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To the Parents of the Boy We Lost. 致我们失去的男孩的父母
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-06-24 DOI: 10.1097/PCC.0000000000003559
Stefanie Gauguet

Recently, we took care of a teenage boy in our PICU who had been struggling with a lifelong chronic illness and accompanied him and his parents during the last few days of his life. We had the privilege of getting to know him and his parents quite well during the last few years, as he required hospitalization several times during this time. We saw how extremely dedicated his parents had been to him and his care, how they left no stone unturned and sacrificed everything they could to help him have the best quality of life possible. I happened to not be on service, nor know about the moment when he passed away. I also missed when his funeral took place. I wanted to reach out to his parents, to express how much his life and their love for him had meant to me, too, and to find some closure. So I wrote this short poem for them, and for all the other parents, who have to go through the most difficult time a parent can ever go through-as a pediatric intensivist, a Mom who has never been where they had to go, a fellow human being, and a grieving friend.

最近,我们在重症监护病房照顾了一名终生与慢性疾病作斗争的十几岁男孩,并陪伴他和他的父母度过了生命的最后几天。在过去的几年里,我们有幸对他和他的父母有了相当深入的了解,因为在此期间他需要多次住院治疗。我们看到了他的父母是如何全心全意地照顾他,如何不遗余力地牺牲一切来帮助他获得尽可能好的生活质量。我碰巧不在现场,也不知道他去世的那一刻。我也错过了他的葬礼。我想联系他的父母,表达他的生命和他们对他的爱对我来说有多么重要,也想找到一些了结。因此,我写了这首短诗,作为一名儿科重症监护医生、一位从未经历过他们必须经历的事情的母亲、一位同胞和一位悲伤的朋友,送给他们,也送给所有其他必须经历父母最艰难时刻的父母。
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引用次数: 0
Trajectories in Intensity of Medical Interventions at the End of Life: Clustering Analysis in a Pediatric, Single-Center Retrospective Cohort, 2013-2021. 生命末期医疗干预强度的轨迹:2013-2021年儿科单中心回顾性队列的聚类分析。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-07-18 DOI: 10.1097/PCC.0000000000003579
Kelly M Liesse, Lakshmee Malladi, Tu C Dinh, Brendan M Wesp, Brittni N Kam, Benjamin A Turturice, Kimberly A Pyke-Grimm, Danton S Char, Seth A Hollander

Objective: Pediatric deaths often occur within hospitals and involve balancing aggressive treatment with minimization of suffering. This study first investigated associations between clinical/demographic features and the level of intensity of various therapies these patients undergo at the end of life (EOL). Second, the work used these data to develop a new, broader spectrum for classifying pediatric EOL trajectories.

Design: Retrospective, single-center study, 2013-2021.

Setting: Four hundred sixty-one bed tertiary, stand-alone children's hospital with 112 ICU beds.

Patients: Patients of age 0-26 years old at the time of death.

Interventions: None.

Measurements and main results: Of 1111 included patients, 85.7% died in-hospital. Patients who died outside the hospital were older. Among the 952 in-hospital deaths, most occurred in ICUs (89.5%). Clustering analysis was used to distinguish EOL trajectories based on the presence of intensive therapies and/or an active resuscitation attempt at the EOL. We identified five simplified categories: 1) death during active resuscitation, 2) controlled withdrawal of life-sustaining technology, 3) natural progression to death despite maximal therapy, 4) discontinuation of nonsustaining therapies, and 5) withholding/noninitiation of future therapies. Patients with recent surgical procedures, a history of organ transplantation, or admission to the Cardiovascular ICU had more intense therapies at EOL than those who received palliative care consultations, had known genetic conditions, or were of older age.

Conclusions: In this retrospective study of pediatric EOL trajectories based on the intensity of technology and/or resuscitation discontinued at the EOL, we have identified associations between these trajectories and patient characteristics. Further research is needed to investigate the impact of these trajectories on families, patients, and healthcare providers.

