Intensive Care Unit Physician Discretion in Pediatric Critical Care. Polarized, Evaluated, and Reframed

2016 ◽  
Vol 194 (12) ◽  
pp. 1443-1444
Author(s):  
Christopher S. Parshuram
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Unit Physician ◽  
Pediatric Critical Care

scholarly journals A study of medication errors during the prescription stage in the pediatric critical care services of a secondary-tertiary level public hospital

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lorena Michele Brennan-Bourdon ◽  
Alan O. Vázquez-Alvarez ◽  
Jahaira Gallegos-Llamas ◽  
Manuel Koninckx-Cañada ◽  
José Luis Marco-Garbayo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medication Errors ◽  
Public Hospital ◽  
Care Practice ◽  
Tertiary Level ◽  
Skin Reactions ◽  
Pediatric Critical Care ◽  
Care Services

Abstract Background Medication Errors (MEs) are considered the most common type of error in pediatric critical care services. Moreover, the ME rate in pediatric patients is up to three times higher than the rate for adults. Nevertheless, information in pediatric population is still limited, particularly in emergency/critical care practice. The purpose of this study was to describe and analyze MEs in the pediatric critical care services during the prescription stage in a Mexican secondary-tertiary level public hospital. Methods A cross-sectional study to detect MEs was performed in all pediatric critical care services [pediatric emergency care (PEC), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and neonatal intermediate care unit (NIMCU)] of a public teaching hospital. A pharmacist identified MEs by direct observation as the error detection method and MEs were classified according to the updated classification for medication errors by the Ruíz-Jarabo 2000 working group. Thereafter, these were subclassified in clinically relevant MEs. Results In 2347 prescriptions from 301 patients from all critical care services, a total of 1252 potential MEs (72%) were identified, and of these 379 were considered as clinically relevant due to their potential harm. The area with the highest number of MEs was PICU (n = 867). The ME rate was > 50% in all pediatric critical care services and PICU had the highest ME/patient index (13.1). The most frequent MEs were use of abbreviations (50.9%) and wrong speed rate of administration (11.4%), and only 11.7% of the total drugs were considered as ideal medication orders. Conclusion Clinically relevant medication errors can range from mild skin reactions to severe conditions that place the patient’s life at risk. The role of pharmacists through the detection and timely intervention during the prescription and other stages of the medication use process can improve drug safety in pediatric critical care services.

scholarly journals Incidence and predictors of mortality among children admitted to the pediatric intensive care unit at the University of Gondar comprehensive specialized hospital, northwest Ethiopia: A prospective observational cohort study

2020 ◽  
Author(s):  
Nahom Worku Teshager ◽  
Ashenafi Tazebew Amare ◽  
koku Tamirat
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Cohort Study ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Pediatric Critical Care ◽  
Predictors Of Mortality

Abstract Background Pediatric intensive care unit (PICU) tremendously improves the success of saving patients having potentially life-threatening illness. An accurate estimate of lives saved through pediatric critical care intervention is important to evaluate the quality of the health care system. Data on pediatric critical care in developing countries remain scarce yet is much needed to improve clinical practices and outcomes. This study aimed to determine the incidence and predictors of mortality in the pediatric intensive care unit in the study setting.Method An institution based prospective cohort study was conducted from February 2018 to July 2019. We collected data by interview, chart and registration book review. Life table was used to estimate the cumulative survival of patients and Log rank test was used to compare survival curves between different categories of the explanatory variables. Survival trend over the follow up time was described using the Kaplan Meier graph. Bivariate and multivariate Cox proportional hazard model were used to identify predictors.Result Based on the 10 th version of international classifications of disease (ICD) of WHO, neurologic disorders (22.7%) infectious disease (18.8%) and environmental hazards (11.8%) account for the top three diagnoses. The median observation time was 3 days with IQR of 1 to 6 days. Of the total of 313 participants, 102 (32.6%) died during the follow-up time. This gives the incidence of mortality of 6.9 deaths per 100 person day observation. Caregivers’ occupation of government-employed (AHR=0.35, 95%CI: 0.14, 0.89), weekend admission (AHR=1.63, 95%CI: 1.02, 2.62), critical illness (AHR=1.79, 95%CI: 1.13, 2.85) Mechanical ventilation AHR=2.36,95%CI: 1.39, 4.01)and PIM2 score (AHR=1.53, 95%CI: 1.36, 1.72) were predictors of mortality in the pediatric ICU.Conclusion Neurologic disorder was the leading causes of admission followed by infectious diseases, and environmental hazards. Rate of mortality was high and admission over weekends, caregivers' occupation, mechanical ventilation, critical illness diagnosis, and higher PIM2 scores were found to be significant and independent predictors of mortality at the PICU. This suggests that ICU medical equipment, diagnostics, and interventions should be available up to the standard. Intensivist and full staffing around the clock has to be available in the PICU.

