Severe Food Protein Induced Enterocolitis Syndrome (FPIES) in the Pediatric Intensive Care Unit (PICU): A Retrospective Chart Review

AbstractTo improve the efficiency of nosocomial infection detection, a highly structured system combining initial reporting by the bedside night nurse of symptoms possibly related to infection with follow-up by the infection control nurse (ICN) was developed: The Infection Control Sentinel Sheet System (ICSSS).Between July 1, 1987 and February 28, 1988, a prospective comparison of results obtained through ICSSS and daily bedside observation/chart review by a full-time trained intensivist was undertaken in the pediatric intensive care unit (PICU). Ratios of nosocomial infections and nosocomially-infected patients were 15.8 and 7.0 respectively among 685 admissions; included are seven infections identified only through the ICSSS so that the “gold standard” became an amalgamation of the two systems. The sensitivity for detection of nosocomially-infected patients by bedside observation/chart review and ICSSS was 100% and 87% respectively. The sensitivity for detection of standard infections (blood, wound and urine) was 88% and 85% respectively. The sensitivity for detection of nosocomial infections at all sites was 94% and 72% respectively. Missed infections were minor (e.g., drain, skin, eye), required physician diagnosis (e.g., pneumonia), were not requested on the sentinel sheet (SS) (e.g., otitis media), related to follow-up of deceased patients or were minor misclassifications or failures to associate with device (e.g., central-line related). Daily PICU surveillance by the ICN required only 20 minutes a day. The ICSSS appears highly promising and has many unmeasured benefits.

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Impact of a Drug Shortage on Medication Errors and Clinical Outcomes in the Pediatric Intensive Care Unit

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-20.6.453 ◽

2015 ◽

Vol 20 (6) ◽

pp. 453-461 ◽

Cited By ~ 3

Author(s):

Kaitlin M. Hughes ◽

Elizabeth S. Goswami ◽

Jennifer L. Morris

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Adverse Events ◽

Pediatric Intensive Care Unit ◽

Clinical Pharmacist ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Prescribing Errors ◽

Drug Shortage

OBJECTIVES: The purpose of this study was to assess the rate of prescribing errors, resulting adverse events, and patient outcomes associated with sedation and analgesia in the pediatric intensive care unit (PICU) before and during a national shortage of fentanyl and injectable benzodiazepines. METHODS: A retrospective chart review was performed of patients admitted to the PICU with at least 1 prescribed order for a sedative or analgesic agent during the time periods of January to February of 2011 and 2012. Initial orders for sedative and analgesic agents were identified and investigated for appropriateness of dose and were assessed for error-associated adverse events. Orders were stratified by timing in regard to clinical pharmacist on-site availability. Demographic and outcome information, including unintended extubations, ventilator days, and PICU length of stay, were gathered. RESULTS: One hundred sixty-nine orders representing 72 patients and 179 orders representing 75 patients in 2011 and 2012, respectively, were included in analysis. No differences were found in the rate of prescribing errors in 2011 and 2012 (33 errors in 169 orders vs. 39 errors in 179 orders, respectively, p=0.603). No differences were found in rates of prescribing errors in regard to clinical pharmacist on-site availability. A significant increase was seen in unintended extubations per 100 ventilator days, with 0.15 in 2011 vs. 1.13 in 2012, respectively (p<0.001). A significant decrease was seen in ventilator days per patient (p<0.001) and PICU length of stay per patient (p=0.019). CONCLUSIONS: There were no differences in rates of prescribing errors before versus during the fentanyl and benzodiazepine shortage.

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Hyperoxemia among Pediatric Intensive Care Unit Patients Receiving Oxygen Therapy

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1740586 ◽

2021 ◽

Author(s):

Azadeh R. Fayazi ◽

Matteo Sesia ◽

Kanwaljeet J. S. Anand

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Oxygen Therapy ◽

Oxygen Toxicity ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Organ Injury ◽

Arterial Blood Gas ◽

Arterial Blood

AbstractSupratherapeutic oxygen levels consistently cause oxygen toxicity in the lungs and other organs. The prevalence and severity of hyperoxemia among pediatric intensive care unit (PICU) patients remain unknown. This was the first study to examine the prevalence and duration of hyperoxemia in PICU patients receiving oxygen therapy. This is a retrospective chart review. This was performed in a setting of 36-bed PICU in a quaternary-care children's hospital. All the patients were children aged <18 years, admitted to the PICU for ≥24 hours, receiving oxygen therapy for ≥12 hours who had at least one arterial blood gas during this time.There was no intervention. Of 5,251 patients admitted to the PICU, 614 were included in the study. On average, these patients received oxygen therapy for 91% of their time in the PICU and remained hyperoxemic, as measured by pulse oximetry, for 65% of their time on oxygen therapy. Patients on oxygen therapy remained hyperoxemic for a median of 38 hours per patient and only 1.1% of patients did not experience any hyperoxemia. Most of the time (87.5%) patients received oxygen therapy through a fraction of inspired oxygen (FiO2)-adjustable device. Mean FiO2 on noninvasive support was 0.56 and on invasive support was 0.37. Mean partial pressure of oxygen (PaO2) on oxygen therapy was 108.7 torr and 3,037 (42.1%) of PaO2 measurements were >100 torr. Despite relatively low FiO2, PICU patients receiving oxygen therapy are commonly exposed to prolonged hyperoxemia, which may contribute to ongoing organ injury.

