Effect of Separating Intensive Care Units on Physician Productivity: Comparison of Work Rvu Generation Between a Cardiac Intensive Care Unit and General Pediatric Intensive Care Unit

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 265A-265A
Author(s):  
Alexander M Cartron ◽  
Anne Watson ◽  
Venkat Shankar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Physician Productivity ◽  
Cardiac Intensive Care

Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

2007 ◽  
Vol 17 (S4) ◽  
pp. 116-126 ◽  
Author(s):  
Stacie B. Peddy ◽  
Mary Fran Hazinski ◽  
Peter C. Laussen ◽  
Ravi R. Thiagarajan ◽  
George M. Hoffman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Cardiac Disease ◽  
Paediatric Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Paediatric Intensive Care Units

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

Living with Dying in the Pediatric Intensive Care Unit: A Nursing Perspective

2016 ◽  
Vol 25 (4) ◽  
pp. 350-356 ◽  
Author(s):  
Debbie Stayer ◽  
Joan Such Lockhart
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Emotional Impact ◽  
Pediatric Intensive Care Units ◽  
Personal Support ◽  
Life Threatening

Background Despite reported challenges encountered by nurses who provide palliative care to children, few researchers have examined this phenomenon from the perspective of nurses who care for children with life-threatening illnesses in pediatric intensive care units. Objectives To describe and interpret the essence of the experiences of nurses in pediatric intensive care units who provide palliative care to children with life-threatening illnesses and the children’s families. Methods A hermeneutic phenomenological study was conducted with 12 pediatric intensive care unit nurses in the northeastern United States. Face-to-face interviews and field notes were used to illuminate the experiences. Results Five major themes were detected: journey to death; a lifelong burden; and challenges delivering care, maintaining self, and crossing boundaries. These themes were illuminated by 12 subthemes: the emotional impact of the dying child, the emotional impact of the child’s death, concurrent grieving, creating a peaceful ending, parental burden of care, maintaining hope for the family, pain, unclear communication by physicians, need to hear the voice of the child, remaining respectful of parental wishes, collegial camaraderie and support, and personal support. Conclusion Providing palliative care to children with life-threatening illnesses was complex for the nurses. Findings revealed sometimes challenging intricacies involved in caring for dying children and the children’s families. However, the nurses voiced professional satisfaction in providing palliative care and in support from colleagues. Although the nurses reported collegial camaraderie, future research is needed to identify additional supportive resources that may help staff process and cope with death and dying.

scholarly journals Pediatric Delirium in the Cardiac Intensive Care Unit: Identification and Intervention

2018 ◽  
Vol 38 (4) ◽  
pp. e1-e7 ◽  
Author(s):  
Kristen J. Bryant
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Current Knowledge ◽  
Adult Population ◽  
Pediatric Intensive Care ◽  
Screening Tools ◽  
Cardiac Intensive Care Unit ◽  
Recent Developments ◽  
Cardiac Intensive Care ◽  
Definition Of

Delirium is characterized by transient behavioral manifestations of acute brain disturbances. Delirium in the intensive care unit has been well researched and documented in the adult population. Pediatric delirium research has lagged, but recent developments in screening tools have shed light on the prevalence of delirium among children. The overall prevalence of delirium in the pediatric intensive care unit is 25%. A recent study showed a prevalence of 49% in the pediatric cardiac intensive care unit; this higher prevalence may be due to factors related to critical illness and the postoperative environment. This article is intended to increase awareness of delirium in the pediatric cardiac intensive care unit and give nurses the tools to identify it and intervene when necessary. A definition of delirium is provided, and its prevalence, risk factors, and current knowledge are reviewed. Available screening tools and environmental and pharmacological interventions are explored.

scholarly journals Descriptive study of differences in acute kidney injury progression patterns in General and Cardiac Intensive Care Units

2018 ◽  
Vol 20 (3) ◽  
pp. 216-222 ◽  
Author(s):  
Marcin A Pachucki ◽  
Erina Ghosh ◽  
Larry Eshelman ◽  
Krishnamoorthy Palanisamy ◽  
Timothy Gould ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Intensive Care Units ◽  
Kidney Injury ◽  
General Intensive Care Unit ◽  
Cardiac Intensive Care Unit ◽  
Acute Kidney Injury Stage ◽  
Cardiac Intensive Care

