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.

Clinical frailty and polypharmacy in older emergency critical care patients: a single-centre retrospective case series

2021 ◽  
pp. ejhpharm-2020-002618
Author(s):  
Richard S Bourne ◽  
Christopher P Ioannides ◽  
Christopher S Gillies ◽  
Kathryn M Bull ◽  
Elin C O Turton ◽  
...  
Keyword(s):  
Critical Care ◽  
Case Series ◽  
Single Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Critical Care Patients

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 Australian Intensive Care Educational Links with Asian Countries

1995 ◽  
Vol 23 (6) ◽  
pp. 718-720
Author(s):  
A. S. Mclean ◽  
E. J. Egan
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Asian Country ◽  
Asian Countries ◽  
Doctors And Nurses

A survey examining the level of Australian Intensive Care Unit involvement in the education of Asian critical care doctors and nurses was performed. Of the 49 hospitals surveyed, 34% have ongoing links. An analysis of countries involved, proportion of medical and nursing numbers, and whether the teaching was performed in Australia or the Asian country was undertaken. The survey revealed that a high proportion of Australian Intensive Care Units are actively involved, or would consider future participation, in educational links with Asian units.

scholarly journals Hospital Acquired Blood Stream Infection in an Adult Intensive Care Unit: a Retrospective Case Series

2020 ◽  
Author(s):  
Jeffrey Harte ◽  
Germander Soothill ◽  
Jack Samuel ◽  
Laurence Sharifi ◽  
Mary White
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Stream Infection ◽  
Case Series ◽  
Blood Stream ◽  
Apache Ii Score ◽  
Invasive Procedures ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Hospital Acquired

Abstract Introduction: Hospital acquired blood stream infections are a common and serious complication in critically ill patients. Methods: A retrospective case series was undertaken investigating the incidence and causes of bacteraemia on an intensive care unit with a high proportion of postoperative cardiothoracic surgical and oncology patients. Results: 405 eligible patients were admitted to the intensive care unit over the course of nine months. 12 of these patients developed a unit acquired blood stream infection. The average Acute Physiology And Chronic Health Evaluation II (APACHE II) score of patients, who developed bacteraemia was greater than those who did not (19.8 versus 16.8 respectively). The risk of developing bacteraemia was associated with intubation and higher rates of invasive procedures. The mortality rate amongst the group of patients that developed bacteraemia was 33%. There was a higher proportion of Gram-negative bacteria isolated on blood cultures than in intensive care units reported in other studies.Conclusion: Critical care patients are at risk of secondary bloodstream infection. This study highlights the importance of measures to reduce the risk of infection in the intensive care setting particularly in patients who have undergone invasive procedures.

scholarly journals Collagenase for Wound Debridement in the Neonatal Intensive Care Unit: A Retrospective Case Series

2017 ◽  
Vol 34 (3) ◽  
pp. 277-281 ◽  
Author(s):  
Elizabeth Huett ◽  
Whitney Bartley ◽  
Darla Morris ◽  
Della Reasbeck ◽  
Beth McKitrick-Bandy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Case Series ◽  
Retrospective Case ◽  
Wound Debridement ◽  
Retrospective Case Series

Efficacy of bortezomib in non-IgM type I cryoglobulinaemic vasculitis: a single-centre retrospective case series

2018 ◽  
Vol 101 (5) ◽  
pp. 635-642 ◽  
Author(s):  
Hervé Lobbes ◽  
Vincent Grobost ◽  
Richard Lemal ◽  
Virginie Rieu ◽  
Guillaume Le Guenno ◽  
...  
Keyword(s):  
Case Series ◽  
Type I ◽  
Single Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Cryoglobulinaemic Vasculitis

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 The Association Between Variability in Electrolytes and the In-Hospital Mortality in Critically Ill Children in Pediatric Intensive Care Units

2021 ◽  
Vol 9 ◽  
Author(s):  
Jilei Lin ◽  
Yin Zhang ◽  
Meng Chen ◽  
Jihong Dai ◽  
Anchao Song ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
High Variability ◽  
Critically Ill Children ◽  
Retrospective Case ◽  
Potassium Sodium ◽  
The Mean

Objective: This study aimed to explore the association between the variability in electrolytes and the in-hospital mortality in critically ill children admitted into intensive care units (ICUs).Design: This is a retrospective case–control study.Setting and Participants: Total of 11,245 children have been admitted to ICUs of Children's Hospital of Zhejiang University from 2010 to 2018.Methods: The coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM) were calculated as variability indices. High variability was defined as having values in the highest quartile for each parameter. Age, sex, diagnoses of disease, and surgical treatment were adjusted in the multivariable-adjusted logistic regression model.Results: A total of 11,245 children were included, and 660 patients died in the hospital. The median (P25, P75) potassium, sodium, and chloride of all patients were 3.8 (3.58, 4.09), 136.83 (135.11, 138.60), and 108.67 (105.71, 111.17), respectively. U-shaped relationships between the mean, lowest, and highest levels of potassium, sodium, and chloride and the in-hospital mortality were observed. The lowest mortality was noted when serum potassium, sodium, and chloride were between ~3.5 and 5.0, 135 and 145, and 105 and 115 mmol/l, respectively. The areas under the curve (AUCs) of three indices of variability in electrolytes were larger than those of the mean and lowest levels of electrolytes in predicting the in-hospital mortality. In the multivariable-adjusted model, the odds ratios and 95% confidence interval (CI) of the in-hospital mortality were 3.14 (2.44–4.04) for one parameter, 5.85 (4.54–7.53) for two parameters, and 10.32 (7.81–13.64) for three parameters compared with subjects having no parameters of high variability measured as the CV. The results were consistent when the variability was determined using the SD and VIM (all P for trend &lt;0.001). Consistent results were noted in various subgroup analyses.Conclusions: This study showed that individuals with higher variability of each parameter were related with higher risk of in-hospital mortality. There was a linear association between the number of high variability parameters and the in-hospital mortality. The variability of electrolytes might be a good predictor for in-hospital mortality of children in ICUs.

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