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Borrelli G, Nittolo I, Bochicchio C, Trainelli L, Confalone V, Satta T, Cancani F, Kirk R, Amodeo A, Di Nardo M. What the pediatric nurse needs to know about the Impella cardiac assist device. Perfusion 2024; 39:95S-106S. [PMID: 38651583 PMCID: PMC11041080 DOI: 10.1177/02676591241237761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Background: Cardiogenic shock in children still carries a high mortality risk despite advances in medical therapy. The use of temporary mechanical circulatory supports is an accepted strategy to bridge patients with acute heart failure to recovery, decision, transplantation or destination therapy. These devices are however limited in children and extracorporeal membrane oxygenation (ECMO) remains the most commonly used device. Veno-arterial ECMO may provide adequate oxygen delivery, but it does not significantly unload the left ventricle, and this may prevent recovery. To improve the likelihood of left ventricular recovery and minimize the invasiveness of mechanical support, the Impella axial pump has been increasingly used in children with acute heart failure in the last decade. Purpose: There are still limited data describing the Impella indications, management and outcomes in children, therefore, we aimed to provide a comprehensive narrative review useful for the pediatric nurses to be adequately trained and acquire specific competencies in Impella management.
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Affiliation(s)
- Giorgia Borrelli
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ilaria Nittolo
- Academic Department of Pediatrics (DPUO), Immune and Infectious Diseases Division, Research Unit of Primary Immunodeficiencies, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Chiara Bochicchio
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Laura Trainelli
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valerio Confalone
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Tiziana Satta
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federica Cancani
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Richard Kirk
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Sansone V, Cancani F, Cecchetti C, Rossi A, Gagliardi C, Di Nardo M, Satta T, De Ranieri C, Dall'Oglio I, Tiozzo E, Gawronski O. Staff perception of the implementation, enablers and barriers to pediatric intensive care unit diary writing: A qualitative study. Intensive Crit Care Nurs 2023; 75:103351. [PMID: 36496317 DOI: 10.1016/j.iccn.2022.103351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore how the multi-professional pediatric intensive care unit staff experienced the implementation of the diary. RESEARCH METHODOLOGY/DESIGN Qualitative study using the implementation research approach. SETTING a six-bed pediatric intensive care unit at a large Italian tertiary care pediatric hospital, treating patients with acute conditions from the Emergency Department or hospital wards. MAIN OUTCOME MEASURES Healthcare providers' experiences of the implementation of the diaries. Data was collected by focus groups and interviews and thematic analysis was performed. FINDINGS Three focus groups and four interviews with staff were conducted after the implementation of thediaries from August 2020 to June 2021. Staff describe an initial disbelief towards the effectiveness of diaries followed by an increasing perception of their relevance for parents' emotional expression through shared narration. Diaries are reported as a beneficial communication tool between the family, the child, and health care providers, increasing staff understanding of parents' experiences of their child's admission and parents' sense of the care received by their child. For staff, barriers for diary writing were logistics, lack of time, limited sense of ownership, fear of legal retaliation and fear of emotional labor. CONCLUSION Health care providers perceived diaries as beneficial for parents and the healthcare team, potentially supporting their partnership as recommended by Family Centered Care models. The enablers and barriers that emerged for diary writing can support the development of implementation strategies to prevent the reported challenges to diary writing in the healthcare team, enhancing their uptake in the pediatric intensive care unit setting.
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Affiliation(s)
- Vincenza Sansone
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Pediatric Hemato-Oncology, Santobono-Pausilipon Hospital, Naples, Italy.
