Pediatric Critical Care
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M. R. Roopashree

Introduction: Safety concerns of outborn neonatal infant babies during transportation to the NICU had been a concern. Better team coordination and improvement in the technical competency of the care providers helped implement the ambulance policy. Methods: With the background of the Donabedian model and Juran's Trilogy concepts, process improvisation was performed. The RCA (Root Cause Analysis) and HFMEA (Healthcare Failure Mode and Effects Analysis) as tools were used for better deliverables. Results: The measurable outcomes in terms of time taken for departure before and after were compared, which showed considerable significance. By measuring the baby temperatures, a significant difference was seen in clinical aspects. Discussion: Lack of infrastructure, equipment for neonatal transportation was a challenge that required prioritization of budget allocation. The procurement policy of equipment had to be relooked for user-friendly strategies. Lack of trained staff and doctors, which were major issues, required an intense training and development module. The challenges of hypothermia, ventilation issues during transportation of neonates were of major concern, were tackled using quality tools. Application: To minimize the mortality and morbidity of neonates, infants by Specialized Pediatric Critical Care Transport (SPCCT) ambulance policy was implemented. The value addition was to minimize the risks and prevention of hazards. Conclusion: Improvement in the Technical competency of nurses and caregivers was observed. Nurses were well exposed to handling transporting sick babies. Logistics, equipment handling was performed properly.  With better team coordination, the babies were safe. The trust and confidence among the members of the community at large improved. The patient footfall increased in numbers.

2021 ◽  
pp. 088506662110478
Laura A. Watkins ◽  
Sharon P. Dial ◽  
Seth J. Koenig ◽  
Dalibor N. Kurepa ◽  
Paul H. Mayo

Objectives: Point of care ultrasound (POCUS) in adult critical care environments has become the standard of care in many hospitals. A robust literature shows its benefits for both diagnosis and delivery of care. The utility of POCUS in the pediatric intensive care unit (PICU), however, is understudied. This study describes in a series of PICU patients the clinical indications, protocols, findings and impact of pediatric POCUS on clinical management. Design: Retrospective analysis of 200 consecutive POCUS scans performed by a PICU physician. Patients: Pediatric critical care patients who required POCUS scans over a 15-month period. Setting: The pediatric and cardiac ICUs at a tertiary pediatric care center. Interventions: Performance of a POCUS scan by a pediatric critical care attending with advanced training in ultrasonography. Measurement and Main Results: A total of 200 POCUS scans comprised of one or more protocols (lung and pleura, cardiac, abdominal, or vascular diagnostic protocols) were performed on 155 patients over a 15-month period. The protocols used for each scan reflected the clinical question to be answered. These 200 scans included 133 thoracic protocols, 110 cardiac protocols, 77 abdominal protocols, and 4 vascular protocols. In this series, 42% of scans identified pathology that required a change in therapy, 26% confirmed pathology consistent with the ongoing plans for new therapy, and 32% identified pathology that did not result in initiation of a new therapy. Conclusions: POCUS performed by a trained pediatric intensivist provided useful clinical information to guide patient management.

2021 ◽  
Vol Publish Ahead of Print ◽  
Patricia L. Trbovich ◽  
Jessica N. Tomasi ◽  
Lauren Kolodzey ◽  
Sonia J. Pinkney ◽  
Anne-Marie Guerguerian ◽  

Devin Murphy ◽  
Etan Orgel ◽  
Wouter Koek ◽  
Melissa Frei-Jones ◽  
Christopher Denton ◽  

AbstractRed cell distribution width (RDW) is an average of the variation in red blood cell (RBC) sizes reported on a complete blood count. An elevated RDW indicates a pathological process that is affecting erythropoiesis. Studies showed that as the severity of disease process increases, the RDW often increases as well. Particularly in resource-limited countries, RDW has been studied as an outcome predictor for conditions in a variety of disciplines and is offered as an adjunct monitoring tool that is cost effective, readily available, and indicative of pathological processes amenable to intervention. Particularly in pediatric critical care settings, RDW has been shown to be a reliable tool for surveillance of disease states such as sepsis. Despite the increased attention of RDW as a marker for disease outcome, collective evaluation on the utility of RDW as a marker for outcome in pediatric critical care settings is lacking. We offer a systematic review and meta-analysis of published studies to assess the ability of RDW to predict illness severity and mortality among pediatric critical care patients. Among eight studies of over 4,800 patients, we found over a two-fold increase in odds for mortality in critically ill children whose RDW was above 15.7%. This is the first systematic review of RDW being used to predict mortality in critically ill children and findings of this study may prompt early intervention in the pediatric critical care setting.

