Cases in Paediatric Critical Care Transfer and Retrieval Medicine

2021 ◽  
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Transfer Process ◽  
The Past ◽  
Clinical Presentations ◽  
Paediatric Critical Care ◽  
Care Transfer ◽  
Case Based

Critically ill paediatric transfers have expanded rapidly over the past ten years and, as such, the need for transfer teams to recognise, understand and treat the various illnesses that they encounter is greater than ever. This highly illustrated book covers a multitude of clinical presentations in a case-based format to allow an authentic feel to the transfer process. Written by clinicians with experience in thousands of transfers, it brings together many years of experience from a world-renowned hospital. Following the case from initial presentation, to resuscitation and referral and finally with the transfer itself; the book explores the clinical stabilisation, human factors decisions and logistical challenges that are encountered every day by these teams. Following the entire journey, this is an ideal resource for all professionals who may be involved in critical care transfer and retrieval medicine, particularly those working in paediatrics, emergency medicine, anaesthesiology, intensive care, or pre-hospital settings.

scholarly journals Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

2021 ◽  
pp. 175114372110121
Author(s):  
Stephen A Spencer ◽  
Joanna S Gumley ◽  
Marcin Pachucki
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Case Series ◽  
Critically Ill Children ◽  
Single Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Paediatric Critical Care ◽  
Doctors And Nurses

Background Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

scholarly journals Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
M. Ostermann ◽  
A. Schneider ◽  
T. Rimmele ◽  
I. Bobek ◽  
M. van Dam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Critical Care ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Future Research ◽  
Knowledge Gaps ◽  
Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

Survey of Physiotherapy Practice in Ontario Cardiac Surgery Intensive Care Units

2021 ◽  
pp. e20200069
Author(s):  
Anastasia N.L. Newman ◽  
Michelle E. Kho ◽  
Jocelyn E. Harris ◽  
Alison Fox-Robichaud ◽  
Patricia Solomon
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Critically Ill ◽  
Outcome Measures ◽  
Median Number ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Physiotherapy Practice

Purpose: This article describes current physiotherapy practice for critically ill adult patients requiring prolonged stays in critical care (> 3 d) after complicated cardiac surgery in Ontario. Method: We distributed an electronic, self-administered 52-item survey to 35 critical care physiotherapists who treat adult cardiac surgery patients at 11 cardiac surgical sites. Pilot testing and clinical sensibility testing were conducted beforehand. Participants were sent four email reminders. Results: The response rate was 80% (28/35). The median (inter-quartile range) reported number of cardiac surgeries performed per week was 30 (10), with a median number of 14.5 (4) cardiac surgery beds per site. Typical reported caseloads ranged from 6 to 10 patients per day pe therapist, and 93% reported that they had initiated physiotherapy with patients once they were clinically stable in the intensive care unit. Of 28 treatments, range of motion exercises (27; 96.4%), airway clearance techniques (26; 92.9%), and sitting at the edge of the bed (25; 89.3%) were the most common. Intra-aortic balloon pump and extracorporeal membrane oxygenation appeared to limit physiotherapy practice. Use of outcome measures was limited. Conclusions: Physiotherapists provide a variety of interventions with critically ill cardiac surgery patients. Further evaluation of the limited use of outcome measures in the cardiac surgical intensive care unit is warranted.

Challenging Concepts in Paediatric Critical Care

2020 ◽  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
Evidence Base ◽  
Paediatric Intensive Care ◽  
Circulatory Support ◽  
Cell Transplant ◽  
Patient Journey ◽  
Expert Commentary ◽  
Paediatric Critical Care

This textbook, ‘Challenging concepts in paediatric critical care’, has been designed to cater to the needs of paediatric intensivists, current trainees and those intending to train in the future. Similar to its predecessors in this ‘Challenging concepts’ series, this book aims to educate clinicians by describing clinical situations that are both common, such as bronchiolitis, sepsis etc., and complex, such as mechanical circulatory support, stem cell transplant etc., in paediatric intensive care medicine. The textbook contains 18 chapters based on challenging scenarios involving variety of diseases and organ dysfunctions. Each chapter contains several “Learning Points”, “Clinical Tips” and “Evidence Base” boxes embedded in the text with the aim to promote memory and stimulate learning. These run alongside an “Expert Commentary” written by an international group of experts in the field, to give practical advice of how they approach these difficult situations. Many chapters include results and imaging to enhance the fidelity and narrative style of text, that encourage the reader to understand the patient journey and feel part of the decision making process. The clinical topics in this book are aligned to match the Royal College of Paediatrics and Child Health’s paediatric intensive care medicine curriculum in the UK, as well as the curriculum of Paediatric Basic assessment and support in intensive care (BASIC) course and the various domains of Paediatric/neonatal European Diploma in Intensive Care (PEDIC) curriculum.

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

2021 ◽  
Vol 1 (3) ◽  
pp. 44-48
Author(s):  
Cendy Legowo
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Postoperative Delirium ◽  
Mechanistic Explanation ◽  
Clinical Results ◽  
Care Plan ◽  
Prevention And Treatment

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).

