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Miller AG, Curley MA, Destrampe C, Flori H, Khemani R, Ohmer A, Thomas NJ, Yehya N, Ward S, West L, Zimmerman KO, Venkatachalam S, Sutton S, Hornik CP. A Master Protocol Template for Pediatric ARDS Studies. Respir Care 2024:respcare.11839. [PMID: 38688543 DOI: 10.4187/respcare.11839] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Pediatric ARDS is associated with significant morbidity and mortality. High-quality data from clinical trials in children are limited due to numerous barriers to their design and execution. Here we describe the collaborative development of a master protocol as a tool to address some of these barriers and support the conduct of pediatric ARDS studies. METHODS Using PubMed, we performed a literature search of randomized controlled trials (RCTs) in pediatric ARDS to characterize the current state and evaluate potential benefit of harmonized master protocols. We used a multi-stakeholder, collaborative, and team science-oriented process to develop a master protocol template with links to common data elements (CDEs) for pediatric ARDS trials. RESULTS We identified 11 RCTs that enrolled between 14-200 total subjects per trial. Interventions included mechanical ventilation, prone positioning, corticosteroids, and surfactant. Studies displayed significant heterogeneity in ARDS definition, design, inclusion and exclusion criteria, and reported outcomes. Mortality was reported in 91% of trials and ventilator-free days in 73%. The trial heterogeneity made pooled analysis unfeasible. These findings underscore the need for a method to facilitate combined analysis of future trials through standardization of trial elements. As a potential solution, we developed a master protocol, iteratively revised with input from a multidisciplinary panel of experts and organized into 3 categories: instructions and general information, templated language, and a series of text options of common pediatric ARDS trial scenarios. Finally, we linked master protocol sections to relevant CDEs previously defined for pediatric ARDS and captured in a series of electronic case report forms. CONCLUSIONS The majority of pediatric ARDS trials identified were small and heterogeneous in study design and outcome reporting. Using a master protocol template for pediatric ARDS trials with CDEs would support combining and comparing pediatric ARDS trial findings and increase the knowledge base.
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Affiliation(s)
- Andrew G Miller
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
| | - Martha Aq Curley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | | | - Heidi Flori
- Pediatric Critical Care Medicine, Pediatrics, University of Michigan School Medicine, Ann Arbor, Michigan
| | - Robinder Khemani
- Clinical Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Amy Ohmer
- International Children's Advisory Network
| | - Neal J Thomas
- Penn State College of Medicine, Hershey, Pennsylvania; and Pediatric Acute Lung Injury and Sepsis Investigators Network
| | - Nadir Yehya
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Shan Ward
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | | | - Kanecia O Zimmerman
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and Duke Clinical Research Institute, Durham, North Carolina
| | | | - Sonya Sutton
- Duke Clinical Research Institute, Durham, North Carolina
| | - Christoph P Hornik
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and Duke Clinical Research Institute, Durham, North Carolina
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Agus MS, Hirshberg E, Srinivasan V, Faustino EV, Luckett PM, Curley MA, Alexander J, Asaro LA, Coughlin-Wells K, Duva D, French J, Hasbani N, Sisko MT, Soto-Rivera CL, Steil G, Wypij D, Nadkarni VM. Design and rationale of Heart and Lung Failure - Pediatric INsulin Titration Trial (HALF-PINT): A randomized clinical trial of tight glycemic control in hyperglycemic critically ill children. Contemp Clin Trials 2016; 53:178-187. [PMID: 28042054 PMCID: PMC5285511 DOI: 10.1016/j.cct.2016.12.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 11/02/2016] [Revised: 12/21/2016] [Accepted: 12/24/2016] [Indexed: 01/04/2023]
Abstract
Objectives Test whether hyperglycemic critically ill children with cardiovascular and/or respiratory failure experience more ICU-free days when assigned to tight glycemic control with a normoglycemic versus hyperglycemic blood glucose target range. Design Multi-center randomized clinical trial. Setting Pediatric ICUs at 35 academic hospitals. Patients Children aged 2 weeks to 17 years receiving inotropic support and/or acute mechanical ventilation, excluding cardiac surgical patients. Interventions Patients receive intravenous insulin titrated to either 80–110 mg/dL (4.4–6.1 mmol/L) or 150–180 mg/dL (8.3–10.0 mmol/L). The intervention begins upon confirmed hyperglycemia and ends when the patient meets study-defined ICU discharge criteria or after 28 days. Continuous glucose monitoring, a minimum glucose infusion, and an explicit insulin infusion algorithm are deployed to achieve the BG targets while minimizing hypoglycemia risk. Measurements and main results The primary outcome is ICU-free days (equivalent to 28-day hospital mortality-adjusted ICU length of stay). Secondary outcomes include 90-day hospital mortality, organ dysfunction scores, ventilator-free days, nosocomial infection rate, neurodevelopmental outcomes, and nursing workload. To detect an increase of 1.25 ICU-free days (corresponding to a 20% relative reduction in 28-day hospital mortality and a one-day reduction in ICU length of stay), 1414 patients are needed for 80% power using a two-sided 0.05 level test. Conclusions This trial tests whether hyperglycemic critically ill children randomized to 80–110 mg/dL benefit more than those randomized to 150–180 mg/dL. This study implements validated bedside support tools including continuous glucose monitoring and a computerized algorithm to enhance patient safety and ensure reproducible bedside decision-making in achieving glycemic control.