Guidelines and Levels of Care for Pediatric Intensive Care Units

PEDIATRICS ◽  
1993 ◽  
Vol 92 (1) ◽  
pp. 166-175 ◽  
Author(s):  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
American Academy ◽  
Pediatric Intensive Care Unit ◽  
Hospital Care ◽  
Pediatric Intensive Care ◽  
Critical Care Medicine ◽  
Pediatric Critical Care ◽  
American Academy Of Pediatrics

Pediatric critical care medicine has matured dramatically during the past two decades. Knowledge of the pathophysiology of life-threatening processes and the technologic capacity to monitor and treat pediatric patients suffering from them have advanced rapidly during this period. Along with the scientific and technical advances has been the evolution of the pediatric intensive care unt (PICU), where the special needs of critically ill or injured children can be met by pediatric specialists. In 1985, the American Board of Pediatrics recognized the new subspecialty of Pediatric Critical Care Medicine and established criteria for subspecialty certification. The American Boards of Medicine, Surgery, and Anesthesiology gave similar recognition to the subspecialty. In 1990, the Residency Review Committee of the Accreditation Council for Graduate Medical Education completed its first accreditation of Pediatric Critical Care Medicine Training Programs. In view of these developments, the Pediatric Section of the Society of Critical Care Medicine and the American Academy of Pediatrics Section on Critical Care Medicine and Committee on Hospital Care believe that existing published1 guidelines should now be revised for the pediatric intensive care unit. This policy represents the consensus of the three above-mentioned groups who believe the recommendations that follow are current, necessary, and attainable in 1993. The guidelines are not intended as a statement of the ideal or ultimate requirements for PICUs. We expect standards for PICUs to rise as critical care medicine continues to develop and appropriately trained providers become more readily available. In view of these developments, the Pediatric Section of the Society of Critical Care Medicine and the American Academy of Pediatrics Section on Critical Care Medicine and Committee on Hospital Care believe that existing published1 guidelines should now be revised for the pediatric intensive care unit.

The Utility of Point-of-Care Ultrasound in the Pediatric Intensive Care Unit

2021 ◽  
pp. 088506662110478
Author(s):  
Laura A. Watkins ◽  
Sharon P. Dial ◽  
Seth J. Koenig ◽  
Dalibor N. Kurepa ◽  
Paul H. Mayo
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Point Of Care ◽  
Pediatric Intensive Care ◽  
Pediatric Care ◽  
Point Of Care Ultrasound ◽  
Pediatric Critical Care ◽  
New Therapy

Objectives: Point of care ultrasound (POCUS) in adult critical care environments has become the standard of care in many hospitals. A robust literature shows its benefits for both diagnosis and delivery of care. The utility of POCUS in the pediatric intensive care unit (PICU), however, is understudied. This study describes in a series of PICU patients the clinical indications, protocols, findings and impact of pediatric POCUS on clinical management. Design: Retrospective analysis of 200 consecutive POCUS scans performed by a PICU physician. Patients: Pediatric critical care patients who required POCUS scans over a 15-month period. Setting: The pediatric and cardiac ICUs at a tertiary pediatric care center. Interventions: Performance of a POCUS scan by a pediatric critical care attending with advanced training in ultrasonography. Measurement and Main Results: A total of 200 POCUS scans comprised of one or more protocols (lung and pleura, cardiac, abdominal, or vascular diagnostic protocols) were performed on 155 patients over a 15-month period. The protocols used for each scan reflected the clinical question to be answered. These 200 scans included 133 thoracic protocols, 110 cardiac protocols, 77 abdominal protocols, and 4 vascular protocols. In this series, 42% of scans identified pathology that required a change in therapy, 26% confirmed pathology consistent with the ongoing plans for new therapy, and 32% identified pathology that did not result in initiation of a new therapy. Conclusions: POCUS performed by a trained pediatric intensivist provided useful clinical information to guide patient management.

scholarly journals Trends in Pediatric Palliative Care Research (TPPCR) 2021; Issue #3: Commentary on Guttmann et al and Dryden-Palmer et al.

2021 ◽  
Author(s):  
Christina Vadeboncoeur ◽  
TPPCR
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
Symptom Management ◽  
Neonatal Intensive Care ◽  
Moral Distress ◽  
Pediatric Palliative Care ◽  
Pediatric Critical Care ◽  
Intensive Care Unit Staff

This TPPCR commentary discusses the 2021 paper by Guttmann et al and Dryden-Palmer et al., “Goals of Care Discussions and Moral Distress among Neonatal Intensive Care Unit Staff” published in the Journal of Pain and Symptom Management and the 2021 paper by Dryden-Palmer et al., “Moral Distress of Clinicians in Canadian Pediatric and Neonatal ICUs” published in Pediatric Critical Care Medicine.

scholarly journals DYSNATREMIAS;

2017 ◽  
Vol 24 (07) ◽  
pp. 1076-1080
Author(s):  
Riffat Omer ◽  
Muhammad Khalid Masood ◽  
Saima Asghar ◽  
Muhammad Jawad ◽  
Amir Afzal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Serum Sodium ◽  
Prospective Observational Study ◽  
Pediatric Intensive Care ◽  
Pediatric Critical Care ◽  
Life Threatening ◽  
Study Setting ◽  
Critical Care Patients

Dysnatremias (hyponatremia and hypernatremia) are common electrolytedisorders encountered in pediatric critical care patients. The spectrum of both hypo- andhypernatremia varies from mild to severe, being life threatening occasionally. We carried outa study to determine the etiology, epidemiology and effect of dysnatremias on outcomes ofpediatric critical care patients. Objectives: To determine the etiology, epidemiology and effectof dysnatremias on outcomes of pediatric critical care patients. Study Design: Prospective,observational study. Setting: Paediatric Intensive Care Unit (PICU) Services Hospital Lahore.Period: October 2014 to March 2015. Results: 185 patients were included. 19 (10.3%) patientshad hyponatremia and 22 (11.9%) patients had hypernatremia. A weak but significant inverserelationship between presentation serum sodium and mortality was observed (r = - 0.39,n=185, p= <0.001, two-tailed). Conclusions: Presentation serum sodium may influence theoutcomes of the patients admitted to the pediatric intensive care unit.

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