scholarly journals Extravasation Injuries, Pressure Ulcers and Ocular Surface Disorders in a Tertiary Paediatric Intensive Care Unit in South India

2020 ◽  
Vol 39 (1) ◽  
pp. 29-34
Author(s):  
Puja Amatya ◽  
Kalaimaran Sadasivam
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ocular Surface ◽  
Paediatric Intensive Care Unit ◽  
South India ◽  
Pressure Ulcers ◽  
Critically Ill Children ◽  
Intervention Period ◽  
Post Intervention ◽  
Common Problems

Introduction: Extravasation injuries, pressure ulcers (PU), and ocular surface disorders (OSD) like exposure keratitis are common problems that we encounter in critically ill children admitted in Paediatric Intensive Care unit (PICU). There is sparse data regarding these injuries due to under reporting by staffs in intensive care unit. The primary aim of this study was to know the prevalence of extravasation injuries, ocular surface disorders and pressure ulcers in tertiary intensive care unit of south India. The secondary objective of this study was to re-evaluate the prevalence of these injuries after interventions.  Methods: During pre-intervention period, number of children with extravasation injuries, pressure ulcers and ocular surface disorders were identified. The qualitative improvement practices was implemented to decrease the prevalence of these injuries. This was followed by re-evaluation of these injuries during post-intervention period. Results: During pre-intervention period the overall prevalence of these injuries was 36/273 (13.2%). The prevalence of extravasation injuries, pressure ulcers and ocular surface disorders was 16/273 (5.9%), 12/273 (4.4%) and 8/273 (2.9%) respectively. The qualitative improvement practices were implemented in intensive care unit. During post-intervention period, the prevalence of these injuries was reduced to 10/157 (6.4%). The extravasation injuries reduced to 4/157 (2.5%), PUs to 4/157 (2.5%) and OSD to 2/157 (1.3%). Conclusions: The extravasation injuries, PUs and OSD are common problems in critically ill children. The qualitative improvement practices should be implemented and reinforced in intensive care units to prevent these injuries.

DOES CHLORHEXIDINE WIPE HELP IN REDUCING HOSPITAL ACQUIRED INFECTIONS (HAIS) AMONG CRITICALLY ILL CHILDREN ADMITTED TO A PAEDIATRIC INTENSIVE CARE UNIT?

2021 ◽  
pp. 35-37
Author(s):  
Madhan Kumar ◽  
Jolly Chandran ◽  
Pragathesh Pragathesh ◽  
Ebor Jacob Gnananayagam ◽  
Hema Paul ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Paediatric Intensive Care Unit ◽  
Paediatric Intensive Care ◽  
Critically Ill Children ◽  
Intervention Period ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
Historical Controls

OBJECTIVE: To determine the effect of chlorhexidine wipes in reducing the incidence of hospital acquired infections (HAIs) among critically ill children admitted in Paediatric Intensive Care Unit (PICU). METHODS: An interventional study, wherein enrolled children were wiped with chlorhexidine after routine bath. The incidence of HAIs were noted and compared with data from historical controls of previous year during the same period (pre-intervention). RESULTS: One hundred and ninety nine children in the intervention period were compared with 271 children from pre-intervention period. The numbers of ventilator-days were 777 and 696 respectively for the intervention period and pre-intervention periods. Incidence of ventilator associated pneumonia (VAP) reduced from 12.9/1000 ventilator-days in the pre-intervention period to 6.4/1000 ventilator-days in the intervention period (p=0.1). VAP prevalence was 3.3% in the pre-intervention period as compared to 2.5% in the intervention period (p=0.6). The incidence of CLABSI was 3.6/1000 catheter-days (catheter days: 1377) with prevalence of 2.5% in the intervention period, whereas among the historic controls of the previous year it was 4.2/1000 days (catheter days 1432) with a prevalence of 2.2% (p= 0.8). No untoward effect was reported. CONCLUSION: The use of chlorhexidine wipes in ICU was feasible but did not signicantly decrease HAIs.

scholarly journals Enteral Nutrition Practices in Children with Cancer admitted into a Paediatric Intensive Care Unit and Clinical Outcomes

2020 ◽  
Author(s):  
Wanelia Afonso ◽  
Wilza Peres ◽  
Nivaldo Pinho ◽  
Renata Martucci ◽  
Daúbia Saraiva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
Paediatric Intensive Care Unit ◽  
Paediatric Intensive Care ◽  
Critically Ill Children ◽  
Children With Cancer ◽  
Nutrition Practices ◽  
Younger Age