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Affiliation(s)
- Michael Sd Agus
- Boston Children's Hospital Division of Medicine Critical Care, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Ellie Hirshberg
- Intermountain Medical Center Division of Pulmonary and Critical Care, University of Utah, 100 Mario Capecchi Dr., Salt Lake City, UT 84132, United States.
| | - Vijay Srinivasan
- The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104, United States.
| | - Edward Vincent Faustino
- Yale-New Haven Children's Hospital, Yale University, 1 Park St., New Haven, CT 06510, United States.
| | - Peter M Luckett
- Children's Medical Center Dallas, University of Texas Southwestern, 1935 Medical District Dr., Dallas, TX 75235, United States.
| | - Martha Aq Curley
- University of Pennsylvania School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, United States.
| | - Jamin Alexander
- Boston Children's Hospital Division of Medicine Critical Care, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Lisa A Asaro
- Boston Children's Hospital Department of Cardiology, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Kerry Coughlin-Wells
- Boston Children's Hospital Division of Medicine Critical Care, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Donna Duva
- Boston Children's Hospital Department of Cardiology, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Jaclyn French
- Boston Children's Hospital Division of Medicine Critical Care, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Natalie Hasbani
- Boston Children's Hospital Department of Cardiology, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Martha T Sisko
- The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104, United States.
| | - Carmen L Soto-Rivera
- Boston Children's Hospital Division of Medicine Critical Care, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Garry Steil
- Boston Children's Hospital Division of Medicine Critical Care, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - David Wypij
- Boston Children's Hospital Department of Cardiology, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Vinay M Nadkarni
- The Children's Hospital of Philadelphia, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104, United States.
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Truog RD, Cist AF, Brackett SE, Burns JP, Curley MA, Danis M, DeVita MA, Rosenbaum SH, Rothenberg DM, Sprung CL, Webb SA, Wlody GS, Hurford WE. Recommendations for end-of-life care in the intensive care unit: The Ethics Committee of the Society of Critical Care Medicine. Crit Care Med 2001; 29:2332-48. [PMID: 11801837 DOI: 10.1097/00003246-200112000-00017] [Citation(s) in RCA: 286] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R D Truog
- Harvard Medical School, Boston, MA 02115, USA
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Abstract
STUDY OBJECTIVE To describe the physiologic changes and to evaluate the safety of placing pediatric patients with acute lung injury (ALI) prone for 20 h/d during the acute phase of their illness. DESIGN Single-center prospective case series. SETTING Tertiary-level pediatric ICU. PATIENTS Consecutive patients with bilateral pulmonary parenchymal disease requiring intubation and mechanical ventilation with a PaO(2)/fraction of inspired oxygen (FIO(2)) ratio </= 300 mm Hg. INTERVENTIONS Patients were enrolled as soon as possible after meeting criteria and were placed in a prone position for 20 h/d daily until clinical improvement or death occurred. MEASUREMENTS AND RESULTS Twenty-five pediatric patients who had ALI/ARDS, ranging in age from 2 months to 17 years, were placed in a prone position within 19 h of meeting the study criteria for a median time of 4 days, which accounted for 47% of their time receiving mechanical ventilation. Eighty-four percent of patients (n = 21) were categorized as overall responders to prone positioning because they experienced more days of increases of >/= 20 mm Hg in PaO(2)/FIO(2) ratio or a decrease of >/= 10% in oxygenation index when shifted from a supine to a prone position during the study period. During the 107 patient-days and 214 positioning cycles, no critical incidents occurred. Furthermore, no patient experienced a persistent decrease in oxygen saturation as measured by pulse oximetry (SpO(2)) of > 10% from values obtained when in the supine position, failed to keep their SpO(2) at > 85%, or experienced an increased respiratory rate of > 40 breaths/min when prone. Using the COMFORT score, patients were objectively rated to be equally comfortable in both the supine and prone positions. Patients also were able to resume spontaneous ventilation and to progress toward endotracheal extubation while in the prone position. Iatrogenic injury associated with prolonged prone positioning included stage II pressure ulcers in six patients (24%). CONCLUSIONS The pediatric patients in this series demonstrated improvements in oxygenation without serious iatrogenic injury after prone positioning. This study provides a foundation for a prospective randomized study investigating the effect of early and repeated prone positioning on clinical outcomes in pediatric patients with ALI.
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Affiliation(s)
- M A Curley
- Multidisciplinary Intensive Care Unit, Children's Hospital, Boston, MA, USA.
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Doble RK, Curley MA, Hession-Laband E, Marino BL, Shaw SM. Using the Synergy Model to link nursing care to diagnosis-related groups. Crit Care Nurse 2000. [DOI: 10.4037/ccn2000.20.3.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Doble RK, Curley MA, Hession-Laband E, Marino BL, Shaw SM. Using the Synergy Model to link nursing care to diagnosis-related groups. Crit Care Nurse 2000; 20:86-92. [PMID: 11876218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Abstract
A computerized bibliographic search of published research and a citation review of English-language publications about prone positioning of patients with acute respiratory distress syndrome were done. Information on prone positioning related to technique, patients' responses, complications, and recommendations to prevent complications was extracted. In the 20 pertinent clinical studies found, 297 patients (mean age, 39 years) with acute respiratory failure were positioned prone. Timing from the onset of respiratory failure to when the patient was first positioned prone varied, as did the frequency of prone positioning. Patients spent from 30 minutes to 42 hours prone. In 47% of the studies in which abdominal position was noted, chest and pelvic cushions were used to allow the abdomen to protrude while the patient was prone. Improved oxygenation within 2 hours was reported in 69% of patients, and the improvements were cumulative and persistent. Aside from early intervention, factors predictive of patients' responses were inconsistent, and patients' initial responses were not predictive of subsequent responses. Iatrogenic critical events were rare. Dependent edema of the face was prevalent. Pressure ulcers were reported in studies with longer periods of prone positioning. The most serious complication, corneal abrasion requiring corneal transplantation, was reported in one patient. Clinical knowledge about prone positioning is limited. Phase 1 studies focusing on how to safely turn and care for critically ill patients positioned prone for prolonged periods are needed.
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Curley MA. Prone positioning of patients with acute respiratory distress syndrome: a systematic review. Am J Crit Care 1999; 8:397-405. [PMID: 10553180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A computerized bibliographic search of published research and a citation review of English-language publications about prone positioning of patients with acute respiratory distress syndrome were done. Information on prone positioning related to technique, patients' responses, complications, and recommendations to prevent complications was extracted. In the 20 pertinent clinical studies found, 297 patients (mean age, 39 years) with acute respiratory failure were positioned prone. Timing from the onset of respiratory failure to when the patient was first positioned prone varied, as did the frequency of prone positioning. Patients spent from 30 minutes to 42 hours prone. In 47% of the studies in which abdominal position was noted, chest and pelvic cushions were used to allow the abdomen to protrude while the patient was prone. Improved oxygenation within 2 hours was reported in 69% of patients, and the improvements were cumulative and persistent. Aside from early intervention, factors predictive of patients' responses were inconsistent, and patients' initial responses were not predictive of subsequent responses. Iatrogenic critical events were rare. Dependent edema of the face was prevalent. Pressure ulcers were reported in studies with longer periods of prone positioning. The most serious complication, corneal abrasion requiring corneal transplantation, was reported in one patient. Clinical knowledge about prone positioning is limited. Phase 1 studies focusing on how to safely turn and care for critically ill patients positioned prone for prolonged periods are needed.