| | - Federica Cancani
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Angela Rossi
- Clinical Psychology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Chiara Gagliardi
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Tiziana Satta
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | | | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Ciprandi G, Crucianelli S, Zama M, Antonielli G, Armani R, Aureli S, Barra G, Beetham CJC, Bernardini G, Cancani F, Carai A, Cajozzo M, Carlesi L, Cialdella A, Ciaralli I, Ciliento G, Corsetti T, De Chirico B, Di Corato P, Dotta A, Filippelli S, Franci M, Frattaroli J, Grussu F, Lico S, Losani P, Giergji M, Magli S, Marino SF, Mongelli A, Nazzarri M, Pace M, Palmieri G, Pannacci I, Paparozzi F, Pomponi M, Portanova A, Preziosi A, Ragni A, Raponi M, Renzetti T, Rizzo M, Roberti M, Sasso E, Savarese I, Secci S, Selvaggio D, Serafini L, Spuntarelli G, Urbani U, Vanzi V, Permatunga R, Santamaria N. The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study. Int Wound J 2022; 19:1887-1900. [PMID: 36250520 PMCID: PMC9615277 DOI: 10.1111/iwj.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022] Open
Abstract
The prevention of hospital‐acquired pressure injuries (HAPIs) in children undergoing long‐duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long‐duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi‐modal, multi‐disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long‐duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long‐duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence‐based, multi‐modal, multidisciplinary HAPI prevention strategy.
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Affiliation(s)
- Guido Ciprandi
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Serena Crucianelli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mario Zama
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Giancarlo Antonielli
- Operative Unit of Odontostomatology, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Riccarda Armani
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Stefano Aureli
- Cardiology ICU, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Gianmarco Barra
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | | | - Giulio Bernardini
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Federica Cancani
- Emergency Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Andrea Carai
- Division of Neurology-Neurosurgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marta Cajozzo
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Laura Carlesi
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Alessandra Cialdella
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Italo Ciaralli
- Dpt of Pediatric Oncohematology and Transfusion Medicine, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Gaetano Ciliento
- Health Management, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Tiziana Corsetti
- Clinical Pharmacology Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Benedetta De Chirico
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Paolo Di Corato
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Sergio Filippelli
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marina Franci
- Pediatric Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Jacopo Frattaroli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Francesca Grussu
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Silvia Lico
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Patrizia Losani
- Neonatal Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marjola Giergji
- Dpt of Pediatric Oncohematology and Transfusion Medicine, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Simonetta Magli
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Simone Faustino Marino
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Antonella Mongelli
- Clinical Pharmacology Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Martina Nazzarri
- Cardiology ICU, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mauro Pace
- Pediatric Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Giancarlo Palmieri
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Ilaria Pannacci
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Franca Paparozzi
- Dpt of Pediatric Oncohematology and Transfusion Medicine, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Manuel Pomponi
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Anna Portanova
- Neonatal Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Alessandra Preziosi
- Pediatric Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Angela Ragni
- Neonatal Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Massimiliano Raponi
- Health Management, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Tommaso Renzetti
- Division of Neurology-Neurosurgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mirialda Rizzo
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marco Roberti
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Eleonora Sasso
- Neonatal Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Immacolata Savarese
- Neonatal Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Simone Secci
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Daniele Selvaggio
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Laura Serafini
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Giorgio Spuntarelli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Urbano Urbani
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Valentina Vanzi
- Division of General and Specialized Pediatrics, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Roshani Permatunga
- Department of Nursing, University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
| | - Nick Santamaria
- Department of Nursing, University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
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Gawronski O, Sansone V, Cancani F, Di Nardo M, Rossi A, Gagliardi C, De Ranieri C, Satta T, Dall'Oglio I, Tiozzo E, Alvaro R, Raponi M, Cecchetti C. Implementation of paediatric intensive care unit diaries: Feasibility and opinions of parents and healthcare providers. Aust Crit Care 2022; 36:370-377. [PMID: 35305896 DOI: 10.1016/j.aucc.2022.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The implementation of paediatric intensive care unit (PICU) diaries has been reported as feasible in routine care. To date no feasibility study has compared PICU healthcare providers' (HCPs) and parents' opinions on this tool. OBJECTIVES The aim of this study is to describe the feasibility and perception of PICU diaries in an Italian PICU from the point of view of parents and HCPs. METHODS This is a single-centre, prospective, observational study conducted in a tertiary care paediatric hospital from August 2020 to May 2021. Children admitted to the emergency department PICU, intubated, and sedated for ≥48 h were enrolled. To explore their perceptions and attitudes with the PICU diary, parents were interviewed at 30 days from their child's discharge from the PICU, whereas PICU HCPs were surveyed at the end of the study. Data were analysed as proportions for categorical variables and means and medians for continuous variables according to the distribution, whereas qualitative data were summarised in categories by two independent researchers. RESULTS Twenty families were enrolled in this study. A total of 275 daily PICU diary entries were collected. Children's median age was 9 years (interquartile range = 2-13.25), and the length of stay ranged from 6 to 39 days. PICU diary applicability was rated high by parents and HCPs (>8 on a 1-10 Likert scale). Parents and HCPs perceived PICU diaries as beneficial for communication between staff and families, for parents by expressing their emotions and for staff by becoming aware of how parents experienced their child's admission. Reported barriers were the lack of a private environment, the risk of exposure to public reading, and PICU workload. CONCLUSIONS PICU diaries were feasible and perceived as beneficial both by parents and HCPs. Future research is warranted to understand the effect of PICU diaries on post-PICU outcomes.
