Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2011
Lean analysis of a pediatric intensive care unit physician group rounding process to identify inefficiencies and opportunities for improvement.
A physician group in a pediatric intensive care unit faced challenges when moving to a larger unit. Challenges included increased time for rounds, nonbillable attending physician hours, poor communication with pediatric intensive care unit staff, and meeting resident physician duty hours and teaching requirements. The purpose of this analysis was to identify waste and opportunities for improvement to improve physician efficiency. ⋯ In a large physician group, essential activities showed the least variation. Practice variation focused on minimizing nonessential activities could have dramatic impacts on standardizing practice. Further study is indicated to determine whether standardizing rounds to focus on essential activities can lead to more effective processes that require fewer resources while improving outcomes for all stakeholders.
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Pediatr Crit Care Me · Jul 2011
Comparative StudyFirst responder performance in pediatric trauma: a comparison with an adult cohort.
Is the prehospital care of injured children comparable with adult standards? This question has been asked repeatedly by many clinicians, yet there are no definite answers. ⋯ Prehospital care of children is suboptimal compared with adults in areas of endotracheal intubation, establishment of peripheral intravenous access, and fluid resuscitation.
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Pediatr Crit Care Me · Jul 2011
Energy imbalance and the risk of overfeeding in critically ill children.
To examine the role of targeted indirect calorimetry in detecting the adequacy of energy intake and the risk of cumulative energy imbalance in a subgroup of critically ill children suspected to have alterations in resting energy expenditure. We examined the accuracy of standard equations used for estimating resting energy expenditure in relation to measured resting energy expenditure in relation to measured resting energy expenditure and cumulative energy balance over 1 week in this cohort. ⋯ We detected a high incidence of overfeeding in a subgroup of critically ill children using targeted indirect calorimetry The predominance of hypometabolism, failure of physicians to correctly predict metabolic state, use of stress factors, and inaccuracy of standard equations all contributed to overfeeding in this cohort. Critically ill children, especially those with a longer stay in the PICU, are at a risk of unintended overfeeding with cumulative energy excess.
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Pediatr Crit Care Me · Jul 2011
Utility of bedside angiography in the evaluation of vascular obstruction in the pediatric intensive care patient.
To review our experience with bedside angiography in order to demonstrate the utility of this technique for evaluation of blood vessels in the critically ill patient. ⋯ Bedside angiography is a rapid, safe, and useful tool for the evaluation of complex vascular anatomy in critically ill patients. In cases where vascular ultrasound is unable to provide detailed anatomy or identify collateral flow, this technique may be useful in providing safe and accurate assessment of blood vessels associated with vascular access devices.
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Pediatr Crit Care Me · Jul 2011
Active surveillance culturing impacts methicillin-resistant Staphylococcus aureus acquisition in a pediatric intensive care unit.
To determine whether active surveillance culturing for methicillin-resistant Staphylococcus aureus (MRSA) decreases nosocomial MRSA acquisition in the pediatric intensive care unit. ⋯ Active surveillance culturing resulted in significantly decreased nosocomial acquisition of MRSA in a pediatric intensive care unit setting. Admission and weekly active surveillance culturing appears to be an effective tool to decrease the spread of MRSA in the pediatric intensive care unit, independent of improvement in hand hygiene compliance. The impact on hospital-acquired MRSA infections and the cost benefit of active surveillance culturing require further study.