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Curley MA, Fackler JC. Weaning from mechanical ventilation: patterns in young children recovering from acute hypoxemic respiratory failure. Am J Crit Care 1998. [DOI: 10.4037/ajcc1998.7.5.335] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE: The purpose of the study was to describe the patterns of weaning from mechanical ventilation in young children recovering from acute hypoxemic respiratory failure. METHODS: Decision-making rules on progressive weaning were developed and applied to existing data on 82 patients 2 weeks to 6 years old in the Pediatric Acute Respiratory Distress Syndrome Data Set. RESULTS: Three patterns of weaning progress were detected: sprint, consistent, and inconsistent. Length of ventilation and weaning progressively increased from the sprint, to the consistent, to the inconsistent subset. Patients in the inconsistent subset were most likely to have a systemic (sepsis or shock) trigger of acute respiratory distress syndrome and to be rated as having at least moderate disability at discharge. Hypothesis-generating univariate and then multivariate logistic regression analyses indicated that patients who experienced more days of mechanical ventilation before the start of weaning and who had a higher oxygenation index during the weaning process were most likely to have an inconsistent pattern of weaning. CONCLUSION: Patterns of weaning are discernible in a population of young children and indicate a subset at risk for inconsistent weaning. Knowing the patterns of weaning may help clinicians anticipate, perhaps plot, and then modulate a patient's weaning trajectory.
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Curley MA, Fackler JC. Weaning from mechanical ventilation: patterns in young children recovering from acute hypoxemic respiratory failure. Am J Crit Care 1998; 7:335-45. [PMID: 9740883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of the study was to describe the patterns of weaning from mechanical ventilation in young children recovering from acute hypoxemic respiratory failure. METHODS Decision-making rules on progressive weaning were developed and applied to existing data on 82 patients 2 weeks to 6 years old in the Pediatric Acute Respiratory Distress Syndrome Data Set. RESULTS Three patterns of weaning progress were detected: sprint, consistent, and inconsistent. Length of ventilation and weaning progressively increased from the sprint, to the consistent, to the inconsistent subset. Patients in the inconsistent subset were most likely to have a systemic (sepsis or shock) trigger of acute respiratory distress syndrome and to be rated as having at least moderate disability at discharge. Hypothesis-generating univariate and then multivariate logistic regression analyses indicated that patients who experienced more days of mechanical ventilation before the start of weaning and who had a higher oxygenation index during the weaning process were most likely to have an inconsistent pattern of weaning. CONCLUSION Patterns of weaning are discernible in a population of young children and indicate a subset at risk for inconsistent weaning. Knowing the patterns of weaning may help clinicians anticipate, perhaps plot, and then modulate a patient's weaning trajectory.
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Curley MA, Castillo L. Nutrition and shock in pediatric patients. New Horiz 1998; 6:212-25. [PMID: 9654328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Critically ill patients, including those in shock, often present with significant metabolic derangement in protein and energy metabolism characterized by: increased protein breakdown which is not suppressed by protein or energy intake; reprioritization of protein synthesis with increased synthesis of acute-phase proteins; decreased synthesis of structural proteins; and high protein turnover. In addition, there is also glucose and lipid intolerance. Adequate nutritional and metabolic support of the critically ill child under these conditions is a challenging endeavor. Traditionally, critically ill children have received nutritional requirements based on those of healthy children despite the fact that the critically ill population is physiologically and metabolically different. Furthermore, nutritional requirements in healthy children are largely based on limited data. With emerging knowledge of non-nutritional functions of nutrients, adequacy of nutritional support and requirements will eventually depend on the goals to be achieved: nutritional, physiologic, and/or pharmacologic.
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Affiliation(s)
- M A Curley
- Department of Nursing, Children's Hospital Boston, MA 02115, USA
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Curley MA. Patient-nurse synergy: optimizing patients' outcomes. Am J Crit Care 1998; 7:64-72. [PMID: 9429685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Given the current demands of the healthcare environment, a clear sense of the unique contributions of nursing to patients' outcomes is critical. This paper articulates a model that describes nursing practice on the basis of the needs and characteristics of patients. The model was developed by the American Association of Critical-Care Nurses Certification Corporation to link certified practice to patients' outcomes. The fundamental premise of this model, known as the Synergy Model, is that patients' characteristics drive nurses' competencies. When patients' characteristics and nurses' competencies match and synergize, outcomes for the patient are optimal. This paper presents the major tenets of the Synergy Model: patients' characteristics of concern to nurses, nurses' competencies important to patients, and patients' outcomes that result when patients' characteristics and nurses' competencies are mutually enhancing. By creating safe passage for patients, nurses make a significant contribution to the quality of patients' care, containment of costs, and patients' outcomes. Although the Synergy Model will be used as a blueprint for the certification of acute and critical care nurses, it is conceptually relevant to the entire profession. Dissemination of this model may help situate nursing within the current healthcare environment and facilitate intradisciplinary dialogue.
