AACN advanced critical care
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The interplay of pain, discomfort, and fear can cause agitation in critically ill children. Therefore, sedation and analgesia are essential components in the intensive care unit setting and are best managed with a multidisciplinary team approach. No one standard approach exists to assess and manage pain and anxiety. ⋯ Multiple pharmacological therapies are available to manage pain, anxiety, fear, and agitation. Dosing of these agents can be influenced by age-related pharmacokinetic and pharmacodynamic changes. Agents should be selected on the basis of the child's disease state, desired level of sedation, and cardiac and respiratory status.
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With an overall mortality rate of 4.2%, sepsis is one of the most common causes of death in children worldwide. The Surviving Sepsis Campaign outlines rapid initiation of volume resuscitation with crystalloids and timely administration of broad-spectrum antibiotics as the backbone of sepsis treatment. Initial antibiotics should be broad enough to cover the most likely pathogens, but antibiotic therapy should be de-escalated when culture results become available. ⋯ Insulin may also be needed in some patients for the treatment of hyperglycemia. Current guidelines have improved the treatment of sepsis, but more research is needed. This article reviews sepsis pathophysiology, treatment, and supportive care specifically as they relate to pediatric patients.
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Guidelines for pediatric advanced life support have been available for nearly a quarter of a century. Recommendations for the pharmacological management of pediatric cardiac arrest have changed over these years. ⋯ To make matters more complicated, differences also exist across neonatal and pediatric age spectrums. In addition, some toxicological emergencies commonly occurring in children require pharmacological management with agents that have a unique mechanism of action for cardiac support.
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The tele-intensive care unit (ICU) provides a remote monitoring system that adds an additional layer of support for critically ill patients. However, to optimize contributions, the bedside team must incorporate this resource into the patient's plan of care. Using the American Association of Critical-Care Nurses' Healthy Work Environment Standards as a platform, we can create and nurture a new partnership model. ⋯ Trust and the desire to cooperate encourage provider engagement to strengthen collaboration. The use of tele-ICU technology can assist in the interpretation and transformation of data to affect decision making at all levels to influence patient care. Through the lens of the healthy work environment, the tele-ICU/ICU partnership provides enhanced opportunities for improved patient care and team satisfaction.
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The purpose of this study was to determine patients' and families' perceptions of care in 10 critical care units enhanced by a tele-intensive care unit (ICU) in a 5-hospital health care system. Patients and family members who had a critical care experience were approached for participation. ⋯ Analysis of data from patients and family members indicated significantly higher means for the following factors: seeing the individual patient (P =.004), responding (P =.002), and watching over (P =.006) only when there was an awareness by the patient and family members that the care team was at the bedside and at the tele-ICU command center. The perceptions of care in these cases may suggest an improved patient experience when a tele-ICU is part of the care team.