Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2023
ReviewImplementation Science Research in Pediatric Critical Care Medicine.
Delay or failure to consistently adopt evidence-based or consensus-based best practices into routine clinical care is common, including for patients in the PICU. PICU patients can fail to receive potentially beneficial diagnostic or therapeutic interventions, worsening the burden of illness and injury during critical illness. Implementation science (IS) has emerged to systematically address this problem, but its use of in the PICU has been limited to date. We therefore present a conceptual and methodologic overview of IS for the pediatric intensivist. ⋯ Research in pediatric critical care practice must acknowledge the limitations and potential for patient harm that may result from a failure to implement evidence-based or professionals' consensus-based practices. IS represents an innovative, pragmatic, and increasingly popular approach that our field must readily embrace in order to improve our ability to care for critically ill children.
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Pediatr Crit Care Me · Oct 2023
ReviewContinuity Strategies for Long-Stay PICU Patients: Consensus Statements From the Lucile Packard Foundation PICU Continuity Panel.
To develop consensus statements on continuity strategies using primary intensivists, primary nurses, and recurring multidisciplinary team meetings for long-stay patients (LSPs) in PICUs. ⋯ These expert/parent-developed consensus statements provide PICUs with novel summaries on how to operationalize, implement, and sustain continuity strategies for LSP, a rapidly growing, vulnerable, resource-intensive population in PICUs.
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Pediatr Crit Care Me · Sep 2023
Adaptive Clinical Trials in Pediatric Critical Care: A Systematic Review.
This systematic review investigates the use of adaptive designs in randomized controlled trials (RCTs) in pediatric critical care. ⋯ Little evidence of the use of adaptive designs was found, with only 3% of PICU RCTs incorporating an adaptive design and only two types of adaptations used. Identifying the barriers to adoption of more complex adaptive trial designs is needed.
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Pediatr Crit Care Me · Aug 2023
ReviewEnteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review.
The number of infants and children requiring extracorporeal membrane oxygenation (ECMO) is rising. While critically ill, providers may believe that enteral nutrition puts the patient at risk for severe complications such as necrotizing enterocolitis. However, enteral nutrition is associated with the potential to improve the gut barrier and reduce the risk of morbidity and mortality. The purpose of this article is to review the existing evidence about providing exclusive enteral and parenteral nutrition and its association with rates of complications and mortality in critically ill neonatal and pediatric populations on ECMO. ⋯ The use of enteral nutrition in the neonatal and pediatric population while on ECMO has the potential to improve survival rates and reduce complications. Further studies are needed to investigate how to optimize this population's nutrition and develop feeding protocols and pathways.
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Pediatr Crit Care Me · Jul 2023
Meta AnalysisAortic Peak Flow Velocity As a Predictor of Fluid Responsiveness in Mechanically Ventilated Children: A Systematic Review and Meta-Analysis.
This meta-analysis aimed to determine the accuracy of the respiratory variations in aortic peak flow velocity (delta Vpeak) in predicting fluid responsiveness and the moderators of that accuracy. ⋯ By using the cutoff of approximately 12.3%, the delta Vpeak appears to have good accuracy in predicting fluid responsiveness in mechanically ventilated children. The moderators of delta Vpeak predictability are not found.