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Abstract
Given the current demands of the healthcare environment, a clear sense of the unique contributions of nursing to patients' outcomes is critical. This paper articulates a model that describes nursing practice on the basis of the needs and characteristics of patients. The model was developed by the American Association of Critical-Care Nurses Certification Corporation to link certified practice to patients' outcomes. The fundamental premise of this model, known as the Synergy Model, is that patients' characteristics drive nurses' competencies. When patients' characteristics and nurses' competencies match and synergize, outcomes for the patient are optimal. This paper presents the major tenets of the Synergy Model: patients' characteristics of concern to nurses, nurses' competencies important to patients, and patients' outcomes that result when patients' characteristics and nurses' competencies are mutually enhancing. By creating safe passage for patients, nurses make a significant contribution to the quality of patients' care, containment of costs, and patients' outcomes. Although the Synergy Model will be used as a blueprint for the certification of acute and critical care nurses, it is conceptually relevant to the entire profession. Dissemination of this model may help situate nursing within the current healthcare environment and facilitate intradisciplinary dialogue.
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Abstract
Nursing exists in the details of relationships. One crucial element of therapeutic nurse-patient/parent relationships is the attribute of mutuality. Mutuality not only embodies the philosophy of family-centered-care, it acknowledges and supports the evolution of parents and nurses toward greater competency in their role. Using concept analysis, this article explores the phenomenon of mutuality. The desired outcome is to provide a theoretical and operational definition of mutuality that will help guide practice and direct future research in the area of therapeutic nurse-parent relationships.
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Affiliation(s)
- M A Curley
- Multidisciplinary ICU, Children's Hospital, Boston, MA, USA
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Curley MA. The Synergy Model of certified practice: creating safe passage for patients. Interview by Michael Villaire. Crit Care Nurse 1996; 16:94-9. [PMID: 8852250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Curley MA. The Synergy Model of certified practice: creating safe passage for patients. Interview by Michael Villaire. Crit Care Nurse 1996. [DOI: 10.4037/ccn1996.16.4.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
PURPOSE To summarize clinical and empirical knowledge about pressure ulcers in infants and children and to describe an approach developed at Children's Hospital, Boston, to prevent and manage pressure ulcers. POPULATION Acutely ill children with potential or actual alteration in skin integrity due to pressure ulcers. CONCLUSIONS The three-pronged approach for pressure ulcer prevention and management developed by the Skin Care Task Force at the Children's Hospital, Boston, decreases unnecessary variation in practice surrounding the prevention and care of pressure ulcers in acutely ill children. PRACTICE IMPLICATIONS The Skin Care Task Force recommends use of Braden Q for pediatric risk assessment, a skin care algorithm for prevention of pressure ulcers, and a pressure ulcer algorithm for staging and managing pressure ulcers.
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Affiliation(s)
- S M Quigley
- Multidisciplinary ICU, Children's Hospital, Boston, MA, USA.
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Curley MA, Molengraft JA. Providing comfort to critically ill pediatric patients: isoflurane. Crit Care Nurs Clin North Am 1995; 7:267-74. [PMID: 7619369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Isoflurane is a fluorinated ether used primarily as an inhalation anesthetic. Rapid titratable effects, limited metabolism, and a reliable mode of administration make isoflurane an appealing alternative to the use of intravenous sedatives and narcotics in critically ill patients requiring prolonged mechanical ventilation. This article, in reviewing this novel approach to management of patient discomfort, focuses on nursing practice issues and provides a critical analysis of isoflurane use in the intensive care unit.
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Abstract
High frequency oscillatory ventilation is a new mode of ventilatory support of acute respiratory failure in the pediatric population. Delineating the nursing care required of this fragile group of infants and children is challenging, because there is a paucity of published data and national clinical experience. The author reviews a management plan that was used to guide the care of over 40 patients, ranging in age from 1 months to 24 years, with acute respiratory failure supported on high frequency oscillatory ventilation. In total, seven patient-care problems and associated interventions are delineated.
