scholarly journals Dr Ian Hamilton McDonald, MBBS, DA, FANZCA: The evolution of paediatric anaesthesia and intensive care at the Royal Children’s Hospital, Melbourne

2019 ◽  
Vol 47 (3_suppl) ◽  
pp. 6-16
Author(s):  
Adam Keys
Keyword(s):  
Intensive Care ◽  
Nasotracheal Intubation ◽  
Paediatric Anaesthesia ◽  
Further Training ◽  
Children's Hospital ◽  
Profound Influence ◽  
Nuffield Department ◽  
Children’S Hospital ◽  
Anaesthesia Department ◽  
Assistant Director

Dr Ian Hamilton McDonald (1923–2019) was a pioneer of paediatric anaesthesia and intensive care at the Royal Children’s Hospital, Melbourne. He first started working at the hospital in the 1940s, later doing further training from 1953–1955 at the Nuffield Department of Anaesthesia in Oxford under Sir Robert Macintosh. McDonald returned to Melbourne as assistant director supporting Dr Margaret (Gretta) McClelland as the director of anaesthesia, together pioneering the development of a major paediatric anaesthesia department. McDonald, along with Dr John Stocks (1930–1974), was intimately involved in pioneering prolonged nasotracheal intubation in children, following on from earlier work by Dr Bernard Brandstater (an Australian working in Beirut), and Drs Tom Allen and Ian Steven in Adelaide. Ian McDonald was an influential, highly respected and greatly loved paediatric anaesthetist who had a profound influence on the early days of paediatric anaesthesia in Australia.

Duration of Intubation in Children with Acute Epiglottitis

1986 ◽  
Vol 95 (4) ◽  
pp. 477-481 ◽  
Author(s):  
Carlos Gonzalez ◽  
James S. Reilly ◽  
Margaret A. Kenna ◽  
Ann E. Thompson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Operating Room ◽  
Retrospective Review ◽  
Nasotracheal Intubation ◽  
Staging System ◽  
Acute Epiglottitis ◽  
Children's Hospital ◽  
Time Period ◽  
Children’S Hospital

Nasotracheal intubation has been demonstrated to be effective in supporting the airways of children with acute epiglottitis. Length of intubation and criteria used for extubation are still controversial. A 6-year retrospective review at Children's Hospital of Pittsburgh identified 100 cases of acute epiglottitis, which were initially managed with nasotracheal intubation. Extubation was based on direct laryngeal inspection performed in the operating room (1979–1981) and, more recently, in the intensive care unit (1982–1984). Length of intubation decreased from 63.8 hours in 1979 to 42.1 hours in 1984. The percent of children intubated longer than 48 hours decreased from 69% to 22% in the same time period. These data indicate that a shorter period of intubation is aided by daily laryngeal inspection in the ICU. We propose a staging system for acute epiglottitis to aid in the decision to safely extubate these children.

An Outbreak of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit

2003 ◽  
Vol 24 (5) ◽  
pp. 317-321 ◽  
Author(s):  
Lisa Saiman ◽  
Alicia Cronquist ◽  
Fann Wu ◽  
Juyan Zhou ◽  
David Rubenstein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Methicillin Resistant ◽  
Children's Hospital ◽  
Surveillance Cultures ◽  
Children’S Hospital ◽  
Incident Cases

AbstractObjective:To describe the epidemiologic and molecular investigations that successfully contained an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in a neonatal intensive care unit (NICU).Design:Isolates of MRSA were typed by pulsed-field gel electrophoresis (PFGE) and S. aureus protein A (spa).Setting:A level III-IV, 45-bed NICU located in a children's hospital within a medical center.Patients:Incident cases had MRSA isolated from clinical cultures (eg, blood) or surveillance cultures (ie, anterior nares).Interventions:Infected and colonized infants were placed on contact precautions, cohorted, and treated with mupirocin. Surveillance cultures were performed for healthcare workers (HCWs). Colonized HCWs were treated with topical mupirocin and hexachlorophene showers.Results:From January to March 2001, the outbreak strain of MRSA PFGE clone B, was harbored by 13 infants. Three (1.3%) of 235 HCWs were colonized with MRSA. Two HCWs, who rotated between the adult and the pediatric facility, harbored clone C. One HCW, who exclusively worked in the children's hospital, was colonized with clone B. From January 1999 to November 2000, 22 patients hospitalized in the adult facility were infected or colonized with clone B. Spa typing and PFGE yielded concordant results. PFGE clone B was identified as spa type 16, associated with outbreaks in Brazil and Hungary.Conclusions:A possible route of MRSA transmission was elucidated by molecular typing. MRSA appears to have been transferred from our adult facility to our pediatric facility by a rotating HCW. Spa typing allowed comparison of our institution's MRSA strains with previously characterized outbreak clones.

scholarly journals Sepsis epidemiology and outcome in the paediatric intensive care unit of Vilnius University Children’s Hospital

2017 ◽  
Vol 24 (2) ◽  
pp. 113-120
Author(s):  
Odeta Bobelytė ◽  
Ieva Gailiūtė ◽  
Vytautas Zubka ◽  
Virginija Žilinskaitė
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Paediatric Intensive Care Unit ◽  
Paediatric Intensive Care ◽  
Multi Drug Resistance ◽  
Registration System ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Vilnius University ◽  
Hospital Acquired

Research was carried out at the paediatric intensive care unit (paediatric ICU) of the  Children’s Hospital, affiliate of Vilnius University Hospital Santariškių klinikos. Background. Being the most common cause of children’s death, sepsis is a challenge for most physicians. In order to improve the outcomes, it is important to know the aetiology and peculiarities of sepsis in a particular region and hospital. The aim of this study was to analyse the outcomes of sepsis in a paediatric intensive care unit and their relation with patients’ characteristics and causative microorganisms. Materials and Methods. A retrospective analysis of the Sepsis Registration System in Vilnius University Children’s hospital was started in 2012. From 2012 to 2015, we found 529 sepsis cases in our hospital, 203 of which were found to be fulfilling all of the inclusion criteria (patient’s age >28 days on admission, taken blood culture/positive PCR test, need for paediatric ICU hospitalization) and were included in the final analysis. Abbreviations: ICD – international disease classification PCR – polymerase chain reaction Results. Sepsis made 4% of all patients of the paediatric ICU in the period from 2012 to 2015 and caused 32% of deaths in the unit. Paediatric mortality reached 14% of all sepsis cases in our analysis, the majority of them due to hospital-acquired sepsis that occurred in patients suffering from oncologic or hematologic diseases. Another significant part of the patients that did not survive were previously healthy with no co-morbidities. The  most common microorganism in lethal community-acquired cases was N. meningitidis and in hospital-acquired sepsis – Staphylococcus spp. Multi-drug resistance was observed, especially in the cases of hospital-acquired sepsis. Conclusions. A large percentage of lethal outcomes that occur in the paediatric ICU are due to sepsis. The majority of lethal cases of sepsis occur in patients suffering from chronic co-morbidities, such as oncologic, hematologic, neurologic, and others.

Use of Emergency-Release, Uncrossmatched O Negative Red Blood Cells (RBCs) in a Tertiary Care Children’s Hospital