目的:小儿死亡通常发生在医院内,需要在积极治疗和减少痛苦之间取得平衡。本研究首先调查了临床/人口学特征与这些患者在生命末期(EOL)所接受的各种治疗强度之间的关联。其次,该研究利用这些数据开发了一种新的、更广泛的儿科生命末期轨迹分类方法:设计:回顾性单中心研究,2013-2021年:461张床位的独立三级儿童医院,拥有112张重症监护室床位:干预措施:无:测量和主要结果在纳入的1111名患者中,85.7%死于院内。在医院外死亡的患者年龄更大。在952例院内死亡病例中,大多数发生在重症监护病房(89.5%)。通过聚类分析,我们根据患者在临终前是否接受了强化治疗和/或进行了积极的复苏尝试来区分其临终轨迹。我们确定了五个简化类别:1)在积极复苏过程中死亡;2)在控制下撤除维持生命的技术;3)尽管接受了最大限度的治疗,但仍自然进展至死亡;4)停止非维持生命疗法;5)暂停/不启动未来疗法。与接受姑息治疗咨询、有已知遗传病史或年龄较大的患者相比,近期接受过外科手术、有器官移植史或入住心血管重症监护室的患者在临终前接受的治疗更为密集:在这项基于生命末期停止的技术和/或复苏强度的儿科生命末期轨迹回顾性研究中,我们发现了这些轨迹与患者特征之间的关联。需要进一步研究这些轨迹对家庭、患者和医疗服务提供者的影响。
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引用次数: 0
Cardiopulmonary Resuscitation: Push Hard, Push Fast, But Where to Push? 心肺复苏术:用力推、快速推,但往哪里推?
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-10-03 DOI: 10.1097/PCC.0000000000003586
Lindsay N Shepard, Akira Nishisaki
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引用次数: 0
Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY) Study: Secondary Workload and Provider Outcomes in a Simulation-Based Trial. 气雾剂盒用于减少医护人员在气道操作过程中的污染(AIRWAY)研究:模拟试验中的次要工作量和医护人员成果。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-06-05 DOI: 10.1097/PCC.0000000000003535
Dana Singer Harel, Yiqun Lin, Carl Y Lo, Adam Cheng, Jennifer Davidson, Todd P Chang, Clyde Matava, Michael Buyck, Guylaine Neveu, Natasha Collia, Jabeen Fayyaz, Keya Manshadi, Arielle Levy, Stephanie Pellerin, Jonathan Pirie

Objectives: An aerosol box aims to reduce the risk of healthcare provider (HCP) exposure to infections during aerosol generating medical procedures (AGMPs), but little is known about its impact on workload of team members. We conducted a secondary analysis of data from a prospective, multicenter, randomized controlled trial evaluating the impact of aerosol box use on patterns of HCP contamination during AGMPs. The objectives of this study are to: 1) evaluate the effect of aerosol box use on HCP workload, 2) identify factors associated with HCP workload when using an aerosol box, and 3) describe the challenges perceived by HCPs of aerosol box use.

Design: Simulation-based randomized trial, conducted from May to December 2021.

Setting: Four pediatric simulation centers.

Subjects: Teams of two HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box).

Interventions: Each team performed three scenarios requiring different pediatric airway management (bag-valve-mask [BVM] ventilation, laryngeal mask airway [LMA] insertion, and endotracheal intubation [ETI] with video laryngoscopy) on a simulated COVID-19 patient. National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a standard tool that measures subjective workload with six subscales.

Measurements and main results: A total of 64 teams (128 participants) were recruited. The use of aerosol box was associated with significantly higher frustration during LMA insertion (28.71 vs. 17.42; mean difference, 11.29; 95% CI, 0.92-21.66; p = 0.033). For ETI, there was a significant increase in most subscales in the intervention group, but there was no significant difference for BMV. Average NASA-TLX scores were all in the "low" range for both groups (range: control BVM 23.06, sd 13.91 to intervention ETI 38.15; sd 20.45). The effect of provider role on workloads was statistically significant only for physical demand ( p = 0.001). As the complexity of procedure increased (BVM → LMA → ETI), the workload increased in all six subscales ( p < 0.05).