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Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio 4, Rome, Italy.
| | - Vincenza Sansone
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio 4, Rome, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Federica Cancani
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Angela Rossi
- Clinical Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Chiara Gagliardi
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | | | - Tiziana Satta
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio 4, Rome, Italy.
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio 4, Rome, Italy.
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | | | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Sansone V, Cancani F, Gagliardi C, Satta T, Cecchetti C, de Ranieri C, Di Nardo M, Rossi A, Dall'Oglio I, Alvaro R, Tiozzo E, Gawronski O. Narrative diaries in the paediatric intensive care unit: A thematic analysis. Nurs Crit Care 2021; 27:45-54. [PMID: 34256419 DOI: 10.1111/nicc.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The paediatric intensive care unit (PICU) diary is a shared tool, kept at the patient bedside, written by relatives and health care providers. There is little evidence about its feasibility and how it supports the families of children admitted to the PICU. Currently, there is no evidence about how the PICU diary is used and what we can learn from it. AIM To explore the contents of narrative PICU diaries in an Italian PICU. STUDY DESIGN Qualitative study of PICU diaries conducted with a narrative research approach. METHODS Children sedated and mechanically ventilated for >48 hours were enrolled in a six-bed Italian PICU of a tertiary care paediatric hospital. During the child's PICU admission, caregivers, relatives, friends, and health care providers were invited to report events, thoughts, and messages, and attach drawings/pictures for the child in the PICU diary. A thematic analysis of the PICU diary contents was performed. RESULTS Thirteen PICU diaries were completed between August and December 2020, mainly by parents (n = 95; 45%) and health care providers (n = 52; 25%). Three main themes emerged: "Social and spiritual support," "Caregiver's emotions, feelings and distress," and "PICU life." Diaries offer insight into caregivers' emotions, social support, clinical activities, and interactions with health care providers, and on progression towards recovery. CONCLUSION PICU diaries are valuable in facilitating family-centred care by providing a space for the written account of the child's admission by parents, other visitors, and health care providers. RELEVANCE TO CLINICAL PRACTICE PICU diaries support the relationship and the communication between the family and the team; they provide an informal account of the emotions and needs of parents that has the potential to improve mutual understanding and family-centred care. Social support and spiritual support are key elements reported by parents for coping with their child's PICU admission.
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Affiliation(s)
- Vincenza Sansone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federica Cancani
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Gagliardi
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tiziana Satta
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Rossi
- Clinical Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Sansone V, Dall'Oglio I, Gesualdo F, Cancani F, Cecchetti C, Di Nardo M, Rossi A, De Ranieri C, Alvaro R, Tiozzo E, Gawronski O. Narrative Diaries in Pediatrics: A Scoping Review. J Pediatr Nurs 2021; 59:e93-e105. [PMID: 33622642 DOI: 10.1016/j.pedn.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
PROBLEM Health diaries with both clinical and narrative elements have been widely used in pediatrics to study children's and families' experiences of illness and coping strategies. The objective of this study is to obtain a synthesis of the literature about narrative health diaries using the PRISMA extension for scoping reviews. ELIGIBILITY CRITERIA Sources were limited to: English language; narrative diaries; children/adolescents and/or parents/caregivers. SAMPLE The following databases were searched: PubMed, Embase and CINAHL with no time limits. RESULTS Among 36 articles included the most common context where a diary was implemented was the home (61%), the hospital (17%) and the school (14%). The most common diarist is the child or adolescent (50%). Paper diary was the most common type (53%), followed by the video diary (19%), the e-diary (8%) or the audio diary (8%). None of the studies explored the impact of the use of diaries on patient outcomes. CONCLUSIONS The narrative health diary is used to report patient experiences of illness or common life from the point of view of the child, adolescent or other family members. The diversity of the diaries found shows how the narrative diary may be 'adapted' to different settings and pediatric populations. IMPLICATIONS The narrative diary is a relevant tool for the exploration of children's and adolescents' experiences of illness and common life. Studies are still needed to describe the impact of narrative diaries keeping on children's health outcomes.