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Affiliation(s)
- M A Curley
- Department of Nursing, Children's Hospital, Boston, MA
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Curley MA, Wallace J. Effects of the nursing Mutual Participation Model of Care on parental stress in the pediatric intensive care unit--a replication. J Pediatr Nurs 1992; 7:377-85. [PMID: 1291673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The pediatric intensive care unit (PICU) hospitalization of a child is stressful for parents. Helping parents to decrease their stress is warranted so that they can function in a vital role that is therapeutic to them and their critically ill child. Although many interventions have been recommended to help parents decrease their stress, only the Nursing Mutual Participation Model of Care (NMPMC) has been tested in the clinical setting. This article reports a study that expands on Curley's original work by investigating the effects of the NMPMC on parental stress when implemented by PICU staff nurses. Fifty-six parents participated in the study, which used a quasi-experimental design. Sequential sampling placed the first 31 subjects into the control group and the next 25 subjects in the experimental group. The experimental group received care from staff nurses instructed in the NMPMC. The dependent measure was the Parental Stressor Scale:Pediatric Intensive Care Unit (PSS:PICU) administered within 24 to 48 hours of PICU admission, every 48 hours thereafter, and 24 hours after PICU discharge. The results indicated that parents in the experimental group perceived less stress than the control group, specifically the stress related to alterations in parental role in the PICU setting. Implications for nursing care are discussed.
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Kent PA, Curley MA. Challenges in nursing: infants with congenital diaphragmatic hernia. Heart Lung 1992; 21:381-9. [PMID: 1629008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite advances in the care of infants born with congenital diaphragmatic hernia, mortality rate continues to be high. Immediate survival is directly related to the degree of pulmonary hypoplasia present. The spectrum is wide, from minimal pulmonary hypoplasia, in which neonates do well, to severe pulmonary hypoplasia, which is incompatible with life. Between these two extremes lie infants with compromised pulmonary function whose long-term survival depends on the clinical strengths of their multidisciplinary team. Over the past year, 23 infants with congenital diaphragmatic hernia were cared for in the Multidisciplinary Intensive Care Unit at Children's Hospital, Boston. A retrospective chart review enabled the authors to describe the trajectory of illness and generate nursing practice guidelines. This article presents the nursing care issues that were identified in this challenging population.
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Affiliation(s)
- P A Kent
- Multidisciplinary ICU, Children's Hospital, Boston, MA
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Curley MA, Kinnen S, Geller M. Venous Arterial Management Protection System product evaluation. J Pediatr Nurs 1992; 7:67-9. [PMID: 1548566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. The history, mechanics, and current applications of ECMO are discussed in this article. Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed.
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Curley MA, Thompson JE. End-tidal CO2 monitoring in critically ill infants and children. Pediatr Nurs 1990; 16:397-403. [PMID: 2118248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
End-tidal carbon dioxide (ETCO2) monitoring is an effective tool to continuously assess the adequacy of ventilation in critically ill infants and children. Optimal clinical application of this noninvasive monitoring technique requires an understanding of the physiologic principles of ETCO2 monitoring and its unique technologic considerations.
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Curley MA. Effects of the nursing mutual participation model of care on parental stress in the pediatric intensive care unit. Heart Lung 1988; 17:682-8. [PMID: 3192414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The pediatric intensive care unit (PICU) hospitalization of a child is stressful for parents. Helping parents to decrease their stress is warranted so that they can function in the vital role that is therapeutic to them and their critically ill child. Many parent-supportive nursing interventions have been recommended but none has been tested in the clinical setting. A quasi-experimental design was used to study the effects of the nursing mutual participation model of care (NMPMC) on the perceived environmental stress of parents in the PICU. Thirty-three parents, experiencing the PICU for the first time, participated in the study. Sequential sampling divided the participants into two groups, control and experimental. The experimental group participated in the NMPMC, designed to be supportive to and guided by the perceived individual needs of each parent. The dependent measure was the Parental Stressor Scale: Pediatric Intensive Care Unit administered within 24 to 48 hours of PICU admission, every 48 hours thereafter, and 24 hours after PICU discharge. The results indicate that the NMPMC is helpful in alleviating parental stress, specifically the stress related to interruption in the parent-child relationship, in the PICU setting.
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Affiliation(s)
- M A Curley
- Yale University School of Nursing, New Haven, Conn
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Curley MA, Vaughan SM. Assessment and resuscitation of the pediatric patient (continuing education credit). Crit Care Nurse 1987; 7:26-45. [PMID: 3665526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Curley MA. Employee solicitation rights in the health-care industry--a proposal for change. Spec Law Dig Health Care (Mon) 1985; 6:5-31. [PMID: 10269913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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