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4341-4341
Author(s):  
Jennifer C. Andrews ◽  
Maurene Viele ◽  
Lawrence T Goodnough
Keyword(s):  
Intensive Care Unit ◽  
Congenital Heart Disease ◽  
Intensive Care ◽  
Heart Disease ◽  
Cardiac Catheterization ◽  
Congenital Heart ◽  
Tertiary Care ◽  
Blood Products ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract Abstract 4341 Background: Transfusion services must offer means of issuing blood products quickly for emergent transfusions. At Lucile Packard Children’s Hospital (LPCH), off-site refrigerators were installed in the Neonatal Intensive Care Unit (NICU), the LPCH operating room (OR) and the Cardiovascular Intensive Care Unit (CVICU) inventoried with uncrossmatched O negative RBCs for immediate emergency use. Uncrossmatched O negative RBCs are also provided to children undergoing cardiac catheterization at the discretion of the Pediatric Cardiologist, since these patients commonly do not have type and screen samples drawn until large vessel venous cannulation via insertion of the catheter. Uncrossmatched blood products are also provided for children per our massive transfusion protocol (MTP). The purpose of this study was to assess the utilization of these uncrossmatched blood products in children and its impact on transfusion service (TS) inventory of O negative RBCs. Methods: Orders received for emergency-release uncrossmatched RBCs for patients ages 0 days to 18 years including MTPs from January 1 2011 to March 31 2011 were evaluated retrospectively. Variables collected include: patient demographic information and diagnosis; blood products ordered, released and transfused; location of the patient and location from where blood was dispensed (off-site refrigerator versus [vs] TS). Results: Median patient age was 3.46 years (range 0 days to 15.62 years), and 82% of the patients had congenital heart disease. Sixty four RBCs were issued to 33 patients during the 3-month study period. Of those, 32 RBCs were transfused, 8 RBCs were wasted because temperature parameters were exceeded before return to the TS, and 24 RBCs (38%) were not transfused and returned to TS inventory. Nineteen of the 32 RBCs were transfused, representing 2% of the total 964 O negative RBC units transfused at our institution for that time period. Nineteen (58%) units were for children in the cardiac catheterization suite. Seven patients were in the CVICU, five children were in the NICU, and two were in the Pediatric Intensive Care Unit. Two units of O negative RBCs were dispensed from the emergency off-site refrigerator in the CVICU. Discussion: The majority of children (79%) who received emergency-release uncrossmatched O negative RBCs at LPCH were those with congenital heart disease undergoing cardiac catheterization or being cared for post-operatively in the CVICU. There were 2 instances of children requiring RBCs from off-site refrigerators for an emergent transfusion. Emergency-release, uncrossmatched O negative RBCs at LPCH either from the TS or from three off-site refrigerators caused no undue strain on our supply and inventory of donor O negative RBCs. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Trends in Nosocomial Bloodstream Infections following Health Care Restructuring in Alberta between 1999 and 2005

2010 ◽  
Vol 21 (1) ◽  
pp. e1-e5 ◽  
Author(s):  
Mao-Cheng Lee ◽  
Lynora Saxinger ◽  
Sarah E Forgie ◽  
Geoffrey Taylor
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Alberta Hospital ◽  
University Of Alberta ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The University

OBJECTIVE: A previous study at the University of Alberta Hospital/Stollery Children’s Hospital in Edmonton, Alberta, revealed an increase in hospital-acquired bloodstream infection (BSI) rates associated with an increase in patient acuity during a period of public health care delivery restructuring between 1993 and 1996. The present study assessed trends in BSIs since the end of the restructuring.DESIGN: Prospective surveillance for BSIs was performed using Centers for Disease Control and Prevention (USA) criteria for infection. BSI cases between January 1, 1999, and December 31, 2005, were reviewed. Available measures of patient volumes, acuity and BSI risk factors between 1999 and 2005 were also reviewed from hospital records.SETTING: The University of Alberta Hospital/Stollery Children’s Hospital (617 adult and 139 pediatric beds, respectively).PATIENTS: All pediatric and adult patients admitted during the above-specified period with one or more episodes of BSIs.RESULTS: There was a significant overall decline in the BSI number and rate over the study period between 1999 and 2005. The downward trend was widespread, involving both adult and pediatric populations, as well as primary and secondary BSIs. During this period, the number of hospital-wide and intensive care unit admissions, intensive care unit central venous catheter-days, total parenteral nutrition days and number of solid-organ transplants were either unchanged or increased. Gram-positive bacterial causes of BSIs showed significant downward trends, but Gram-negative bacterial and fungal etiologies were unchanged.CONCLUSIONS: These data imply that, over time, hospitals can gradually adjust to changing patient care circumstances and, in this example, control infectious complications of health care delivery.

Evaluation of a Lactation Support Service in a Children's Hospital Neonatal Intensive Care Unit

2003 ◽  
Vol 19 (3) ◽  
pp. 286-292 ◽  
Author(s):  
Kristine A. Gonzalez ◽  
Jareen Meinzen-Derr ◽  
Bonnie L. Burke ◽  
Arlene J. Hibler ◽  
Beth Kavinsky ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Support Service ◽  
Children's Hospital ◽  
Children’S Hospital
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