Conclusions: The use of aerosol box increased workload during ETI but not with BVM and LMA insertion. Overall workload scores remained in the "low" range, and there was no significant difference between airway provider and assistant.

目的:气溶胶盒旨在降低医护人员(HCP)在产生气溶胶的医疗过程(AGMP)中受到感染的风险,但人们对其对团队成员工作量的影响知之甚少。我们对一项前瞻性多中心随机对照试验的数据进行了二次分析,该试验评估了气溶胶盒的使用对 AGMP 过程中 HCP 污染模式的影响。本研究的目标是1)评估喷雾盒的使用对 HCP 工作量的影响;2)确定使用喷雾盒时与 HCP 工作量相关的因素;3)描述 HCP 在使用喷雾盒时感受到的挑战:设计:基于模拟的随机试验,2021 年 5 月至 12 月进行:四个儿科模拟中心:由两名保健医生组成的小组被随机分配到对照组(无喷雾盒)或干预组(喷雾盒):每个小组对一名模拟 COVID-19 患者实施三种需要不同儿科气道管理的情景(袋阀面罩 [BVM] 通气、喉罩气道 [LMA] 插入和视频喉镜气管插管 [ETI])。美国国家航空航天局任务负荷指数(NASA-TLX)是一种标准工具,通过六个分量表测量主观工作量:共招募了 64 个团队(128 名参与者)。使用气雾剂盒与 LMA 插入过程中更高的挫败感明显相关(28.71 vs. 17.42;平均差异,11.29;95% CI,0.92-21.66;p = 0.033)。就 ETI 而言,干预组的大多数分量表都有显著提高,但 BMV 没有显著差异。两组的 NASA-TLX 平均得分均在 "低 "范围内(范围:对照组 BVM 23.06,sd 13.91;干预组 ETI 38.15;sd 20.45)。医疗服务提供者的角色对工作量的影响仅在体力需求方面具有统计学意义(p = 0.001)。随着手术复杂程度的增加(BVM → LMA → ETI),所有六个分量表的工作量都增加了(p < 0.05):结论:使用喷雾盒会增加 ETI 期间的工作量,但在插入 BVM 和 LMA 时不会。总体工作量评分仍处于 "低 "范围,气道提供者和助手之间没有显著差异。
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引用次数: 0
Evolution of Pediatric Critical Care Medicine Physicians Clinical and Academic Profile by Gender. 按性别分列的儿科重症医学医生临床和学术概况的演变。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1097/PCC.0000000000003563
Kitman Wai, Murray M Pollack, Sonali Basu

Objectives: To examine career trajectory and academic profile of Pediatric Critical Care Medicine (PCCM) physicians, with special focus on gender differences.

Design: Observational cross-sectional study of PCCM fellowship graduates using publicly available data.

Setting: Publicly available databases including National Provider Identifier registry, American Board of Pediatrics, Doximity, official hospital websites, and Scopus.

Subjects: Two thousand one hundred twenty-nine PCCM fellowship graduates employed in clinical positions in U.S. practice locations.

Intervention: None.