The need to know: experiences of critically ill patients

2000 ◽  
Vol 9 (3) ◽  
pp. 192-198 ◽  
Author(s):  
JE Hupcey ◽  
HE Zimmerman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Nursing Staff ◽  
Critically Ill Patients ◽  
Second Phase ◽  
The Past ◽  
Intensive Care Unit Nurses ◽  
Vivid Memories

BACKGROUND: Critically ill patients vary in their memories of their experience in the intensive care unit. Some have little recall and need to learn about their critical illness. Others have more vivid memories of their experiences, some of which were extremely unpleasant. Patients' not knowing what was happening may have exacerbated the unpleasant experiences. OBJECTIVES: To elicit the experience of knowing for critically ill patients and to explore the differences in perceptions between patients who were intubated and those who were not intubated during the illness. METHODS: Grounded theory was used to explore the meaning of knowing and not knowing and the process by which knowing occurs. Unstructured interviews were done with 14 patients. RESULTS: Knowing had 2 phases: the need to know (1) during and (2) after the critical illness. The first phase had 3 facets: needing information, needing to be oriented, and having confusing perceptions. The second phase had 2 facets: needing information about what had happened and piecing together events. Many experiences with knowing during and after a critical illness were similar for both intubated and nonintubated patients. The main difference was the intensity of the experience in some categories. CONCLUSIONS: Critically ill patients have a strong need to know throughout and after their time in the intensive care unit. Nurses must address this need for constant reorientation to the past and present in these patients. In addition, adequate nursing staff must be available for these patients.

scholarly journals 1 Paediatric Transport Safety Collaborative (PTSIC): Critical Events with Family Presence During Paediatric Critical Care Transport

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e1-e1
Author(s):  
Aaisham Ali ◽  
Michael Miller ◽  
Saoirse Cameron ◽  
Anna Gunz
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Patient Outcomes ◽  
Well Being ◽  
Critical Events ◽  
Family Presence ◽  
Paediatric Patients ◽  
Increased Risk ◽  
Transport Team ◽  
Paediatric Critical Care

Abstract Background Health care of children in Canada is regionalized; thus, critically ill paediatric patients require transfer to a tertiary care centre for definitive medical and surgical management. There are risks inherent to transporting critically ill patients, and there is a body of literature looking to mitigate risk, which includes tracking and benchmarking quality metrics. One accepted metric is family accompaniment of a child during transport, with some studies suggesting that family accompaniment could compromise care. Currently, there has been no research that examines patient safety and outcomes during paediatric critical care transport with family presence. Objectives The primary objective of this study was to compare the rate of critical events (CEs) during the transport of paediatric patients by a specialized paediatric critical care transport team on transports with parental/caregiver accompaniment (P/CA) to those without P/CA. Secondary objectives included whether peak heart rate (HR), systolic blood pressure (SBP), and clinically relevant patient outcomes varied between groups. Design/Methods We conducted a retrospective cohort study of all patients (&lt;18 years old) who were admitted to a Paediatric Critical Care Unit and transported by the local neonatal paediatric transport team between April 1st, 2018 and June 1st, 2019, inclusive. The primary outcome was CE occurrence using the composite definition of CE that was previously identified and defined by a national consensus process, which included patient-, transport provider-, laboratory- and system/vehicle- related safety factors. Secondary outcomes included peak and trough HR/SBP, and clinically relevant outcomes (including length of stay, mechanical ventilation free days, and severity of illness and organ dysfunction scores). Results There were a total of 178 transports eligible for analysis, and of those, 55 were with P/CA and 123 were without P/CA. The occurrence of CE was not significantly different between transports with and without P/CA (66% vs. 65%, respectively). Similarly, patient HR, SBP, and all measured clinical patient outcomes did not vary significantly between groups. Conclusion This study is the first to objectively measure CEs and relate them to patient clinical outcomes with regard to presence of P/CA during paediatric critical care transport. There was no identified increased risk to the patient or crew if parents/caregivers accompanied their child during transport. Areas of future study include whether parental/caregiver presence during transport affects patient anxiety and well-being.

scholarly journals Implementation of the Critical Care Pain Observation Tool

2018 ◽  
Author(s):  
Carla Salvadore
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Pain Assessment ◽  
The United States ◽  
Posttest Score ◽  
Assessment Instrument ◽  
Post Intervention ◽  
Nurses Knowledge

In the United States, greater than half of the adult patients who are admitted to critical care experience pain and report poor pain control. Inadequate management of acute pain is associated with negative outcomes, including high blood sugar, insulin resistance, higher infection risk, increased discomfort, decreased satisfaction, and chronic pain. Patients in the intensive care unit (ICU) cannot always express that they are having pain. Recently modified guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult recommend a reliable and valid pain assessment instrument for patients who are unable to verbalize pain. For the adult critically ill population, the Critical Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS) were identified as the most reliable and valid instruments. The purpose of this program development was to provide education for nurses in the Cardiovascular Intensive Care Unit (CVICU) on the CPOT to assist in transitioning to the CPOT as part of the CVICU pain assessment. A pretest-posttest design was utilized to evaluate the nurses’ knowledge of the CPOT. The intervention consisted of a one-hour education session on pain assessment and the CPOT. Thirteen out of a potential twenty-two nurses (n=13, 59%) participated in the educational session with a mean pretest score of 42.3% and a mean posttest score of 93.1%. There was a 50.8% improvement post-intervention total scores. Findings from this quality improvement education intervention suggest that the CVICU nurses’ knowledge increased in both pain assessment and the CPOT following the intervention.

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