Pediatr Crit Care Me
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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.
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Pediatr Crit Care Me · Oct 2013
Randomized Controlled Trial Multicenter StudyAltered Circulating Leukocytes and Their Chemokines in a Clinical Trial of Therapeutic Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy*
To determine systemic hypothermia's effect on circulating immune cells and their corresponding chemokines after hypoxic ischemic encephalopathy in neonates. ⋯ Our data are consistent with chemokine-associated systemic immunosuppression with hypothermia treatment. In hypothermic neonates, persistence of lower leukocyte counts after rewarming is observed in infants with more severe CNS injury.
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Pediatr Crit Care Me · Oct 2013
Multicenter StudyDifferences in Medical Therapy Goals for Children With Severe Traumatic Brain Injury-An International Study.
To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury. ⋯ There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials.