scholarly journals From despair to hope: copying of relatives of hospitalized children before bad news report

2020 ◽  
Vol 73 (suppl 5) ◽  
Author(s):  
Luciana Palacio Fernandes Cabeça ◽  
Luciana de Lione Melo
Keyword(s):  
Health Professionals ◽  
Phenomenological Study ◽  
Pediatric Intensive Care ◽  
Bad News ◽  
Critically Ill Children ◽  
Emotional Impact ◽  
Hospitalized Children ◽  
News Report ◽  
Philosophical Framework ◽  
Existential Dimension

ABSTRACT Objective: to understand the experiences of relatives of critically ill children before bad news report. Method: a phenomenological study based on Heidegger’s philosophical framework. Data collection was carried out from October 2018 to March 2019, through phenomenological interviews with 15 relatives of children hospitalized in a Pediatric Intensive Care Unit. Results: relatives, in their existentiality, experience the facticity thrown into unpredictable situations, regardless of their choices and are faced with feelings of shock, despair and fear before bad news. After emotional impact, especially regarding the possibility of death, relatives reveal hope as a mechanism for coping with the situation. Final considerations: solidarity and sensitivity by health professionals, especially nurses, are essential in understanding the existential dimension of relatives who experience such an experience, understanding the several facets of their existence and offering them opportunities to project themselves.

scholarly journals Peripheral Inotropes in Critically Ill Children: Is It Safe?

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110222
Author(s):  
Ravi K. Mooli ◽  
Kalaimaran Sadasivam
Keyword(s):  
Central Venous Access ◽  
Pediatric Intensive Care ◽  
Venous Access ◽  
Critically Ill Children ◽  
Middle Income ◽  
Central Lines ◽  
Middle Income Countries ◽  
Peripheral Venous Access ◽  
Vasoactive Medications

Many children needing pediatric intensive care units care require inotropes, which are started peripherally prior to securing a central venous access. However, many hospitals in low- and middle-income countries (LMIC) may not have access to central lines and the vasoactive medications are frequently given through a peripheral venous access. Aim: The aim of our study was to describe the role of peripheral vasoactive inotropes in children. Methods: Children requiring peripheral vasoactive medications were included in this study. We retrospectively collected data at 2 time points on use and complications of peripheral vasoactive medications. Results: Eighty-four children (51 pre-COVID era and 33 COVID pandemic) received peripheral vasoactive medications. Only 3% of children (3/84) developed extravasation injury, all of whom recovered completely. Conclusions: Results from our study suggest that extravasation injury due to peripheral inotrope infusion is very low (3%) and it may be safely administered in children at a diluted concentration.

Pediatric intensive care nurses and their grief experiences: A phenomenological study

Heart & Lung ◽  
1997 ◽  
Vol 26 (5) ◽  
pp. 372-386 ◽  
Author(s):  
Judy Rashotte ◽  
Frances Fothergill-Bourbonnais ◽  
Marie Chamberlain
Keyword(s):  
Intensive Care ◽  
Phenomenological Study ◽  
Pediatric Intensive Care ◽  
Intensive Care Nurses

A Report of 7-Year Experience on Pediatric Continuous Renal Replacement Therapy

2017 ◽  
Vol 34 (11-12) ◽  
pp. 985-989 ◽  
Author(s):  
Ayse Filiz Yetimakman ◽  
Selman Kesici ◽  
Murat Tanyildiz ◽  
Umut Selda Bayrakci ◽  
Benan Bayrakci
Keyword(s):  
Critically Ill ◽  
Metabolic Diseases ◽  
Fluid Overload ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Standardized Mortality Ratio ◽  
Inborn Errors ◽  
Fluid Removal ◽  
Continuous Renal Replacement Therapies ◽  
Organ Failures

Background: Continuous renal replacement therapies (CRRTs) either as continuous venovenous hemofiltration (CVVH) or hemodiafiltration (CVVHD) are used frequently in critically ill children. Many clinical variables and technical issues are known to affect the result. The factors that could be modified to increase the survival of renal replacement are sought. As a contribution, we present the data on 104 patients who underwent CRRT within a 7-year period. Materials and Method: A total of 104 patients admitted between 2009 and 2016 were included in the study. The demographic information, admittance pediatric risk of mortality (PRISM) scores, indication for CRRT, presence of fluid overload, CRRT modality, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and nonsurvivors. Results: The overall rate of survival was 51%. Patients with fluid overload had significantly increased rate of death, CRRT duration, and PICU stay. Multiorgan dysfunction syndrome as the indication for CRRT was significantly related to decreased survival when compared to acute renal failure and acute attacks of metabolic diseases. The CRRT modality was not different between survivors and nonsurvivors. Standardized mortality ratio of the group was calculated to be 0.8. Conclusion: The CRRT in critically ill patients is successful in achieving fluid removal and correction of metabolic imbalances caused by organ failures or attacks of inborn errors of metabolism. It has a positive effect on expected mortality in high-risk PICU patients. To affect the outcome, follow-up should be focused on starting therapy in early stages of fluid overload. Prospective studies defining relative importance of risk factors causing mortality can assist in building up guidelines to affect the outcome.

scholarly journals Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

2021 ◽  
Author(s):  
Zi-Hong Xiong ◽  
Xue-Mei Zheng ◽  
Guo-Ying Zhang ◽  
Meng-Jun Wu ◽  
Yi Qu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Phase Angle ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

scholarly journals Impaired Pancreatic β-Cell Function in Critically Ill Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Shereen A. Mohamed ◽  
Nora E. Badawi ◽  
Hoiyda A. AbdelRasol ◽  
Hossam M. AbdelAziz ◽  
Nirvana A. Khalaf ◽  
...  
Keyword(s):  
Cell Function ◽  
Multivariate Logistic Regression Analysis ◽  
Pediatric Intensive Care ◽  
Glucose Production ◽  
Critically Ill Children ◽  
Model Assessment ◽  
Pancreatic Β Cell ◽  
Β Cell ◽  
Cell Dysfunction ◽  
Β Cell Function

Critical illness hyperglycemia (CIH) is common in the pediatric intensive care unit (PICU). Increased glucose production, insulin resistance (IR), and pancreatic β-cell dysfunction are responsible mechanisms. We aimed to investigate β-cell function in the PICU and to uncover its relation to clinical and laboratory variables and ICU mortality. We prospectively recruited 91 children. Pancreatic β-cell function was assessed by using a homeostasis model assessment (HOMA)-β. Patients with β-cell function &lt;40.0% had significantly higher Pediatric Risk of Mortality III (PRISM III) scores, higher rates of a positive C-reactive protein (CRP), lower IR, and a longer hospital stay. The patients with 40–80% β-cell function had the highest IR. Intermediate IR was found when the β-cell function was &gt;80%. ICU survivors had better β-cell function than ICU non-survivors. A multivariate logistic regression analysis revealed that higher PRISM III score and HOMA-β &lt;80.0% were significant predictors of mortality. In conclusion, β-cell dysfunction is prevalent among PICU patients and influences patient morbidity and mortality.

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

scholarly journals Hyperlactacemia in critically ill children: comparison of traditional and Fencl-Stewart methods

2007 ◽  
Vol 47 (1) ◽  
pp. 35
Author(s):  
Hari Kushartono ◽  
Antonius H. Pudjiadi ◽  
Susetyo Harry Purwanto ◽  
Imral Chair ◽  
Darlan Darwis ◽  
...  
Keyword(s):  
Base Excess ◽  
Pediatric Intensive Care ◽  
Blood Gases ◽  
Critically Ill Children ◽  
Strongly Correlated ◽  
Acid Base ◽  
Arterial Blood ◽  
Acid Base Status ◽  
Lactate Levels ◽  
Elevated Lactate

Background Base excess is a single variable used to quantifymetabolic component of acid base status. Several researches havecombined the traditional base excess method with the Stewartmethod for acid base physiology called as Fencl-Stewart method.Objective The purpose of the study was to compare two differentmethods in identifying hyperlactacemia in pediatric patients withcritical illness.Methods The study was performed on 43 patients admitted tothe pediatric intensive care unit of Cipto MangunkusumoHospital, Jakarta. Sodium, potassium, chloride, albumin, lactateand arterial blood gases were measured. All samples were takenfrom artery of all patients. Lactate level of >2 mEq/L was definedas abnormal. Standard base excess (SBE) was calculated fromthe standard bicarbonate derived from Henderson-Hasselbalchequation and reported on the blood gas analyzer. Base excessunmeasured anions (BE UA ) was calculated using the Fencl-Stewartmethod simplified by Story (2003). Correlation between lactatelevels in traditional and Fencl-Stewart methods were measuredby Pearson’s correlation coefficient .Results Elevated lactate levels were found in 24 (55.8%) patients.Lactate levels was more strongly correlated with BE UA (r = - 0.742,P<0.01) than with SBE (r = - 0.516, P<0.01).Conclusion Fencl-Stewart method is better than traditionalmethod in identifying patients with elevated lactate levels, so theFencl-Stewart method is suggested to use in clinical practice.

scholarly journals Humanized childbirth: the values of health professionals in daily obstetric care

2022 ◽  
Vol 75 (2) ◽  
Author(s):  
Diego Pereira Rodrigues ◽  
Valdecyr Herdy Alves ◽  
Cristiane Cardoso de Paula ◽  
Bianca Dargam Gomes Vieira ◽  
Audrey Vidal Pereira ◽  
...  
Keyword(s):  
Health Professionals ◽  
Phenomenological Study ◽  
Obstetric Care ◽  
Metropolitan Region ◽  
Care Process ◽  
Methodological Framework ◽  
Physiological Processes ◽  
Maternity Hospitals ◽  
Phenomenological Interview ◽  
Region Ii

ABSTRACT Objective: To understand health professionals' values in the process of thinking and feeling about obstetric care, based on their experienced needs in the care process. Methods: Phenomenological study based on the Schelerian framework, with 48 health professionals from four maternity hospitals within the Metropolitan Region II of the state of Rio de Janeiro. Data collection was done through a phenomenological interview; and the analysis, with the Ricoeurian methodological framework. Results: The vital value was signified in care centered on physiological processes, for an individualized and safe monitoring. The ethical value was signified in the attitudes that provide women with autonomy in their way of giving birth, and recognize dialogue as a process of sympathy, affection, and bonding. Conclusion: The resignification of obstetric practice, articulated with public policies in the field of delivery and birth, supported by a vital ethical value, positively contributes to the humanization of care for women.

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