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Radiation Exposure in Pediatric Intensive Care Unit Patients: How Much Is Too Much?

Clinical Pediatrics ◽

10.1177/0009922818780696 ◽

2018 ◽

Vol 57 (12) ◽

pp. 1391-1397

Author(s):

Yamini S. Kapileshwarkar ◽

Laura T. Smith ◽

Susan M. Szpunar ◽

Premchand Anne

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Radiation Exposure ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

High Radiation ◽

High Exposure ◽

Computed Tomography Scans ◽

Minimize Radiation Exposure

We aimed to determine median cumulative radiation exposure in pediatric intensive care unit (PICU) patients, proportion of patients with high radiation exposure (above annual average radiation per person of 6.2 mSv), and determine risk factors for high exposure. This was a retrospective chart review of PICU patients up to 18 years of age admitted to a large community hospital over 2 years. Radiologic studies and radiation exposure were determined for each patient, and total hospital radiation exposure was classified as high (>6.2 mSv) or not (≤6.2 mSv). Median radiation exposure per patient was 0.2 mSv (interquartile range = 2.1) and 11.7% of patients received >6.2 mSv radiation during their hospitalization. Factors associated with high radiation exposure included admission for trauma or surgery, number of computed tomography scans, age, and PICU length of stay (all P < .0001). We concluded that subsets of PICU patients are at risk of high radiation exposure. Policies and protocols may help minimize radiation exposure among PICU patients.

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Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-21.6.486 ◽

2016 ◽

Vol 21 (6) ◽

pp. 486-493 ◽

Cited By ~ 3

Author(s):

Sarah Bonazza ◽

Lauren C. Bresee ◽

Timothy Kraft ◽

B. Catherine Ross ◽

Deonne Dersch-Mills

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Primary Objective ◽

Vancomycin Trough

BACKGROUND: Published information evaluating frequency of and risk factors for vancomycin-induced acute kidney injury (AKI) in the pediatric intensive care unit (PICU) population is conflicting. OBJECTIVES: The primary objective was to describe the proportion of our PICU patients who developed AKI with intravenous (IV) vancomycin. The secondary objective was to describe the associated potential risk factors. METHODS: Pediatric patients (0–18 years) who received their first IV vancomycin dose in the PICU were evaluated in this retrospective chart review. AKI was defined based on Pediatric-Modified RIFLE (pRIFLE) criteria. Patient demographics, vancomycin trough concentrations, concomitant nephrotoxins, and estimated creatinine clearance changes were analyzed. RESULTS: Of 265 patients included, the primary outcome of AKI (defined by meeting any pRIFLE criteria) occurred in 62 (23.4%) patients (48 category R, 11 category I, 3 category F). Patients who received vancomycin treatment for = 5 days were more likely to develop AKI (unadjusted odds ratio [uOR]: 2.52; 95% confidence interval [CI]: 1.11–5.73), as were patients with a maximum vancomycin trough level = 20 mg/L (OR: 2.99; 95% CI: 1.54–5.78) and patients on 1 (uOR: 2.29; 95% CI: 1.12–4.66) or more concurrent nephrotoxin (uOR: 3.11; 95% CI: 1.43–6.77). Among nephrotoxins, patients receiving furosemide concomitantly with vancomycin were more likely to develop AKI (uOR: 3.47; 95% CI: 1.92–6.27). After adjustment, only furosemide was a significant predictor of risk of AKI/AKI (adjusted OR: 3.52; 95% CI: 1.88–6.62). The study was limited by its retrospective and observational design, and confounding variables. CONCLUSIONS: Patients who were receiving vancomycin with concurrent furosemide were at highest risk of developing AKI.

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Community-associated methicillin-resistant Staphylococcus aureus infections in a pediatric intensive care unit

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1565 ◽

2011 ◽

Vol 5 (08) ◽

pp. 587-591 ◽

Cited By ~ 4

Author(s):

Khaled Menif ◽

Asma Bouziri ◽

Ammar Khaldi ◽

Asma Hamdi ◽

Sarra Belhadj ◽

...

Keyword(s):

Intensive Care Unit ◽

Staphylococcus Aureus ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Methicillin Resistant Staphylococcus Aureus ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Pulmonary Involvement ◽

Methicillin Resistant ◽

Mrsa Infection

Introduction: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is an increasing problem worldwide. In developing countries, there is little data on CA-MRSA infection in children. This study reviewed the clinical features and outcomes of children admitted in a Tunisian pediatric intensive care unit with severe CA-MRSA infections. Methodology: Retrospective chart review of patients coded for CA-MRSA over 10 years. Results: There were 14 (0.32% of all admissions) patients identified with severe CA-MRSA infections. The median age was three months (range, 0.5-156 months). All patients had pulmonary involvement. Six children (42.8%) developed septic shock. Two (14.3%) patients had multifocal infection with deep venous thrombosis. Two (14.3%) patients died. Conclusions: Severe CA-MRSA pneumonia dominated presentation. The mortality of CA-MRSA infection in our series is lower than that previously reported.

