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.

scholarly journals The effect of care provided by paediatric critical care transport teams on mortality of children transported to paediatric intensive care units in England and Wales: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah E. Seaton ◽  
◽  
Elizabeth S. Draper ◽  
Christina Pagel ◽  
Fatemah Rajah ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critical Incidents ◽  
Paediatric Intensive Care ◽  
Junior Doctors ◽  
England And Wales ◽  
The Impact ◽  
Paediatric Critical Care ◽  
Paediatric Intensive Care Units

Abstract Background Centralisation of paediatric intensive care units (PICUs) has the increased the need for specialist paediatric critical care transport teams (PCCT) to transport critically ill children to PICU. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes. Methods We analysed linked national data from the Paediatric Intensive Care Audit Network (PICANet) from children admitted to PICUs in England and Wales (2014–2016) to assess the impact of who led the child’s transport, whether prolonged stabilisation by the PCCT was detrimental and the impact of critical incidents during transport on patient outcome. We used logistic regression models to estimate the adjusted odds and probability of mortality within 30 days of admission to PICU (primary outcome) and negative binomial models to investigate length of stay (LOS) and length of invasive ventilation (LOV). Results The study included 9112 children transported to PICU. The most common diagnosis was respiratory problems; junior doctors led the PCCT in just over half of all transports; and the 30-day mortality was 7.1%. Transports led by Advanced Nurse Practitioners and Junior Doctors had similar outcomes (adjusted mortality ANP: 0.035 versus Junior Doctor: 0.038). Prolonged stabilisation by the PCCT was possibly associated with increased mortality (0.059, 95% CI: 0.040 to 0.079 versus short stabilisation 0.044, 95% CI: 0.039 to 0.048). Critical incidents involving the child increased the adjusted odds of mortality within 30 days (odds ratio: 3.07). Conclusions Variations in team composition between PCCTs appear to have little effect on patient outcomes. We believe differences in stabilisation approaches are due to residual confounding. Our finding that critical incidents were associated with worse outcomes indicates that safety during critical care transport is an important area for future quality improvement work.

scholarly journals Prospective paediatric intensive care registry in Latvia: one year outcomes

2019 ◽  
Vol 26 (1) ◽  
pp. 64-71
Author(s):  
Ivars Veģeris ◽  
Iveta Daukšte ◽  
Arta Bārzdiņa ◽  
Roger C. Parslow ◽  
Reinis Balmaks
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Admission Rate ◽  
Paediatric Intensive Care ◽  
High Rate ◽  
Critically Ill Children ◽  
Unplanned Extubations ◽  
Retrospective Audit ◽  
One Year ◽  
Paediatric Critical Care

Background. In Latvia, there is a single eight-bed paediatric intensive care unit (PICU) where all critically ill children are admitted. A recent retrospective audit of the outcomes of paediatric critical care in this unit revealed a high number of unplanned extubations and excess crude mortality. In 2017, our centre joined the UK and Ireland based Paediatric Intensive Care Audit Network (PICANet) as a pilot project to investigate the feasibility of developing a paediatric critical care registry in Latvia and in the Baltic states. Methods. Riga Stradins University Ethics Committee approved the study. Anonymized data on all patients admitted to our unit from 1 June, 2017 to 31 May 2018 were prospectively entered onto the PICANet database. Results. A total of 774 PICU admissions were analysed; 45% of admissions were elective. The median age was 59 months (IQR: 14–149). The highest admission rate was on Wednesdays representing the flow of elective surgical patients. The median length of stay was 0.95 days (IQR: 0.79–1.98). Twenty-five percent required respiratory support. The expected number of deaths estimated using the Paediatric Index of Mortality 3 (PIM 3) 15.16; 15 patients (1.94%) died resulting in Standartized Mortality Ratio (SMR) of 0.99 (95% CI 0.57–1.60). The emergency readmission rate within 48 hours after PICU discharge was 0.9%. There were 1.8 unplanned extubations per 100 invasive ventilation days. Other paediatric intensive care audit networks reported similar adjusted mortality rates but lower rates of unplanned extubations. Thirty days after PICU discharge, 653 (84.36%) patients were alive and outside hospital, 98 (12.66%) were inpatients, six (0.78%) had died, two (0.26%) were lost to the follow-up. We observed a marked peak of infant emergency respiratory admissions in February. Conclusions. This project explored the possibility of prospective paediatric critical care audit in Latvia by joining an established international network. This allowed direct comparison of outcomes between the countries. Excess mortality was not observed during one-year data collection period, however a high rate of unplanned extubations was revealed. The results allowed a better planning of elective patient flow by spreading elective cases over the week to avoid “rush hours”

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.

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.

Law and ethics in intensive care

2020 ◽  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
Ethical Issues ◽  
Daily Basis ◽  
Scarce Resources ◽  
Ethical Concerns ◽  
Law And Ethics ◽  
Invasive Management ◽  
Legal And Ethical Issues

The practice of intensive care medicine raises multiple legal and ethical issues on a daily basis, making it increasingly difficult to know whom to admit and when, at what stage invasive management should be withdrawn, and who, importantly, should decide? These profound dilemmas, already complicated in a setting of scarce resources, mandate an understanding of law and ethics for those working in intensive care medicine. Clinically focused, the book explains the relevance of landmark rulings to aid the day-to-day decision making of critical care professionals. A spectrum of ethical and legal controversies in critical care are addressed to demonstrate how law and ethics affect the care available to patients, and how patients’ responses to advances in treatment in turn influence legal and ethical concerns. Discussion of conflict resolution advises on the options that are open to doctors when agreement on treatment decisions or withdrawal cannot be reached. The literature and variations surrounding ‘Do not attempt resuscitation’ (DNAR) decisions are outlined. This edition also provides an up-to-date analysis of issues such as futility and deprivation of liberty.

scholarly journals Professional Quality of Life in intensive care medicine: The 2018 Faculty of Intensive Care Medicine Workforce survey

2019 ◽  
Vol 21 (4) ◽  
pp. 299-304
Author(s):  
Julie Highfield ◽  
Jack Parry-Jones
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
Critical Care Medicine ◽  
Professional Quality Of Life ◽  
Survey Tool ◽  
Professional Quality

Background Critical care is widely perceived, both within and outside of the speciality, as unremitting and emotionally burdensome. There is a perception of a higher risk to medical staff of burnout than other specialities. Critical care also has considerable emotional and professional rewards. We sought to examine this balance between emotional reward and stress in UK critical care consultants registered with the Faculty of Intensive Care Medicine. Method We conducted a Wellbeing survey of the Faculty of Intensive Care Medicine consultant membership utilising the Professional Quality of Life (Pro-QOL) survey tool. The survey was conducted as part of the Annual Workforce Census. Results In sum, 799 members completed the Pro-QOL survey, making this one of the largest surveys of physician wellbeing in critical care medicine. Data were analysed in accordance with the Pro-QOL manual. Conclusions The results demonstrate moderate risk for burnout and secondary traumatic stress, but this is balanced by moderate compassion satisfaction. No association was demonstrated between age, sex, or size of critical care unit worked in. Further follow-up of this consultant group is warranted to better understand risk factors for burnout and for future mitigation of these risk factors whilst also enhancing the positive aspects of working as a consultant in critical care medicine.

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