Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Objective: Bleeding can be a severe complication of critical illness, but its true epidemiologic impact on children has seldom been studied. Our objective is to describe the epidemiology of bleeding in critically ill children, using a validated clinical tool, as well as the hemostatic interventions and clinical outcomes associated with bleeding.Design: Prospective observational cohort study.Setting: Tertiary pediatric critical care unitPatients: All consecutive patients (1 month to 18 years of age) admitted to a tertiary pediatric critical care unitMeasurements and Main Results: Bleeding events were categorized as minimal, moderate, severe, or fatal, according to the Bleeding Assessment Scale in Critically Ill Children. We collected demographics and severity at admission, as evaluated by the Pediatric Index of Mortality. We used regression models to compare the severity of bleeding with outcomes adjusting for age, surgery, and severity. Over 12 months, 902 critically ill patients were enrolled. The median age was 64 months (IQR 17; 159), the median admission predicted risk of mortality was 0.5% (IQR 0.2; 1.4), and 24% were post-surgical. Eighteen percent of patients experienced at least one bleeding event. The highest severity of bleeding was minimal for 7.9% of patients, moderate for 5.8%, severe for 3.8%, and fatal for 0.1%. Adjusting for age, severity at admission, medical diagnosis, type of surgery, and duration of surgery, bleeding severity was independently associated with fewer ventilator-free days (p < 0.001) and fewer PICU-free days (p < 0.001). Adjusting for the same variables, bleeding severity was independently associated with an increased risk of mortality (adjusted odds ratio for each bleeding category 2.4, 95% CI 1.5; 3.7, p < 0.001).Conclusion: Our data indicate bleeding occurs in nearly one-fifth of all critically ill children, and that higher severity of bleeding was independently associated with worse clinical outcome. Further multicenter studies are required to better understand the impact of bleeding in critically ill children.

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Pediatric Critical Care Simulation Curriculum: Training Nurse Practitioners to Lead in the Management of Critically Ill Children

Journal of Pediatric Health Care ◽

10.1016/j.pedhc.2020.07.001 ◽

2020 ◽

Vol 34 (6) ◽

pp. 584-590

Author(s):

Kristen M. Brown ◽

Elizabeth A. Hunt ◽

Jordan Duval-Arnould ◽

Nicole Ann Shilkofski ◽

Chakra Budhathoki ◽

...

Keyword(s):

Critical Care ◽

Critically Ill ◽

Nurse Practitioners ◽

Critically Ill Children ◽

Pediatric Critical Care

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Remote Pediatric Critical Care Telephone Consultations: Quality and Outcomes

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1679900 ◽

2019 ◽

Vol 08 (03) ◽

pp. 148-155

Author(s):

Janice A. Tijssen ◽

Michael R. Miller ◽

Christopher S. Parshuram

Keyword(s):

Critical Care ◽

Intensive Care ◽

Critically Ill ◽

Vital Signs ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Pediatric Critical Care ◽

Care Consultation ◽

Quality And Outcomes

AbstractThere are no studies describing the nature and quality of telephone consultations for critically ill children despite being an important part of pediatric intensive care. We described pediatric telephone consultations to a PICU in Ontario, Canada in 2011 and 2012. Of 203 consultations, 104 patients (51.2%) were admitted to the PICU; this was associated with weekend consultations (p = 0.005) and referral hospital location (p = 0.036). Frequency of interruptions was 1 in every 3.2 (2.0, 5.7) minutes and not associated with call content. Twenty-one percent of consults had limited discussion of vital signs. Our study described our center's remote critical care consultation program and outcomes.

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A Survey of Pediatric Critical Care Providers on the Presence, Severity, and Assessment of Capillary Leak in Critically Ill Children

Journal of Pediatric Intensive Care ◽

10.1055/s-0036-1593388 ◽

2016 ◽

Vol 06 (03) ◽

pp. 145-151 ◽

Cited By ~ 1

Author(s):

Peter Luckett ◽

Edward Faustino ◽

Richard Pierce

Keyword(s):

Critical Care ◽

Cardiopulmonary Bypass ◽

Critically Ill ◽

Critically Ill Children ◽

Care Providers ◽

Capillary Leak ◽

Multiple Choice Questions ◽

Pediatric Critical Care ◽

Electronic Survey ◽

Patient Factor

Purpose To determine provider opinions on factors most commonly used to assess the presence and severity of pathologic capillary leak in critically ill children. Methods We conducted an electronic survey of pediatric critical care providers. Patient scenarios were presented to assess opinions on the risk, presence, and clinical significance of capillary leak. Responses were obtained using Likert scales and multiple-choice questions. Results A total of 160 responses were analyzed. Respondents agreed that capillary leak is present in the scenario with septic shock while respondents somewhat agreed that it is also present with poly-trauma, cardiac arrest, or cardiopulmonary bypass. They agreed that physical exam, but neither agreed nor disagreed that laboratory tests, can be used to assess and follow the severity of capillary leak in these children. Generalized edema, increase in weight, and pulmonary crackles were commonly identified parameters for assessing capillary leak. The patient factor most commonly identified with capillary leak was presence of infection, while treatment factors most commonly identified were cardiopulmonary bypass and general anesthesia. Conclusion There is agreement that capillary leak is common in critically ill children and exacerbates disease. The parameters identified in this study may facilitate a more standardized clinical evaluation of pathologic capillary leak for future studies.

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