Abstract Background and Aim: Delays in both the prescription of, as well as interruptions in the administration of ENT, have been widely investigated. The most common reasons for damage in the nutritional impairment in children in a PICU are the presence of gastrointestinal disorders, together with medical and nursing procedures. This study aims to describe enteral nutrition practices in children with cancer and to evaluate the factors related to clinical outcomes, hospitalisation time (HT) and mechanical ventilation time (MVT), in a Paediatric Intensive Care Unit (PICU) of an Oncological Treatment Centre in Rio de Janeiro, Brazil.Method: It is a retrospective longitudinal study, with children that were admitted into the PICU during 2013. Those children who had been diagnosed with a malignancy, aged 1 to 18 years, HT > 72 h, as well as with the use of enteral nutrition therapy (ENT) during their hospitalisation in the PICU, were included in the study. The controlled variables were severity, age, caloric deficiencies, cumulative proteins, gastrointestinal symptoms and the early initiation of ENT. The odds ratios between the exposure factors were estimated with a confidence interval (CI) of 95% and a significance level of p < 0.05. Results: The study selected 54 patients; the median age was 8.02 (2.35–12.79) years. The cumulative deficiencies of calories and proteins were 21.5 (14.0–29.6) kcal / kg / day and 0.60 (0.33–0.97) g / kg / day, respectively. Diarrhoea and younger age and the cumulative caloric deficiencies were HT predictors. Abdominal distention and younger age were associated with a higher MVT. Conclusions: Changes in the gastrointestinal tract, with evaluation of the cumulative caloric deficiencies in critically ill children with cancer, should be monitored more continuously, as well as with the impact of these variables on the HT and MVT outcomes.

scholarly journals Clinical and Demographic Profiles of Children Presenting with Acetaminophen Induced Acute Liver Failure in a Tertiary Paediatric Intensive Care Unit of South India

2021 ◽  
Vol 41 (1) ◽  
pp. 23-28
Author(s):  
Puja Amatya ◽  
Sudeep Kumar Kapalavai ◽  
Ravi Kumar Krupanandan ◽  
Kalaimaran Sadasivam ◽  
Srinivas Sankaranarayanan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Paediatric Intensive Care Unit ◽  
South India ◽  
Paediatric Population ◽  
Paediatric Intensive Care ◽  
Average Dose ◽  
Demographic Profiles

Introduction: Acetaminophen (APAP) is the most widely used over-the-counter antipyretic and analgesic medicine in children. Although hepatic failure and death is rare in paediatric population, it is one of the most important and dangerous presentation of acetaminophen induced toxicity in children. There is very sparse data regarding APAP induced paediatric acute liver failure in our settings, hence this study was done to know the clinical and demographic profiles as well as outcome of children with APAP induced acute liver failure. Methods: This was a retrospective study done in children aged 0 - 18 years admitted with the diagnosis of acetaminophen induced acute liver failure in a tertiary paediatric intensive care unit of South India from January 2014 to December 2018. The clinical, demographic profiles and outcome of these patients were reviewed and analysed. Results: A total of 26 children had acetaminophen induced acute liver failure. Out of 26 patients, 53.8% were males and 46.1% were females. Among these, 24 (92.3%) survived and two (7.7%) died. The average dose of acetaminophen ingested was 168.5 mg/ kg/d. The mean serum acetaminophen level was 52.3 mg/dl. The presence of low pH, hypotension and international normalised ratio (INR) value of > 4 showed bad outcome in children with acetaminophen induced acute liver failure. Conclusion: Paracetamol induced acute liver failure is rare but fatal presentation in children. Children with acidosis, shock and INR value of > 4 had poor prognosis. Hence, judicious use of different preparations as well as counselling to parents regarding use of appropriate doses in children should be done while prescribing this medicine.

Does Cues on Mother’s Face Convey the Condition of the Child in a Critical Care Unit - A Prospective Cross-Sectional Study Done in the Paediatric Intensive Care Unit, MGM Hospital, Warangal

2021 ◽  
Vol 8 (32) ◽  
pp. 2928-2932
Author(s):  
Surender Kagithapu ◽  
Padmini Soujanya Balla ◽  
Aparna Varma Bhongir ◽  
Pratap Gudi ◽  
Sri Harsha K ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Facial Expressions ◽  
Clinical Condition ◽  
Paediatric Intensive Care Unit ◽  
Critically Ill Children ◽  
Filling Time ◽  
Peripheral Temperature ◽  
Time Of Admission

BACKGROUND Face is the index of mind. All human beings tend to express various emotions through different facial expressions. Parents of children who are critically ill, experience both positive and negative emotions simultaneously as they may feel love, affection and sometimes sad, angry, and helpless. METHODS We observed facial expressions of mothers of children and recorded vital data of these children in our Paediatric Intensive Care Unit (PICU). 107 children were observed, and vitals recorded simultaneously by two different observers from time of admission to 72 hours at fixed time intervals, using Hamilton’s scoring system. RESULTS 107 critically ill children were observed. Glasgow Coma Scale (GCS), AVPU scale, peripheral temperature, capillary filling time (CFT), seizures at admission, were corelated with facial expressions of the mother at the time of admission, at 12 hours, at 24 hours, at 48 hours and at 72 hours. We found that facial expressions of the mothers changed from fearful/sad to happy as the vital data of the child improved with time interval. CONCLUSIONS At ‘0’ hour of admission, irrespective of the categorization of the GCS score, AVPU scores, peripheral temperature, and capillary filling time, 78 mothers were fearful, and 29 mothers were sad, amounting to a total of 107. None were happy, irrespective of the child’s clinical condition, as, the child being admitted, is in itself a stressful condition. There was a good increase in number of happy mothers in co-relation with child’s improvement. Hence by observing the mother’s face, we can definitely predict the clinical condition of the child and expressions on the mother’s face is a reflection of the clinical condition of the child. KEYWORDS Cues, Mother’s Face, Critically Ill Children

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