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Affiliation(s)
- Vincenza Sansone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Pediatric Oncology, AORN Santobono-Pausilipon, Naples, Italy.
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Gesualdo
- Department of Predictive and Preventive Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federica Cancani
- Pediatric Intensive Care Unit, Department of Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Department of Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Rossi
- Clinical Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Di Nardo M, Boldrini F, Broccati F, Cancani F, Satta T, Stoppa F, Genuini L, Zampini G, Perdichizzi S, Bottari G, Fischer M, Gawronski O, Bonetti A, Piermarini I, Recchiuti V, Leone P, Rossi A, Tabarini P, Biasucci D, Villani A, Raponi M, Cecchetti C, Choong K. The LiberAction Project: Implementation of a Pediatric Liberation Bundle to Screen Delirium, Reduce Benzodiazepine Sedation, and Provide Early Mobilization in a Human Resource-Limited Pediatric Intensive Care Unit. Front Pediatr 2021; 9:788997. [PMID: 34956989 PMCID: PMC8692861 DOI: 10.3389/fped.2021.788997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Delirium, bed immobilization, and heavy sedation are among the major contributors of pediatric post-intensive care syndrome. Recently, the Society of Critical Care Medicine has proposed the implementation of daily interventions to minimize the incidence of these morbidities and optimize children functional outcomes and quality of life. Unfortunately, these interventions require important clinical and economical efforts which prevent their use in many pediatric intensive care units (PICU). Aim: First, to evaluate the feasibility and safety of a PICU bundle implementation prioritizing delirium screening and treatment, early mobilization (<72 h from PICU admission) and benzodiazepine-limited sedation in a human resource-limited PICU. Second, to evaluate the incidence of delirium and describe the early mobilization practices and sedative drugs used during the pre- and post-implementation periods. Third, to describe the barriers and adverse events encountered during early mobilization. Methods: This observational study was structured in a pre- (15th November 2019-30th June 2020) and post-implementation period (1st July 2020-31st December 2020). All patients admitted in PICU for more than 72 h during the pre and post-implementation period were included in the study. Patients were excluded if early mobilization was contraindicated. During the pre-implementation period, a rehabilitation program including delirium screening and treatment, early mobilization and benzodiazepine-sparing sedation guidelines was developed and all PICU staff trained. During the post-implementation period, delirium screening with the Connell Assessment of Pediatric Delirium scale was implemented at bedside. Early mobilization was performed using a structured tiered protocol and a new sedation protocol, limiting the use of benzodiazepine, was adopted. Results: Two hundred and twenty-five children were enrolled in the study, 137 in the pre-implementation period and 88 in the post-implementation period. Adherence to delirium screening, benzodiazepine-limited sedation and early mobilization was 90.9, 81.1, and 70.4%, respectively. Incidence of delirium was 23% in the post-implementation period. The median cumulative dose of benzodiazepines corrected for the total number of sedation days (mg/kg/sedation days) was significantly lower in the post-implementation period compared with the pre-implementation period: [0.83 (IQR: 0.53-1.31) vs. 0.74 (IQR: 0.55-1.16), p = 0.0001]. The median cumulative doses of fentanyl, remifentanil, and morphine corrected for the total number of sedation days were lower in the post-implementation period, but these differences were not significant. The median number of mobilizations per patient and the duration of each mobilization significantly increased in the post-implementation period [3.00 (IQR: 2.0-4.0) vs. 7.00 (IQR: 3.0-12.0); p = 0.004 and 4 min (IQR: 3.50-4.50) vs. 5.50 min (IQR: 5.25-6.5); p < 0.0001, respectively]. Barriers to early mobilization were: disease severity and bed rest orders (55%), lack of physicians' order (20%), lack of human resources (20%), and lack of adequate devices for patient mobilization (5%). No adverse events related to early mobilization were reported in both periods. Duration of mechanical ventilation and PICU length of stay was significantly lower in the post-implementation period as well as the occurrence of iatrogenic withdrawal syndrome. Conclusion: This study showed that the implementation of a PICU liberation bundle prioritizing delirium screening and treatment, benzodiazepine-limited sedation and early mobilization was feasible and safe even in a human resource-limited PICU. Further pediatric studies are needed to evaluate the clinical impact of delirium, benzodiazepine-limited sedation and early mobilization protocols on patients' long-term functional outcomes and on hospital finances.
