Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2015
A Training Program for Anthropometric Measurements by a Dedicated Nutrition Support Team Improves Nutritional Status Assessment of the Critically Ill Child.
The cornerstone of an optimal nutrition approach in PICUs is to evaluate the nutritional status of any patient. Anthropometric measurements and nutritional indices calculation allow for nutritional status assessment, which is not often part of routine management, as it is considered difficult to perform in this setting. We designed a study to evaluate the impact of a training program by the PICU nutritional support team on the implementation of routine anthropometric measurements on our PICU. ⋯ This is the first study, showing that a targeted nutritional assessment teaching program that highlights both the importance and techniques of anthropometrical measurements has successfully been implemented in a PICU. It managed to improve staff knowledge and nutritional practice.
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Pediatr Crit Care Me · Mar 2015
Randomized Controlled TrialLonger RBC Storage Duration Is Associated With Increased Postoperative Infections in Pediatric Cardiac Surgery.
Infants and children undergoing open heart surgery routinely require multiple RBC transfusions. Children receiving greater numbers of RBC transfusions have increased postoperative complications and mortality. Longer RBC storage age is also associated with increased morbidity and mortality in critically ill children. Whether the association of increased transfusions and worse outcomes can be ameliorated by use of fresh RBCs in pediatric cardiac surgery for congenital heart disease is unknown. ⋯ Longer RBC storage duration was associated with increased postoperative nosocomial infections. This association may be secondary in part, to the large doses of stored RBCs transfused, from single-donor units. Washing the oldest RBCs was associated with increased morbidity, possibly from increased destruction of older, more fragile erythrocytes incurred by washing procedures. Additional studies examining the effect of RBC storage age on postoperative infection rate in pediatric cardiac surgery are warranted.
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Pediatr Crit Care Me · Mar 2015
Clinical TrialLow Predictability of Three Different Noninvasive Methods to Determine Fluid Responsiveness in Critically Ill Children.
To predict fluid responsiveness by noninvasive methods in a pediatric critical care population. ⋯ Dynamic preload variables such as stroke volume variation or respiratory variations in vena cava inferior diameter may not be useful for predicting fluid responsiveness in certain pediatric patient populations. Esophageal Doppler peak velocity was predictive of fluid responsiveness where a target value of more than 135,5 cm/s may be a signal to terminate further fluid challenges. This target value may be different in different age groups, as esophageal Doppler peak velocity varies with age.
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Pediatr Crit Care Me · Mar 2015
Standardizing Postoperative PICU Handovers Improves Handover Metrics and Patient Outcomes.
To improve handover communication and patient outcomes for postoperative admissions to a multidisciplinary PICU. ⋯ Postoperative communication and patient outcomes can be improved and sustained over time with implementation of a standardized handover protocol.
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Pediatr Crit Care Me · Mar 2015
Appropriateness of Disposition Following Telemedicine Consultations in Rural Emergency Departments.
To compare the appropriateness of hospital admission in eight rural emergency departments among a cohort of acutely ill and injured children who receive telemedicine consultations from pediatric critical care physicians to a cohort of similar children who receive telephone consultations from the same group of physicians. ⋯ Although the overall admission rate among patients receiving telemedicine consultations was lower than that among patients receiving telephone consultations, there were no statistically significant differences between the observed-to-expected admission ratios using Pediatric Risk of Admission II and Revised Pediatric Emergency Assessment Tool. Our findings may be reassuring in the context of previous research, suggesting that telemedicine specialty consultations can aid in the delivery of more appropriate, safer, and higher quality of care.