Measurements and main results: Physician demographic characteristics included gender and time since fellowship completion. Current career and academic characteristics included employment data, publication productivity (h-index), and academic rank. Data from 2129 career PCCM physicians was included, with recent graduates showing a notable increase in female representation. Workplace characteristics revealed that most PCCM physicians worked in university-affiliated hospitals, with higher percentages of female physicians working in university-affiliated hospitals compared with male physicians. The study also highlighted significant gender disparities in academic metrics, with male physicians having higher h-indices (3 vs. 2; p < 0.001) and more publications (6 vs. 4; p < 0.001) than their female counterparts across various career phases. Additionally, the analysis showed gender differences in academic rank, with a higher proportion of female faculty holding assistant and associate professor ranks (58.2% vs. 47.5%; p < 0.001), while a greater percentage of male faculty held the rank of professor (20.2% vs. 11.1%; p < 0.001). Multiple variable regression analysis identified both male gender and time since fellowship graduation as independently associated with a physician's h-index, while only time since fellowship graduation was linked to current academic rank.

Conclusions: This is the first analysis of career and academic characteristics of practicing PCCM physicians, additionally studying the association of gender and career trajectory. Gender discrepancy was seen in employment hospital characteristics, h-indices, and academic rank. Additional studies are required to further explore the impact of gender on career trajectory.

目的研究儿科重症医学(PCCM)医生的职业轨迹和学术概况,特别关注性别差异:设计:利用公开数据对 PCCM 研究员毕业生进行横断面观察研究:研究对象: 229 名儿科重症医学专业的研究生:干预措施:无:测量和主要结果医生的人口统计学特征包括性别和完成研究金后的时间。目前的职业和学术特征包括就业数据、出版生产力(h 指数)和学术排名。数据来自 2129 名职业 PCCM 医生,其中应届毕业生中女性比例明显增加。工作场所特征显示,大多数 PCCM 医生在大学附属医院工作,与男性医生相比,女性医生在大学附属医院工作的比例更高。研究还强调了学术指标方面的显著性别差异,在不同的职业生涯阶段,男医生的 h 指数(3 对 2;p < 0.001)和发表论文数量(6 对 4;p < 0.001)均高于女医生。此外,分析还显示了学术职级方面的性别差异,女性教员担任助理教授和副教授职级的比例更高(58.2% 对 47.5%;p < 0.001),而男性教员担任教授职级的比例更高(20.2% 对 11.1%;p < 0.001)。多变量回归分析表明,男性性别和研究员毕业后的时间与医生的h指数独立相关,而只有研究员毕业后的时间与目前的学术职级相关:这是首次对 PCCM 执业医师的职业和学术特征进行分析,此外还研究了性别与职业发展轨迹的关系。性别差异体现在就业医院特征、h 指数和学术排名上。需要开展更多研究,进一步探讨性别对职业发展轨迹的影响。
{"title":"Evolution of Pediatric Critical Care Medicine Physicians Clinical and Academic Profile by Gender.","authors":"Kitman Wai, Murray M Pollack, Sonali Basu","doi":"10.1097/PCC.0000000000003563","DOIUrl":"10.1097/PCC.0000000000003563","url":null,"abstract":"<p><strong>Objectives: </strong>To examine career trajectory and academic profile of Pediatric Critical Care Medicine (PCCM) physicians, with special focus on gender differences.</p><p><strong>Design: </strong>Observational cross-sectional study of PCCM fellowship graduates using publicly available data.</p><p><strong>Setting: </strong>Publicly available databases including National Provider Identifier registry, American Board of Pediatrics, Doximity, official hospital websites, and Scopus.</p><p><strong>Subjects: </strong>Two thousand one hundred twenty-nine PCCM fellowship graduates employed in clinical positions in U.S. practice locations.</p><p><strong>Intervention: </strong>None.</p><p><strong>Measurements and main results: </strong>Physician demographic characteristics included gender and time since fellowship completion. Current career and academic characteristics included employment data, publication productivity (h-index), and academic rank. Data from 2129 career PCCM physicians was included, with recent graduates showing a notable increase in female representation. Workplace characteristics revealed that most PCCM physicians worked in university-affiliated hospitals, with higher percentages of female physicians working in university-affiliated hospitals compared with male physicians. The study also highlighted significant gender disparities in academic metrics, with male physicians having higher h-indices (3 vs. 2; p < 0.001) and more publications (6 vs. 4; p < 0.001) than their female counterparts across various career phases. Additionally, the analysis showed gender differences in academic rank, with a higher proportion of female faculty holding assistant and associate professor ranks (58.2% vs. 47.5%; p < 0.001), while a greater percentage of male faculty held the rank of professor (20.2% vs. 11.1%; p < 0.001). Multiple variable regression analysis identified both male gender and time since fellowship graduation as independently associated with a physician's h-index, while only time since fellowship graduation was linked to current academic rank.</p><p><strong>Conclusions: </strong>This is the first analysis of career and academic characteristics of practicing PCCM physicians, additionally studying the association of gender and career trajectory. Gender discrepancy was seen in employment hospital characteristics, h-indices, and academic rank. Additional studies are required to further explore the impact of gender on career trajectory.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Peripheral Perfusion Index in Ugandan Children With Plasmodium falciparum Severe Malaria: Secondary Analysis of Outcomes in a 2014-2017 Cohort Study. 乌干达恶性疟原虫重症疟疾患儿的外周灌注指数:2014-2017 年队列研究结果的二次分析。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-26 DOI: 10.1097/PCC.0000000000003624
Wesley Boland, Dibyadyuti Datta, Ruth Namazzi, Caitlin Bond, Andrea L Conroy, Kagan A Mellencamp, Robert O Opoka, Chandy C John, Michael Lintner Rivera