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Affiliation(s)
- Matteo Di Nardo
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Boldrini
- Unit of Clinical Psychology, Department of Neurological Sciences, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Broccati
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Federica Cancani
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Tiziana Satta
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Stoppa
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Leonardo Genuini
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giorgio Zampini
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Salvatore Perdichizzi
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gabriella Bottari
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maximilian Fischer
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Annamaria Bonetti
- Functional Rehab Unit, Neurorehabilitation and Robotics Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Irene Piermarini
- Respiratory Physiotherapy, Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Veronica Recchiuti
- Functional Rehab Unit, Neurorehabilitation and Robotics Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Paola Leone
- Respiratory Physiotherapy, Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Angela Rossi
- Unit of Clinical Psychology, Department of Neurological Sciences, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Paola Tabarini
- Unit of Clinical Psychology, Department of Neurological Sciences, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Daniele Biasucci
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alberto Villani
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesu' Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Corrado Cecchetti
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Fagioli D, Evangelista C, Gawronski O, Tiozzo E, Broccati F, Ravà L, Dall'Oglio I, Antonielli G, Borgiani A, Cancani F, Monoscalco M, Zambrini C, Stoppa F. Correction: Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale. Nurs Child Young People 2018; 30. [PMID: 31468800 DOI: 10.7748/ncyp.2018.e1081_crt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
[This corrects the article DOI: 10.7748/ncyp.2018.e1081.].
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Di Nardo M, Lonero M, Pasotti E, Cancani F, Perrotta D, Cecchetti C, Stoppa F, Pirozzi N, La Salvia O, Nicolini A, Amodeo A, Patroniti N, Pesenti A. The first five years of neonatal and pediatric transports on extracorporeal membrane oxygenation in the center and south of Italy: The pediatric branch of the Italian "Rete Respira" network. Perfusion 2018; 33:24-30. [PMID: 29788844 DOI: 10.1177/0267659118766829] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Neonatal and pediatric ECMO is a high-risk procedure that should be performed only in expert centers. Children who are eligible for ECMO and are managed in hospitals without ECMO capabilities should be referred to the closest ECMO center before the severity of illness precludes safe conventional transport. When the clinical situation precludes safe conventional transport, ECMO should be provided on site with the patient transported on ECMO. METHODS We retrospectively reviewed our institutional database of all ECMO transports for neonatal and pediatric respiratory failure from February 2013 to February 2018. RESULTS Over the last 5 years, we provided 24 transports covering all requests from the center and south of Italy except for the islands. Of these transports, 20 were performed on ECMO and 4 without ECMO. No patient died during transportation. Five complications were reported only during the ECMO transports, and all of these were managed without compromising the patient's safety. The preferred modes of transport were by ambulance (70%) and ambulance transported into the fixed wing aircraft (30%) for longer national distances. The survival to hospital discharge of the patients transported with ECMO was 75% among the neonatal transports and 83.3% among the pediatric transports. The survival to hospital discharge of the four patients transported without ECMO was 100% for both neonates and children. CONCLUSIONS Neonatal and pediatric ECMO transports can be safely performed with a dedicated team that maintains stringent adherence to well-designed management protocols.
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Affiliation(s)
- Matteo Di Nardo
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Margherita Lonero
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Elisabetta Pasotti
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Federica Cancani
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Daniela Perrotta
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Francesca Stoppa
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Nicola Pirozzi
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Ondina La Salvia
- 2 Department of Medical Cardiology and Pediatric Cardiac Surgery, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Antonella Nicolini
- 2 Department of Medical Cardiology and Pediatric Cardiac Surgery, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Antonio Amodeo
- 3 ECMO and VAD Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Nicolo' Patroniti
- 4 Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico San Martino, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Antonio Pesenti
- 5 Department of Pathophysiology and Transplantation, Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
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