020] [Indexed: 11/20/2022] Open
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Roychoudhury S, Esser MJ, Buchhalter J, Bello-Espinosa L, Zein H, Howlett A, Thomas S, Murthy P, Appendino JP, Scott JN, Metcalfe C, Lind J, Oliver N, Kozlik S, Mohammad K. Implementation of Neonatal Neurocritical Care Program Improved Short-Term Outcomes in Neonates With Moderate-to-Severe Hypoxic Ischemic Encephalopathy. Pediatr Neurol 2019; 101:64-70. [PMID: 31047757 DOI: 10.1016/j.pediatrneurol.2019.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite the introduction of therapeutic hypothermia, infants with moderate-to-severe hypoxic-ischemic encephalopathy remain at risk of mortality and morbidity. A dedicated service with standardized management protocols and improved communication may help improve care. We aimed to evaluate the impact of a dedicated neonatal neurocritical care service on short-term outcomes in infants with hypoxic-ischemic encephalopathy. METHODS We performed a retrospective cohort study (July 2008 to December 2017) on term and near-term infants admitted to two tertiary neonatal intensive care units with moderate-to-severe hypoxic-ischemic encephalopathy, before and after neonatal neurocritical care service implementation. The primary outcome was brain magnetic resonance imaging findings consistent with those of hypoxic-ischemic encephalopathy. Secondary outcomes included the cooling initiation rate, hospital stay duration, antiseizure medication use, and inotrope use. Regression analysis and interrupted time series analysis were performed after adjusting for confounding factors. RESULTS In total, 216 infants with moderate-to-severe hypoxic-ischemic encephalopathy were analyzed-109 before and 107 after neonatal neurocritical care implementation. After adjusting for confounding factors, there was a significant reduction in primary outcomes (adjusted odds ratio: 0.3, confidence interval: 0.15 to 0.57, P < 0.001) after neonatal neurocritical care implementation. Average hospital stay duration reduced by 5.2 days per infant (P = 0.03), identification of eligible infants for cooling improved (P < 0.001), antiseizure medication use reduced (P = 0.001), and early inotropes use reduced (P = 0.04). CONCLUSION Implementation of a neonatal neurocritical care service associated with decreased brain injury shortened the hospital stay duration and improved the care of infants with moderate-to-severe hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Smita Roychoudhury
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Michael J Esser
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey Buchhalter
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Luis Bello-Espinosa
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Hussein Zein
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra Howlett
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Sumesh Thomas
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Prashanth Murthy
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Juan Pablo Appendino
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - James N Scott
- Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Cathy Metcalfe
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jan Lind
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Norma Oliver
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Silvia Kozlik
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Khorshid Mohammad
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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Mouzoon JL, Lloyd-McLennan A, Marcin JP. Emergency Medicine Physicians' Perceptions of Pediatric Tele-Emergency Services. Telemed J E Health 2019; 26:955-958. [PMID: 31621515 DOI: 10.1089/tmj.2019.0121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: This study evaluated general emergency medicine (GEM) physicians' opinions on the barriers, perceptions, and utility of pediatric tele-emergency services, or the use of telemedicine for critically ill children in the emergency department (ED). Methods: Based on previously published surveys, a 27-item survey was created to assess GEM physicians' perspective on tele-emergency services provided by a regional group of pediatric critical care physicians. The survey was distributed to ED medical directors at 15 hospitals who actively participate in tele-emergency services. Results: Twelve of the 15 medical directors responded to the survey (80%). Results demonstrated that GEM physicians consider the pediatric critical care tele-emergency consultations clinically helpful (92%), particularly for the management of patients with respiratory distress, congenital anomalies, and cardiovascular processes. The most common barriers to using tele-emergency services included limited time (42%), integrating new technology and processes in existing workflows (42%), and the lack of clinical utility (42%), particularly for patients with nonacute and/or routine conditions. Lastly, half of GEM physicians felt that families preferred telemedicine to telephone consultations (50%). Conclusion: GEM physicians support the premise that pediatric tele-emergency services help with the clinical management of critically ill children. However, physicians do not consistently believe that tele-emergency services are always clinically necessary and time constraints continue to be a significant barrier. Selected use on specific clinical conditions and improving the integration in workflow processes would help increase the appropriate use of tele-emergency services in the ED.
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Affiliation(s)
- Jamie L Mouzoon
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Allison Lloyd-McLennan
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
| | - James P Marcin
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
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Thompson KP, Newman CD. The Sick Child. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Longacre MM, Cummings BM, Bader AM. Building a Bridge Between Pediatric Anesthesiologists and Pediatric Intensive Care. Anesth Analg 2019; 128:328-334. [DOI: 10.1213/ane.0000000000003708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Murthy S, Chugh K, Musa N, Ouellette Y, Phan PH. Editorial: Pediatric Critical Care in Resource-Limited Settings. Front Pediatr 2019; 7:80. [PMID: 30949460 PMCID: PMC6435514 DOI: 10.3389/fped.2019.00080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/26/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Ndidi Musa
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | | | - Phuc H Phan
- Medical Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
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