Objectives: Continuous, noninvasive tools to monitor peripheral perfusion, such as perfusion index (PI), can detect hemodynamic abnormalities and assist in the management of critically ill children hospitalized with severe malaria. In this study of hospitalized children with severe malaria, we aimed to assess whether PI correlates with clinical markers of perfusion and to determine whether combining PI with these clinical measures improves identification of children with greater odds of mortality.

Design: Post hoc analysis of a prospective, multicenter, cohort study conducted between 2014 and 2017.

Setting: Two referral hospitals in Central and Eastern Uganda.

Patients: Six hundred children younger than 5 years old with severe malaria and 120 asymptomatic community children.

Interventions: None.

Measurements and main results: PI was measured at 6-hour intervals for the first 24 hours of hospitalization. We compared PI to standard clinical perfusion measures such as capillary refill time, presence of cold peripheral limbs, or temperature gradient. Admission PI was highly correlated with clinical measures of perfusion. Admission PI was lower in children with severe malaria compared with asymptomatic community children; and, among the children with severe malaria, PI was lower in those with clinical features of poor perfusion or complications of severe malaria, such as shock and hyperlactatemia (all p < 0.02). Among children with severe malaria, lower admission PI was associated with greater odds of mortality after adjustment for age, sex, and severe malaria criteria (adjusted odds ratio, 2.4 for each log decrease in PI [95% CI, 1.0-5.9]; p = 0.045). Diagnostically, the presence of two consecutive low PI measures (< 1%) predicted mortality, with a sensitivity of 50% and a specificity of 76%.

Conclusions: In severe malaria, PI correlates with clinical complications (including shock and elevated serum lactate) and may be useful as an objective, continuous explanatory variable associated with greater odds of later in-hospital mortality.