Vanessa Soares Lanziotti ◽  
Maya Dewan ◽  
Deanna Behrens ◽  
Yonca Bulut ◽  
Jenna Miller ◽  

2021 ◽  
Lauren E. Cipriano ◽  
Wael M. R. Haddara ◽  
Beate Sander

Background: The goal of this study was to project the number of COVID-19 cases and demand for acute hospital resources for Fall of 2021 in a representative mid-sized community in southwestern Ontario. We sought to evaluate whether current levels of vaccine coverage and contact reduction could mitigate a potential 4th wave fueled by the Delta variant, or whether the reinstitution of more intense public health measures will be required. Methods: We developed an age-stratified dynamic transmission model of COVID-19 in a mid-sized city (population 500,000) currently experiencing a relatively low, but increasing, infection rate in Step 3 of Ontario's Wave 3 recovery. We parameterized the model using the medical literature, grey literature, and government reports. We estimated the current level of contact reduction by model calibration to cases and hospitalizations. We projected the number of infections, number of hospitalizations, and the time to re-instate high intensity public health measures over the fall of 2021 under different levels of vaccine coverage and contact reduction. Results: Maintaining contact reductions at the current level, estimated to be a 17% reduction compared to pre-pandemic contact levels, results in COVID-related admissions exceeding 20% of pre-pandemic critical care capacity by late October, leading to cancellation of elective surgeries and other non-COVID health services. At high levels of vaccination and relatively high levels of mask wearing, a moderate additional effort to reduce contacts (30% reduction compared to pre-pandemic contact levels), is necessary to avoid re-instating intensive public health measures. Compared to prior waves, the age distribution of both cases and hospitalizations shifts younger and the estimated number of pediatric critical care hospitalizations may substantially exceed 20% of capacity. Discussion: High rates of vaccination coverage in people over the age of 12 and mask wearing in public settings will not be sufficient to prevent an overwhelming resurgence of COVID-19 in the Fall of 2021. Our analysis indicates that immediate moderate public health measures can prevent the necessity for more intense and disruptive measures later.

2021 ◽  
Vol 22 (9) ◽  
pp. 771-773
Irvin Kaufman ◽  
Patrick M. Kochanek

2021 ◽  
Vol 10 (17) ◽  
pp. 2170080
Claire Liu ◽  
Jin‐Tae Kim ◽  
Sung Soo Kwak ◽  
Aurelie Hourlier‐Fargette ◽  
Raudel Avila ◽  

2021 ◽  
pp. e1-e19
Tessy A. Thomas ◽  
F. Daniel Davis ◽  
Shelley Kumar ◽  
Satid Thammasitboon ◽  
Cynda H. Rushton

Background Moral distress adversely affects the delivery of high-quality patient care and places health care professionals at risk for burnout, moral injury, and the loss of professional integrity. Objectives To investigate whether pediatric critical care professionals are experiencing moral distress during the COVID-19 pandemic and, if so, for what reasons. Methods An exploratory survey of pediatric critical care professionals was conducted via the Pediatric Acute Lung Injury and Sepsis Investigators Network from April to May 2020. The survey was derived from a framework integrating contemporary literature on moral distress, moral resilience, and expert consensus. Integration of descriptive statistics for quantitative data and thematic analysis for qualitative data yielded mixed insights. Results Overall, 85.8% of survey respondents reported moral distress. Nurses reported higher degrees of moral distress than other professional groups. Inducers of moral distress were related to challenges to professional integrity and lack of organizational support. Five themes were identified: (1) psychological safety, (2) expectations of leadership, (3) connectedness through a moral community, (4) professional identity challenges, and (5) professional versus social responsibility. Most respondents were confident in their ability to reason through ethical dilemmas (76.0%) and think clearly when confronting an ethical challenge even when pressured (78.9%). Conclusions During the COVID-19 pandemic, pediatric critical care professionals are experiencing moral distress due to various factors that challenge their professional integrity. Despite these challenges, they also exhibit attributes of moral resilience. Organizations have opportunities to cultivate a psychologically safe and healthy work environment to mitigate anticipatory, present, and lingering moral distress.

2021 ◽  
Vol 40 (5) ◽  
pp. 280-287
Sandra Hagstrom ◽  
Jaclyn Hall ◽  
Alyssa Sakhitab-Kerestes ◽  
Mary Fran Tracy

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