Background Acute kidney injury is common in critically ill patients with detrimental effects on mortality, length of stay and post-discharge outcomes. The Acute Kidney Injury Network developed guidelines based on urine output and serum creatinine to classify patients into stages of acute kidney injury. Methods In this analysis we utilize the Acute Kidney Injury Network guidelines to evaluate the acute kidney injury stage in patients admitted to general and cardiac intensive care units over a period of 18 months. Acute kidney injury stage was calculated in real time hourly based on the guidelines and using these temporal stage scores calculated for the population; the prevalence and progression of acute kidney injury stage was compared between the two units. We hypothesized that the prevalence and progression of acute kidney injury stage between the two units may be different. Results More cardiac intensive care unit patients had no acute kidney injury (stage <1) during their intensive care unit stay but more cardiac intensive care unit patients developed acute kidney injury (stage >1), compared to the General Intensive Care Unit. Both at intensive care unit admission and discharge, more General Intensive Care Unit patients had acute kidney injury; however, the number of cardiac intensive care unit patients with acute kidney injury was three times higher at discharge than admission. Acute kidney injury developed in a different pattern in the two intensive care units over five days of intensive care unit stay. In the General Intensive Care Unit, acute kidney injury was most prevalent on second day of intensive care unit stay and in cardiac intensive care unit acute kidney injury was most prevalent on the third day of intensive care unit stay. We observed the biggest increase in new acute kidney injury in the first day of General Intensive Care Unit and second day of the cardiac intensive care unit stay. Conclusions The study demonstrates the different trends of acute kidney injury pattern in general and cardiac intensive care unit patient populations highlighting the earlier development of acute kidney injury on General Intensive Care Unit and more prevalence of acute kidney injury on discharge from cardiac intensive care unit.

scholarly journals Establishing Pediatric Cardiac Intensive Care Unit in a Low Resource Setting: Bangladesh Perspective and Dhaka Shishu (Children) Hospital Paediatric Cardiac Intensive Care Unit Model

2017 ◽  
Vol 39 (3) ◽  
pp. 141-147 ◽  
Author(s):  
Manzoor Hussain ◽  
Mohammad Abdullah Al Mamun ◽  
Nurul Akhtar Hasan ◽  
Rezoana Rima ◽  
Abdul Jabbar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Disease ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Critically Ill Children ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Advances in technology and training in paediatric cardiology have improved longterm outcome and promised better quality of life. Bangladesh is facing multitude of health problems and congenital heart disease is one of them. With facilities for accurate diagnosis and scope of complete correction, more and more children are undergoing cardiac intervention and surgical treatment for congenital heart diseases. So there is increasing demand for dedicated personnel for the specialized intensive care of these critically ill children. A dedicated team dictating specialized intensive care has translated into better outcomes in several centers. Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill neonatal and paediatric patients with congenital and acquired heart disease worldwide. The majority of developed centers have dedicated paediatric cardiac intensive care units to care for paediatric cardiac patients. In developing countries with limited resources, pediatric cardiac intensive care is yet to take root as a distinctive discipline. Congenital heart surgery, together with transcatheter interventions, has resulted in marked improvement in cardiac care in Bangladesh. So, we need to establish more and more dedicated paediatric cardiac center and cardiac intensive care units to care for paediatric cardiac patients.Bangladesh J Child Health 2015; VOL 39 (3) :141-147

scholarly journals Clinical significance of potential drug–drug interactions in a pediatric intensive care unit: A single-center retrospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246754
Author(s):  
Yu Hyeon Choi ◽  
In Hwa Lee ◽  
Mihee Yang ◽  
Yoon Sook Cho ◽  
Yun Hee Jo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Drug Interactions ◽  
Intensive Care Units ◽  
Pediatric Intensive Care Unit ◽  
Clinical Relevance ◽  
Pediatric Intensive Care ◽  
Adverse Outcomes ◽  
Potential Drug ◽  
Pediatric Intensive Care Units

Despite the high prevalence of potential drug–drug interactions in pediatric intensive care units, their clinical relevance and significance are unclear. We assessed the characteristics and risk factors of clinically relevant potential drug–drug interactions to facilitate their efficient monitoring in pediatric intensive care units. This retrospective cohort study reviewed the medical records of 159 patients aged <19 years who were hospitalized in the pediatric intensive care unit at Seoul National University Hospital (Seoul, Korea) for ≥3 days between August 2019 and February 2020. Potential drug–drug interactions were screened using the Micromedex Drug-Reax® system. Clinical relevance of each potential drug–drug interaction was reported with official terminology, magnitude of severity, and causality, and the association with the patient’s clinical characteristics was assessed. In total, 115 patients (72.3%) were exposed to 592 potential interactions of 258 drug pairs. In 16 patients (10.1%), 22 clinically relevant potential drug–drug interactions were identified for 19 drug pairs. Approximately 70% of the clinically relevant potential drug–drug interactions had a severity grade of ≥3. Exposure to potential drug–drug interactions was significantly associated with an increase in the number of administrated medications (6–7 medications, p = 0.006; ≥8, p<0.001) and prolonged hospital stays (1–2 weeks, p = 0.035; ≥2, p = 0.049). Moreover, clinically relevant potential drug–drug interactions were significantly associated with ≥8 prescribed drugs (p = 0.019), hospitalization for ≥2 weeks (p = 0.048), and ≥4 complex chronic conditions (p = 0.015). Most potential drug–drug interactions do not cause clinically relevant adverse outcomes in pediatric intensive care units. However, because the reactions that patients experience from clinically relevant potential drug–drug interactions are often very severe, there is a medical need to implement an appropriate monitoring system for potential drug–drug interactions according to the pediatric intensive care unit characteristics.

Sign in / Sign up

Export Citation Format

Share Document