目的:连续、无创的外周灌注监测工具(如灌注指数(PI))可检测血液动力学异常,并有助于重症疟疾住院患儿的治疗。在这项针对重症疟疾住院患儿的研究中,我们旨在评估灌注指数是否与临床灌注指标相关,并确定将灌注指数与这些临床指标相结合是否能更好地识别死亡率较高的患儿:对2014年至2017年间进行的一项前瞻性多中心队列研究进行事后分析:乌干达中部和东部的两家转诊医院:600名5岁以下的重症疟疾患儿和120名无症状的社区儿童:测量和主要结果在住院的头 24 小时内,每隔 6 小时测量一次 PI。我们将 PI 与毛细血管再充盈时间、外周肢体是否冰冷或温度梯度等标准临床灌注测量指标进行了比较。入院 PI 与临床灌注测量结果高度相关。与无症状的社区儿童相比,重症疟疾患儿入院时的血流灌注指数较低;在重症疟疾患儿中,有血流灌注不良临床特征或重症疟疾并发症(如休克和高乳酸血症)的患儿的血流灌注指数较低(均 p <0.02)。在重症疟疾患儿中,在对年龄、性别和重症疟疾标准进行调整后,较低的入院 PI 与较高的死亡几率相关(调整后的几率比,PI 每下降 1 个对数,死亡几率为 2.4 [95% CI,1.0-5.9];P = 0.045)。在诊断上,连续两次出现低 PI(< 1%)可预测死亡率,灵敏度为 50%,特异度为 76%:结论:在重症疟疾中,PI 与临床并发症(包括休克和血清乳酸升高)相关,可作为一个客观、连续的解释变量,与较高的后期院内死亡率相关。
{"title":"Peripheral Perfusion Index in Ugandan Children With Plasmodium falciparum Severe Malaria: Secondary Analysis of Outcomes in a 2014-2017 Cohort Study.","authors":"Wesley Boland, Dibyadyuti Datta, Ruth Namazzi, Caitlin Bond, Andrea L Conroy, Kagan A Mellencamp, Robert O Opoka, Chandy C John, Michael Lintner Rivera","doi":"10.1097/PCC.0000000000003624","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003624","url":null,"abstract":"<p><strong>Objectives: </strong>Continuous, noninvasive tools to monitor peripheral perfusion, such as perfusion index (PI), can detect hemodynamic abnormalities and assist in the management of critically ill children hospitalized with severe malaria. In this study of hospitalized children with severe malaria, we aimed to assess whether PI correlates with clinical markers of perfusion and to determine whether combining PI with these clinical measures improves identification of children with greater odds of mortality.</p><p><strong>Design: </strong>Post hoc analysis of a prospective, multicenter, cohort study conducted between 2014 and 2017.</p><p><strong>Setting: </strong>Two referral hospitals in Central and Eastern Uganda.</p><p><strong>Patients: </strong>Six hundred children younger than 5 years old with severe malaria and 120 asymptomatic community children.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>PI was measured at 6-hour intervals for the first 24 hours of hospitalization. We compared PI to standard clinical perfusion measures such as capillary refill time, presence of cold peripheral limbs, or temperature gradient. Admission PI was highly correlated with clinical measures of perfusion. Admission PI was lower in children with severe malaria compared with asymptomatic community children; and, among the children with severe malaria, PI was lower in those with clinical features of poor perfusion or complications of severe malaria, such as shock and hyperlactatemia (all p < 0.02). Among children with severe malaria, lower admission PI was associated with greater odds of mortality after adjustment for age, sex, and severe malaria criteria (adjusted odds ratio, 2.4 for each log decrease in PI [95% CI, 1.0-5.9]; p = 0.045). Diagnostically, the presence of two consecutive low PI measures (< 1%) predicted mortality, with a sensitivity of 50% and a specificity of 76%.</p><p><strong>Conclusions: </strong>In severe malaria, PI correlates with clinical complications (including shock and elevated serum lactate) and may be useful as an objective, continuous explanatory variable associated with greater odds of later in-hospital mortality.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pediatric Resuscitation Skill of Bag-Tube Manual Ventilation: Developing and Using a Mobile Simulation Program to Assess Competency of a Multiprofessional PICU Team. 儿科复苏技能之袋管人工通气:开发和使用移动模拟程序评估 PICU 多专业团队的能力。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-20 DOI: 10.1097/PCC.0000000000003612
Anna E McCormick, Stuart H Friess, Kimberly S Quayle, John C Lin, Arushi Manga

Objectives: To assess the skill of bag-tube manual ventilation with the flow-inflating bag in multiprofessional PICU team members using a mobile simulation unit.

