Pediatr Crit Care Me
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Pediatr Crit Care Me · Aug 2020
Observational StudyValidation of an Electronic Pediatric Index of Mortality 2 Score in a Mixed Quaternary PICU.
To assess the validity of an electronic version of the Pediatric Index of Mortality 2 score. ⋯ The Pediatric Index of Mortality 2 score can be adapted to utilize retrospective electronic health record data with acceptable discrimination, calibration and accuracy a large mixed-ICU cohort.
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Pediatr Crit Care Me · Aug 2020
Observational StudyProfile of Fluid Exposure and Recognition of Fluid Overload in Critically Ill Children.
Fluid overload is common in the PICU and has been associated with increased morbidity and mortality. It remains unclear whether fluid overload is a surrogate marker for severity of illness and need for increased support, an iatrogenic modifiable risk factor, or a sign of oliguria. The proportions of various fluid intake contributing to fluid overload and its recognition have not been adequately examined. We aimed to: 1) describe the types and amounts of fluid exposure in the PICU and 2) identify the clinicians' recognition of fluid overload. ⋯ Although resuscitation fluids contributed more to fluid exposure on day 1 compared with day 3, fluid exposure frequently exceeded maintenance requirements on day 3. Fluid overload was not always recognized by PICU practitioners. Further studies to correlate modifiable fluid exposure to fluid overload and explore modifiable practice improvement opportunities are needed.
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Pediatr Crit Care Me · Aug 2020
Isolation in Parents and Providers of Children With Chronic Critical Illness.
An increasing number of children with medical complexity spend months or more in PICUs, lending to isolation for their parents and providers. We sought to better describe the experiences of parents and providers of children with chronic critical illness specifically around isolation during PICU admission. ⋯ PICU providers perceived social and medical isolation in parents of children with chronic critical illness; however, parents did not endorse either directly. A majority of parents showed signs of depression despite reporting good social support. Providers reported feeling medically isolated from children with chronic critical illness and their families related to burnout and insufficient training. Novel methods to address these issues are needed.
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Pediatr Crit Care Me · Aug 2020
Factors Behind Decline of Venovenous Extracorporeal Membrane Oxygenation to Support Neonatal Respiratory Failure.
Neonates with respiratory failure are ideally supported with venovenous rather than venoarterial extracorporeal membrane oxygenation due to the reduced rate of neurologic complications. However, the proportion of neonates supported with venovenous extracorporeal membrane oxygenation is declining. We aimed to explore the factors behind this decline. ⋯ The majority of U.K. centers are unable to provide venovenous extracorporeal membrane oxygenation for neonates due to concerns with availability and suitability of dual lumen cannulae. An alternative to be considered is the use of multisite cannulation, which has been used historically and is currently being used in centers internationally and in the United Kingdom.
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Pediatr Crit Care Me · Aug 2020
A Respiratory Therapist-Driven Pathway Improves Timeliness of Extubation Readiness Assessment in a Single PICU.
Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and implementation of a respiratory therapist-driven extubation readiness test pathway. ⋯ A respiratory therapist-driven extubation readiness test pathway can be safely implemented in a large, academic PICU. The pathway resulted in earlier extubation readiness testing without increasing key balancing measures-the duration of mechanical ventilation, PICU length of stay, or the extubation failure rate.