A Survey of Hospital Pharmacy Guidelines for the Administration of 3% Sodium Chloride in Children

Three percent sodium chloride (3% NaCl) is the treatment of choice for symptomatic hyponatremia. A barrier to the use of 3% NaCl is the perceived risk of both local infusion reactions and neurologic complications from overcorrection. We examine whether children’s hospital pharmacies have policies or practice guidelines for the administration of 3% NaCl and whether these pharmacies have restrictions on the administration of 3% NaCl in terms of rate, route, volume and setting. An Internet survey was distributed to the pharmacy directors of 43 children’s hospitals participating in the Children’s Hospital Association (CHA) network. The response rate was 65% (28/43). Ninety-three percent (26/28) of pharmacy directors reported a restriction for the administration of 3% NaCl, with 57% restricting its use through a peripheral vein or in a non-intensive care unit setting, 68% restricting the rate of administration and 54% restricting the volume of administration. Seventy-one percent (20/28) reported having written policy or practice guidelines. Only 32% of hospital pharmacies allowed 3% NaCl to be administered through a peripheral IV in a non-intensive care unit setting. The majority of children’s hospital pharmacies have restrictions on the administration of 3% NaCl. These restrictions could prevent the timely administration of 3% NaCl in children with symptomatic hyponatremia.

Exploring and managing psychiatric symptoms in ICU healthcare professionals during the ongoing COVID-19 pandemic: a focused review and guideline

Introduction: The COVID-19 pandemic has ravaged the healthcare system and stretched resources thin. The impact on healthcare staff working in the intensive care unit setting has been especially devastating. Objective: To conduct a review of the impact of the pandemic on healthcare personnel in the intensive care unit setting in the hope of utilizing information gathered to inform various stakeholders. Design: Focused literature and abstract review Conclusion: This article seeks to highlight the association between critical care as it relates to trauma and COVID-19 and point stakeholders toward opportunities for anticipating and managing secondary effects in effort to promote psychological adaptation.

Microcirculatory changes and thrombotic complications in COVID-19

Despite its many devastating effects, the COVID-19 pandemic has had a positive impact in the ways in which society, scientific institutions, governing bodies, businesses, educational organisations, and communication have functioned unchallenged over the years. Rapid advancement in science enabled identification and characterisation of the virus and in developing vaccines to combat the disease. The mysterious ways in which the virus attacks the vital organs that lead on to multiorgan failure and thrombosis of the arterial and venous system have also been revealed. The ability to study the microcirculatory changes at the bedside and predict prognosis is a way forward. All the evidence suggests that the outcome of COVID-19 infection is related to the severity of the disease seen in the intensive care unit setting. This article discusses microcirculatory changes and immune coagulopathy caused by COVID-19.

Acquired peripheral nerve injuries associated with severe COVID-19

We diagnosed 63 peripheral nerve injuries in 32 patients who survived severe COVID-19. We combine our latest data with published case series re-analyzed here (106 nerve injuries; 49 patients) to provide a comprehensive accounting of lesion sites. The most common are ulnar (26.0%), common fibular (16.0%), median (10.7%), sciatic (10.7%), brachial plexus (9.5%) and radial (8.3%) nerves. Nerve injury prevention should be prioritized during acute care of COVID-19 patients. To this end, we report proof of concept data of a wearable, wireless pressure sensor to provide real time monitoring in the intensive care unit setting.

Requests for futile or inappropriate interventions near the end of life

Patients and families may, at times, request interventions that clinicians believe to be either futile or potentially inappropriate. Futile interventions are those that simply cannot accomplish the intended physiological goal. Requests for futile interventions are uncommon, and when a patient or surrogate decision maker requests an intervention that is futile, the clinician should decline the request and carefully explain the rationale for the refusal. More commonly, a patient or surrogate decision maker may request an intervention that the clinician believes to be potentially inappropriate. Potentially inappropriate interventions are those that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them. Conflicts can often be avoided through excellent communication; however, when conflicts arise and a mutually agreeable solution cannot be reached, such requests should be managed by a fair dispute resolution process. Five leading international, multidisciplinary, critical care organizations have published guidance for handling such disputes in the intensive care unit setting. Although the multi-organization futility statement was developed for use in intensive care units, the definitions and process can be employed in a multitude of healthcare settings and should form the basis of handling such requests in palliative medicine.

Reye's Syndrome

Reye's syndrome is a rare and potentially fatal pediatric illness defined as acute noninflammatory encephalopathy with fatty liver failure. It rarely occurs in elderly patients and is equally distributed between the sexes [1]. It has been usually associated with acute viral infections and the use of salicylate [1- 3]. There is no specific test to diagnose the disease. However, the most common lab finding is an early rise in serum ammonia levels occurring within 1 to 2 days of mental status changes [4-8]. Treatment of the Reye’s syndrome is mainly supportive and requires close monitoring best accomplished in an intensive care unit setting [9,10].