Design: Prospective observational study from January 2022 to April 2022.

Setting: In situ mobile simulation using the flow-inflating bag in an academic PICU.

Subjects: Multiprofessional PICU team members including nurses, respiratory therapists, nurse practitioners, fellows, and attendings.

Interventions: None.

Measurements and main results: We enrolled 129 participants who twice completed 1-minute tasks performing bag-tube manual ventilation with a flow-inflating bag. Sessions were video recorded; four could not be analyzed. Only 30% of participants reported being very to extremely confident, and the majority (62%) reported infrequent skill performance. Task success was defined as achieving target pressure ranges during 80% of the delivered breaths, respiratory rate (RR) of 25-35 breaths/min, and successful pop-off valve engagement. Only five of 129 participants (4%) achieved successful ventilation as defined. Overall, participants were more likely to deliver lower pressures and faster rate. Maintaining target positive end-expiratory pressure (PEEP) was least likely to be achieved (19% success), followed by RR (52%), pop-off valve (64%), then peak inspiratory pressure (71%). Nurses were less likely to achieve target pressures compared with all other professions.

Conclusions: Multiprofessional PICU team members have highly variable self-confidence with bag-tube manual ventilation using a flow-inflating bag. Observed performance demonstrates rare success with achieving targeted ventilation parameters, in particular maintenance of PEEP. Future research should focus on developing mobile simulation units to facilitate profession-specific, real-time coaching to teach high-quality manual ventilation that can be translated to the bedside.

目的使用移动模拟装置,评估 PICU 多专业团队成员使用流量充气袋进行袋管手动通气的技能:设计:2022 年 1 月至 2022 年 4 月的前瞻性观察研究:研究对象: PICU多专业团队成员:多专业 PICU 团队成员,包括护士、呼吸治疗师、执业护士、研究员和主治医师:干预措施:无:我们招募了 129 名参与者,他们两次完成了使用充气袋进行袋管手动通气的 1 分钟任务。会议进行了录像,其中四次无法进行分析。只有 30% 的参与者表示非常自信或非常自信,大多数人(62%)表示不经常进行技能操作。任务成功的定义是在 80% 的送气过程中达到目标压力范围,呼吸频率 (RR) 达到 25-35 次/分钟,以及成功打开阀门。在 129 名参与者中,只有 5 人(4%)达到了成功通气的定义。总体而言,参与者更倾向于使用较低的压力和较快的呼吸频率。维持目标呼气末正压 (PEEP) 的成功率最低(19%),其次是呼吸频率(52%)、关闭活瓣(64%),然后是吸气峰压(71%)。与所有其他专业相比,护士达到目标压力的可能性较低:结论:PICU 多专业团队成员对使用充气袋进行袋管手动通气的自信心差异很大。观察结果表明,在达到目标通气参数,尤其是维持 PEEP 方面,成功率很低。未来的研究应侧重于开发移动模拟装置,以促进针对特定专业的实时指导,教授高质量的手动通气,并将其应用到床旁。
{"title":"Pediatric Resuscitation Skill of Bag-Tube Manual Ventilation: Developing and Using a Mobile Simulation Program to Assess Competency of a Multiprofessional PICU Team.","authors":"Anna E McCormick, Stuart H Friess, Kimberly S Quayle, John C Lin, Arushi Manga","doi":"10.1097/PCC.0000000000003612","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003612","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the skill of bag-tube manual ventilation with the flow-inflating bag in multiprofessional PICU team members using a mobile simulation unit.</p><p><strong>Design: </strong>Prospective observational study from January 2022 to April 2022.</p><p><strong>Setting: </strong>In situ mobile simulation using the flow-inflating bag in an academic PICU.</p><p><strong>Subjects: </strong>Multiprofessional PICU team members including nurses, respiratory therapists, nurse practitioners, fellows, and attendings.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We enrolled 129 participants who twice completed 1-minute tasks performing bag-tube manual ventilation with a flow-inflating bag. Sessions were video recorded; four could not be analyzed. Only 30% of participants reported being very to extremely confident, and the majority (62%) reported infrequent skill performance. Task success was defined as achieving target pressure ranges during 80% of the delivered breaths, respiratory rate (RR) of 25-35 breaths/min, and successful pop-off valve engagement. Only five of 129 participants (4%) achieved successful ventilation as defined. Overall, participants were more likely to deliver lower pressures and faster rate. Maintaining target positive end-expiratory pressure (PEEP) was least likely to be achieved (19% success), followed by RR (52%), pop-off valve (64%), then peak inspiratory pressure (71%). Nurses were less likely to achieve target pressures compared with all other professions.</p><p><strong>Conclusions: </strong>Multiprofessional PICU team members have highly variable self-confidence with bag-tube manual ventilation using a flow-inflating bag. Observed performance demonstrates rare success with achieving targeted ventilation parameters, in particular maintenance of PEEP. Future research should focus on developing mobile simulation units to facilitate profession-specific, real-time coaching to teach high-quality manual ventilation that can be translated to the bedside.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Family-Centered Care in the PICU: Strengthening Partnerships in Pediatric Critical Care Medicine. 以家庭为中心的重症监护病房护理:加强儿科重症监护医学的合作关系》。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-20 DOI: 10.1097/PCC.0000000000003621
Ashleigh E Butler, Florencia Krall, Alexis Shinewald, Joseph C Manning, Karen Choong, Karen Dryden-Palmer
{"title":"Family-Centered Care in the PICU: Strengthening Partnerships in Pediatric Critical Care Medicine.","authors":"Ashleigh E Butler, Florencia Krall, Alexis Shinewald, Joseph C Manning, Karen Choong, Karen Dryden-Palmer","doi":"10.1097/PCC.0000000000003621","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003621","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in PICU: Single-Center Retrospective Study in North India, 2018-2021. 经肺压力引导机械通气在重症急性呼吸窘迫综合征 PICU 中的应用:2018-2021年北印度单中心回顾性研究》。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-18 DOI: 10.1097/PCC.0000000000003609
Anil Sachdev, Anil Kumar, Bharat Mehra, Neeraj Gupta, Dhiren Gupta, Suresh Gupta, Parul Chugh

