P0180 / #1248: IS INTER-FACILITY TRANSPORT SAFE FOR CHILDREN WITH CARDIOMYOPATHY WITH INTENSIVE CARE NEEDS? – AN OVERVIEW OF EXPERIENCES FROM A REGIONAL PAEDIATRIC CRITICAL CARE TRANSPORT SERVICE

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.

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Cases in Paediatric Critical Care Transfer and Retrieval Medicine

10.1017/9781108946438 ◽

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.

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Challenging Concepts in Paediatric Critical Care

10.1093/med/9780198794592.001.0001 ◽

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.

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Priorities for paediatric critical care research: a modified Delphi study by the Australian and New Zealand Intensive Care Society Paediatric Study Group

Critical Care and Resuscitation ◽

10.51893/2021.2.oa6 ◽

2021 ◽

Vol 23 (2) ◽

pp. 194-201

Author(s):

Sainath *Raman ◽

◽

Georgia *Brown ◽

*Equal first authors ◽

Debbie Long ◽

...

Keyword(s):

Quality Of Life ◽

Critical Care ◽

Intensive Care ◽

New Zealand ◽

Delphi Study ◽

Face To Face ◽

Modified Delphi ◽

Research Questions ◽

Paediatric Critical Care

OBJECTIVE: Most interventions in paediatric critical care lack high grade evidence. We aimed to identify the key research priorities and key clinical outcome measures pertinent to research in paediatric intensive care patients. DESIGN: Modified three-stage Delphi study combining staged online surveys, followed by a face-to-face discussion and final voting. SETTING: Paediatric intensive care units in Australia and New Zealand. PARTICIPANTS: Medical and nursing staff working in intensive care. MAIN OUTCOME MEASUREMENTS: Self-reported priorities for research. RESULTS: 193 respondents provided a total of 267 research questions and 234 outcomes. In Stage 3, the top 56 research questions and 50 outcomes were discussed face to face, which allowed the identification of the top 20 research questions with the Hanlon prioritisation score and the top 20 outcomes. Topics centred on the use of intravenous fluids (restrictive v liberal fluids, use of fluid resuscitation bolus, early inotrope use, type of intravenous fluid, and assessment of fluid responsiveness), and patient- and family-centred outcomes (health-related quality of life, liberation) emerged as priorities. While mortality, length of stay, and organ support/organ dysfunction were considered important and the most feasible outcomes, long term quality of life and neurodevelopmental measures were rated highly in terms of their importance. CONCLUSIONS: Using a modified Delphi method, this study provides guidance towards prioritisation of research topics in paediatric critical care in Australia and New Zealand, and identifies study outcomes of key relevance to clinicians and experts in the field.

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Elderly Patients in Critical Care: An Overview

AACN Advanced Critical Care ◽

10.4037/15597768-1992-1015 ◽

1992 ◽

Vol 3 (1) ◽

pp. 120-126 ◽

Cited By ~ 1

Author(s):

Mickey Stanley

Keyword(s):

Older Adults ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Elderly Patients ◽

Nursing Care ◽

Care Setting ◽

Critical Care Setting ◽

Care Planning ◽

Care Needs

Elderly patients who enter the critical care setting have special nursing care needs based on the physiologic changes of aging. An overview of the changes of aging associated with the immunologic, cardiovascular, integumentary, musculoskeletal, and renal systems provides the basis for care planning to meet the needs of older adults in the intensive care unit

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Erratum 1

Critical Care and Resuscitation ◽

10.51893/2021.3.oa6e2 ◽

2021 ◽

Vol 23 (3) ◽

pp. 242-242

Keyword(s):