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Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

Applied Clinical Informatics ◽

10.1055/s-0040-1705108 ◽

2020 ◽

Vol 11 (02) ◽

pp. 226-234

Author(s):

Conrad Krawiec ◽

Christy Stetter ◽

Lan Kong ◽

Paul Haidet

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Electronic Health Record ◽

Pediatric Intensive Care Unit ◽

Chart Review ◽

Strong Association ◽

Pediatric Intensive Care ◽

Health Record ◽

Unit Increase ◽

Electronic Health

Abstract Background Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores. Methods During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. We examined associations between documentation times and patient census and maximum admission mortality scores. Odds ratios (ORs) are reported per 1-unit increase in patient census and mortality scores. Results Overall, total daily EHR usage time (median time [hh:mm] [25th, 75th percentile]) was 2:10 (1:31, 3:08). For all hours (8 a.m.–8 a.m.), no strong association was noted between total EHR time, chart review, and documentation times and patient census, Pediatric Index of Mortality 2 (PIM2), or Pediatric Risk of Mortality 3 (PRISM3) scores. For regular hours (8 a.m.–7 p.m.), no strong association was noted between total EHR, chart review, and documentation times and patient census, PIM2, or PRISM3 scores. When patient census was higher, the odds of EHR after-hour usage (7 p.m.–8 a.m.) was higher (OR 1.262 [1.135, 1.403], p < 0.0001), but there were no increased odds with PIM2 (OR 1.090 [0.956, 1.242], p = 0.20) and PRISM3 (OR 1.010 [0.984, 1.036], p = 0.47) scores. A subset of physicians spent less time performing EHR-related tasks when patient census and admission mortality scores were elevated. Conclusion We performed a novel evaluation of physician EHR workflow in our PICU. Our pediatric critical care physicians spend approximately 2 hours (out of an expected 10-hour shift) each service day using the EHR, but there was no strong or consistent association between EHR usage and patient census or mortality scores. Future larger scale studies are needed to ensure validity of these results.

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623 Melatonin Use in the Pediatric Intensive Care Unit: 5 year single center experience

SLEEP ◽

10.1093/sleep/zsab072.621 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A244-A245

Author(s):

Jessica Jacobson ◽

Joanna Tylka ◽

Savannah Glazer ◽

Rosario Cosme ◽

Pallavi Patwari

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sleep Disturbance ◽

Pediatric Intensive Care Unit ◽

Chart Review ◽

Pediatric Intensive Care ◽

Severe Illness ◽

Average Dose ◽

Home Medication ◽

Melatonin Administration

Abstract Introduction Pediatric patients requiring intensive care are at risk for unavoidable sleep and circadian disturbances because of the frequency and nature of delivering care for severe illness in this setting. There is growing appreciation for sleep as an essential component for neuropsychological and physical health. While exogenous influences (light and noise) and endogenous evaluation (melatonin levels) have been evaluated in this setting, there has not yet been investigation of current practice for exogenously administered melatonin in the pediatric intensive care unit (PICU). We aimed to evaluate baseline practice and changes in melatonin administration after implementation of delirium education. Methods In 2018, pediatric delirium education was implemented and included identification of sleep disturbance. A 5-year retrospective chart review (3-years baseline and 2-years after delirium education) was completed based on a pharmacy database that identified all patients who had melatonin administration while in PICU. Each admission was counted as an unique encounter. Data collection included patient age, date of admission, and length of stay (LOS). Data for melatonin included dose, starting date, duration of treatment (number of days), and indication. Indications for melatonin were (1) delirium, (2) insomnia, (3) circadian sleep wake disorder, (4) previous home medication, and (5) unable to determine from chart review. Results Over 5 years (2015 – 2020), 182 (6.0%) patients admitted to PICU (average age 9.3 +/- 5.8 years, average LOS 24.9 +/- 56.3 days) were given melatonin (average dose 4.0 +/- 2.3 mg). The most frequent indication for melatonin administration was continuation as a home medication (45.9%) and least frequent was sleep-wake disturbance (3.9%). The percentage of patients given melatonin as compared to total PICU admissions, nearly doubled from 4.4% in baseline group to 8.2% in post-delirium-education group. Further, “delirium” as indication for melatonin increased from 5.2% (baseline) to 15.4% (post-education). There were no notable changes for administration indication “insomnia” (18.2% vs 19.2%) or “unknown” (22.1% vs 19.2%). Conclusion This is the first exploratory study to evaluate frequency and indication of melatonin use in the PICU and changes in practice after implementing delirium education. Delirium education that includes sleep disturbance has had significant impact on frequency of melatonin administration. Support (if any):

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