Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2013
Multicenter Study Observational StudyA Comparison of Quality Improvement Practices at Adult and Pediatric Trauma Centers*
Quality assurance practices are structured performance improvement and patient safety processes designed to continuously monitor, evaluate, and improve the performance of a trauma program. These practices are integral in the provision of quality injury care, and yet no comprehensive description of existing quality improvement practices used by pediatric trauma centers is available. Therefore, we compared the quality improvement programs used in adult and pediatric trauma centers by performing a reanalysis of our recent survey of trauma quality improvement practices in Canada, United States, Australia, and New Zealand. ⋯ Opportunities for the improvement of pediatric quality improvement programs exist including a need to determine the optimal structure for trauma quality improvement, develop patient-centered quality indicators of injury care, measure long-term outcomes, and create measures of secondary injury prevention.
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Pediatr Crit Care Me · Oct 2013
Randomized Controlled Trial Clinical TrialPatient-Ventilator Asynchrony During Noninvasive Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist in Infants and Children.
To document the prevalence of asynchrony events during noninvasive ventilation in pressure support in infants and in children and to compare the results with neurally adjusted ventilatory assist. ⋯ Asynchrony events are frequent during noninvasive ventilation with pressure support in infants and in children despite adjusting the cycling-off criterion. Compared with pressure support, neurally adjusted ventilator assist allows improving patient-ventilator synchrony by reducing trigger delay and the number of asynchrony events. Further studies should determine the clinical impact of these findings.
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Pediatr Crit Care Me · Oct 2013
Observational StudyImproving Delivery of Continuous Renal Replacement Therapy: Impact of a Simulation-Based Educational Intervention.
To describe our experience with transitions in both nursing model and educational training program for delivery of continuous renal replacement therapy. There have been very few comparisons between different care and educational models, and the optimal approach remains uncertain. In particular, we evaluated our experience with introducing a simulation-based educational model. ⋯ We report on the impact of transitioning between different educational programs for continuous renal replacement therapy, specifically with the introduction of a simulation-based approach. We observed a significant and sustained improvement in the delivery of continuous renal replacement therapy as demonstrated by a marked increase in filter lifespan.
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Pediatr Crit Care Me · Oct 2013
Observational StudyHypoglycemia Adverse Events in PICUs and Cardiac ICUs: Differentiating Preventable and Nonpreventable Events*
To describe the use of an adverse event detection system to identify, characterize, and categorize preventable versus nonpreventable hypoglycemia AEs in PICUs and cardiac ICUs. ⋯ Preventable hypoglycemia adverse events are associated with patients receiving sole parenteral sources of nutrition in both the PICU and cardiac ICU. In the cardiac ICU, there is an association between weekend and holiday time periods and the development of preventable hypoglycemia adverse events.
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Pediatr Crit Care Me · Oct 2013
Is Shock Index Associated With Outcome in Children With Sepsis/Septic Shock?*
To investigate the association between PICU shock index (the ratio of heart rate to systolic blood pressure) and PICU mortality in children with sepsis/septic shock. To explore cutoff values for shock index for ICU mortality, how change in shock index over the first 6 hours of ICU admission is associated with outcome, and how the use of vasoactive therapy may affect shock index and its association with outcome. ⋯ Shock index may have promise as a marker of mortality in children with sepsis/septic shock. Although there is no clear cutoff shock index to identify risk of mortality, given the higher risk of mortality as shock index increases, children with elevated shock index may benefit from more aggressive resuscitation and higher level of care.