Critical Care ◽

Intensive Care ◽

New Zealand ◽

Delphi Study ◽

Study Group ◽

Intensive Care Society ◽

Care Society ◽

Care Research ◽

Paediatric Study ◽

Paediatric Critical Care

Raman S, Brown G, Long D, et al; the Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG). Priorities for paediatric critical care research: a modified Delphi study by the Australian and New Zealand Intensive Care Society Paediatric Study Group. Crit Care Resusc 2021; 23: 194-201. In this article, on page 200, the Acknowledgements section should read: “We thank Mark Peters, University College London, UK, for sharing his expertise at the Hanlon stage of this exercise. The data team within the Paediatric Critical Care Research Group, Brisbane, Australia helped with the surveys and analyses of the data. We thank Kate Masterson, Royal Children’s Hospital Melbourne, and all staff from PICUs in Australia and New Zealand and the ANZICS PSG Committee who participated in this study. We acknowledge the local research coordinators and research staff, who assisted with study distribution, promotion and the prioritisation process.”

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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

BMC Pediatrics ◽

10.1186/s12887-021-02689-x ◽

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.

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Evaluation of Paediatric Critical Care Needs and Practice in Nigeria: Paediatric Residents’ Perspective

Critical Care Research and Practice ◽

10.1155/2021/2000140 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Moses Temidayo Abiodun ◽

Fidelis E. Eki-Udoko

Keyword(s):

Critical Care ◽

Critically Ill ◽

Unmet Need ◽

Critically Ill Children ◽

Strong Positive Correlation ◽

Care Needs ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Tertiary Hospitals ◽

Paediatric Critical Care

Background. There is a dire need for paediatric critical care (PCC) services, but their availability in tertiary hospitals in Nigeria is not well defined. Objective. We evaluated self-reported PCC practice, resources, and perceived challenges in various zones of the country, using paediatric residents’ perspective. Methods. This is a descriptive cross-sectional survey, carried out at an Intensive Course in Paediatrics at the University of Benin Teaching Hospital, Nigeria. Participants’ PCC practice and perceived adequacy of PCC resources and services were assessed using a 100 mm uncalibrated visual analogue scale (VAS). A comparison between northern and southern zones was done. A 2-sided p value < 0.05 was considered significant. Results. A total of 143 residents participated in the study, 37.1% of them were male, and 62.9% were female. Their mean age was 34.6 ± 3.2 years. They were mainly (86.7%) from federal institutions across the country. Less than a half (46.7%) of the trainees attended to critically ill children daily, but only 4 out of every 10 respondents stated that such severely ill children survived till hospital discharge; 12.1% of the trainees had PICUs in their institutions. Financial constraints hindered PICU admissions. PCC staff were relatively fewer in northern zones than southern zones ( p < 0.05 ). Their perceived adequacy of PCC equipment and services were low (VAS scores 32.7 ± 2.6 and 30.9 ± 2.8, respectively) with a strong positive correlation between the two measurements (r = 0.839; p < 0.001 ). Conclusion. There is an unmet need for PCC practice in Nigerian tertiary hospitals with a resultant low survival rate of critically ill children. PCC training curricula and improved critical care resources are desirable in the setting.

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Pediatric Palliative Transport in Critically Ill Children: A Single Center's Experience and Parents' Perspectives

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-3401009 ◽

2019 ◽

Vol 09 (02) ◽

pp. 099-105

Author(s):

Anuradha P. Menon ◽

Yee Hui Mok ◽

Lik Eng Loh ◽

Jan Hau Lee

Keyword(s):

Critical Care ◽

Intensive Care ◽

Adverse Events ◽

Critically Ill ◽

End Of Life Care ◽

Life Support ◽

Critically Ill Children ◽

Life Care ◽

Transport Service ◽

Pediatric Icu

AbstractThe transfer of critically ill children from intensive care units (ICUs) to their homes for palliation is seldom described. We report our 10-year pediatric palliative transport experience and conducted a survey to gain parents' perspectives of their child's transport experience. Over the study period, eight patients were transported from our pediatric ICU to their homes or hospice facilities. There were no intratransport adverse events. Parents who participated in the survey responded positively to the transport experience. The availability of a dedicated critical care transport service allowed for palliative transfers to be performed safely. Facilitating transport to allow withdrawal of life support at home is an acceptable option to families as part of holistic end-of-life care.

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