Pediatr Crit Care Me
-
Pediatr Crit Care Me · Jun 2019
The Fragility of Statistically Significant Findings in Pediatric Critical Care Randomized Controlled Trials.
The Fragility Index measures the number of events on which the statistical significance of a result depends and has been suggested as an adjunct statistical assessment for interpretation of trial results. This study aimed to assess the robustness of statistically significant results from pediatric critical care randomized controlled trials with dichotomous outcomes. ⋯ Results from pediatric critical care randomized controlled trials with dichotomous outcomes reporting statistically significant findings often hinge on a small number of outcome events. Clinicians should exercise caution when interpreting results of trials with a low Fragility Index.
-
Pediatr Crit Care Me · May 2019
Meta AnalysisEffectiveness of a Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia at the PICU: A Systematic Review and Meta-Analysis.
Ventilator-associated pneumonia is one of the most frequent hospital-acquired infections in mechanically ventilated children. We reviewed the literature on the effectiveness of ventilator care bundles in critically ill children. ⋯ Implementation of a ventilator-associated pneumonia bundle has the potential to reduce the prevalence of ventilator-associated pneumonia in mechanically ventilated children.
-
Pediatr Crit Care Me · Jan 2019
ReviewPain and Sedation Management: 2018 Update for the Rogers' Textbook of Pediatric Intensive Care.
To review important articles on pain, sedation, sleep, and delirium in the field of pediatric critical care published subsequent to the fifth edition of the Rogers' Textbook of Pediatric Critical Care. ⋯ Recent research into pediatric pain and sedation management has focused on optimizing the choice of sedative medications, in particular by increasing the use and understanding of nonopioid and nonbenzodiazepine options such as ketamine and alpha-2 agonists. Delirium has emerged as a significant morbidity in the critically ill pediatric patient, and recent articles have concentrated on the use of validated screening tools to determine the epidemiology and risk factors in specific populations, including patients with cardiac disease and those receiving extracorporeal membrane oxygenation. A consistent theme in the most recent literature is the role of titrated but effective sedation, quality improvement to increase delirium recognition, and optimizing the pediatric intensive care environment to promote sleep.
-
Pediatr Crit Care Me · Jan 2019
Noninvasive Ventilation During Pediatric and Neonatal Critical Care Transport: A Systematic Review.
Noninvasive ventilation is increasingly used in neonatal and pediatric patients, but the intensive care transport setting is lagging in terms of availability of noninvasive ventilation for children. The objective of this systematic review of the literature was to answer the question: In children 0 days to 18 years old, who are hospitalized with acute respiratory distress and require critical care transport, is noninvasive ventilation effective and safe during transport? ⋯ This review found observational study evidence of a rate of intubation or escalation of 0.4% during noninvasive ventilation transport of children 0-18 years old, with an in-transport adverse event rate of 1-4%. Further studies are required. If randomized trials are not possible, it is suggested that well-conducted observational studies are reported in a more standardized manner.
-
Pediatr Crit Care Me · Dec 2018
Impact of Synchronous Telemedicine Models on Clinical Outcomes in Pediatric Acute Care Settings: A Systematic Review.
To evaluate the impact of synchronous telemedicine models on the clinical outcomes in pediatric acute care settings. ⋯ Despite the broad recommendations found for using telemedicine in pediatric acute care settings, high-quality evidence of its impacts is still lacking. Further robust studies are needed to better determine the clinical effectiveness and the associated impacts of telemedicine in pediatric acute care settings.