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
Assessment of the Pediatric Index of Mortality 2 with the Pao₂/Fio₂ ratio derived from the Spo₂/Fio₂ ratio: a prospective pilot study in a French pediatric intensive care unit.
The Pediatric Index of Mortality 2 is a mortality prediction tool used in pediatric intensive care units. Arterial blood gas sampling that is required to calculate the Pao₂/Fio₂ ratio is often unavailable. Several authors have proposed mathematical relations between the Pao₂/Fio₂ and Spo₂/Fio₂ ratios. The main objective of this study was to assess the validity of the Pediatric Index of Mortality 2 score and three modified Pediatric Index of Mortality 2 scores with the Pao2/Fio2 ratio calculated from the Spo₂/Fio₂ ratio. ⋯ This study suggests that the Spo₂/Fio₂ ratio could be used in place of Pao₂/Fio₂ for calculating Pediatric Index of Mortality 2. This must nonetheless be confirmed by a larger prospective multicenter study.
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Pediatr Crit Care Me · Jul 2011
Comparative StudyRole of real-time reverse transcription polymerase chain reaction for detection of respiratory viruses in critically ill children with respiratory disease: Is it time for a change in algorithm?
To identify the respiratory viral pathogens associated with acute lower respiratory tract infection in critically ill pediatric patients by using real-time reverse transcription-polymerase chain reaction, and compare results with those of direct fluorescence antibody assay testing. ⋯ Direct fluorescence antibody assay testing is a suboptimal method for the detection of respiratory viruses in critically ill children with lower respiratory tract infection. Given the importance of a prompt and accurate viral diagnosis for this group of patients, we suggest that real-time reverse transcription-polymerase chain reaction becomes part of the routine diagnostic algorithm in critically ill children when a viral etiology is suspected, even if conventional tests yield a negative result.
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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.