Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2015
Outcomes of Preterm Neonates Transferred Between Tertiary Perinatal Centers.
To verify if preterm neonates transferred between tertiary referral centers have worse outcomes than matched untransferred infants. ⋯ Neonatal transfer between tertiary-level centers does not impact on clinical outcomes, if performed under optimal conditions.
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Pediatr Crit Care Me · Oct 2015
Review Meta AnalysisUltrasound Imaging Reduces Failure Rates of Percutaneous Central Venous Catheterization in Children.
Ultrasound imaging has been shown to be beneficial for percutaneous central venous cannulation in systematic reviews of randomized controlled trials in adult patients, but not in pediatrics. The aim of this updated review was to determine whether percutaneous central venous catheterization with the aid of ultrasound reduces cannulation failure in children. ⋯ The meta-analysis of five nonrandomized studies showed that the rate of cannulation failure was significantly lower with real-time ultrasound guidance than anatomic landmark technique (odds ratio, 0.44 [95% CI, 0.27-0.72]; p = 0.001). The combination of nine randomized controlled trials also showed lower failure rates with either the real-time ultrasound guidance or the prelocation technique over the landmark technique (odds ratio, 0.22 [95% CI, 0.07-0.69]; p = 0.0003) and fewer arterial punctures in the ultrasound group (odds ratio, 0.31 [95% CI, 0.09-1.08]; p = 0.07). However, seven out of nine studies were assessed as having high risk of bias. Since the lower cannulation failure and less frequent chance of arterial puncture with ultrasound were predominantly shown in studies at high risk of bias, further definitive and adequately powered studies with clear outcomes are needed.
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Pediatr Crit Care Me · Oct 2015
ReviewFluid Bolus Therapy-Based Resuscitation for Severe Sepsis in Hospitalized Children: A Systematic Review.
To review systematically data from randomized and nonrandomized studies of fluid bolus therapy in hospitalized children with septic shock. ⋯ There are only limited data to support the use of fluid bolus therapy in hospitalized children. Prospective observational data and randomized controlled trials are urgently needed to evaluate this therapy in resource rich settings.
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Pediatr Crit Care Me · Oct 2015
Observational StudyChanges to Workflow and Process Measures in the PICU During Transition From Semi to Full Electronic Health Record.
Studies showing the changes in workflow during transition from semi to full electronic medical records are lacking. This objective study is to identify the changes in workflow in the PICU during transition from semi to full electronic health record. ⋯ Five hundred and sixty-four patients with 2,355 patient days were evaluated in the three phases. Duration of rounds decreased from a median of 9 minutes per patient pre--electronic health record to 7 minutes per patient post electronic health record. Time to final note decreased from 2.06 days pre--electronic health record to 0.5 days post electronic health record. Time to first medication administration after admission also decreased from 33 minutes pre--electronic health record and 7 minutes post electronic health record. Time to Time to medication reconciliation was significantly higher pre-electronic health record than post electronic health record and percent of medication reconciliation completion was significantly lower pre--electronic health record than post electronic health record and percent of medication reconciliation completion was significantly higher pre--electronic health record than. There was no significant change in time between placement of discharge order and physical transfer from the unit [corrected].changes clinical workflow in a PICU with decreased duration of rounds, time to final note, time to medication administration, and time to medication reconciliation completion. There was no change in the duration from medical to physical transfer.
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Pediatr Crit Care Me · Oct 2015
Developing a Family-Centered Care Model for Critical Care After Pediatric Traumatic Brain Injury.
This study examined the family experience of critical care after pediatric traumatic brain injury in order to develop a model of specific factors associated with family-centered care. ⋯ This study presents a family-centered traumatic brain injury care model based on family perspectives. In addition to communication and coordination strategies, the model offers methods to address cultural and structural barriers to meeting the needs of non-English-speaking families. Given the stress experienced by families of children with traumatic brain injury, careful consideration of the model themes identified here may assist in improving overall quality of care to families of hospitalized children with traumatic brain injury.