Pediatr Crit Care Me
-
Pediatr Crit Care Me · Mar 2022
Observational StudyHuman Factors Analysis of Latent Safety Threats in a Pediatric Critical Care Unit.
To identify unique latent safety threats spanning routine pediatric critical care activities and categorize them according to their underlying work system factors (i.e., "environment, organization, person, task, tools/technology") and associated clinician behavior (i.e., "legal": expected compliance with or "illegal-normal": deviation from and "illegal-illegal": disregard for standard policies and protocols). ⋯ Latent safety threats span various pediatric critical care activities and are attributable to many underlying work system factors. Latent safety threats are present both when staff comply with and deviate from policies and protocols, suggesting that simply reinforcing compliance with existing policies and protocols, the common default intervention imposed by healthcare organizations, will be insufficient to mitigate safety threats. Rather, interventions must be designed to address the underlying work system threats. This human factors informed framework analysis of observational data is a useful approach to identifying and understanding latent safety threats and can be used in other clinical work systems.
-
Pediatr Crit Care Me · Mar 2022
Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients.
The primary objective was to determine the prevalence and characteristics associated with malpositioned temporary, nontunneled central venous catheters (CVCs) placed via the internal jugular (IJ) and subclavian (SC) veins in pediatric patients. ⋯ The prevalence of IJ and SC CVC tips outside of the recommended location was high. Left-sided catheters, patient weight, and sex were associated with malposition. Malpositioned catheters were not associated with increased harm.
-
Pediatr Crit Care Me · Mar 2022
Meta AnalysisBalanced Versus Unbalanced Fluid in Critically Ill Children: Systematic Review and Meta-Analysis.
The ideal crystalloid fluid bolus therapy for fluid resuscitation in children remains unclear, but pediatric data are limited. Administration of 0.9% saline has been associated with hyperchloremic metabolic acidosis and acute kidney injury. The primary objective of this systematic review was to compare the effect of balanced versus unbalanced fluid bolus therapy on the mean change in serum bicarbonate or pH within 24 hours in critically ill children. ⋯ Our systematic review found some evidence of improvement in blood pH and bicarbonate values in critically ill children after 4-12 hours of fluid bolus therapy with balanced fluid compared with the unbalanced fluid. However, a randomized controlled trial is needed to establish whether these findings have an impact on clinical outcomes before recommendations can be generated.
-
Pediatr Crit Care Me · Mar 2022
Multicenter StudyHospital Charges Associated With Critical Bronchiolitis From 2009 to 2019.
To evaluate the contribution of PICU care to increasing hospital charges for patients with bronchiolitis over a 10-year study period. ⋯ In a multicenter cohort study of children hospitalized with bronchiolitis, PICU patients, especially low-risk children without the need for IMV, were the highest driver of increased hospital charges over a 10-year study period.
-
Pediatr Crit Care Me · Mar 2022
Multicenter StudyDevelopmental Care Practice and Documentation Variability in the Cardiac ICU.
Describe variability in developmental care practices, as documented in the electronic health record, for infants undergoing congenital heart surgery. ⋯ There are significant, quantifiable variations in documented developmental care practices at both the individual and site level. More reliable documentation of developmental care practices is required to associate these variables with later outcomes and investigate disparities in individualized developmental care practices.