Objectives: In this study, we have reviewed the association between esophageal pressure-guided positive end-expiratory pressure (PEEP) setting and oxygenation and lung mechanics with a conventional mechanical ventilation (MV) strategy in patient with moderate to severe pediatric acute respiratory distress syndrome (PARDS).

Design: Retrospective cohort, 2018-2021.

Setting: Tertiary PICU.

Patients: Moderate to severe PARDS patients who required MV with PEEP of greater than or equal to 8 cm H2O.

Interventions: Esophageal pressure (i.e., transpulmonary pressure [PTP]) guided MV vs. not.

Measurements and main results: We identified 26 PARDS cases who were divided into those who had been managed with PTP-guided MV (PTP group) and those managed with conventional ventilation strategy (non-PTP). Oxygenation and lung mechanics were compared between groups at baseline (0 hr) and 24, 48, and 72 hours of MV. There were 13 patients in each group in the first 24 hours. At 48 and 72 hours, there were 11 in PTP group and 12 in non-PTP group. On comparing these groups, first, use of PTP monitoring was associated with higher median (interquartile range) mean airway pressure at 24 hours (18 hr [18-20 hr] vs. 15 hr [13-18 hr]; p = 0.01) and 48 hours (19 hr [17-19 hr] vs. 15 hr [13-17 hr]; p = 0.01). Second, use of PTP was associated with higher PEEP at 24, 48, and 72 hours (all p < 0.05). Third, use of PTP was associated with lower Fio2 and greater Pao2 to Fio2 ratio at 72 hours. Last, there were 18 of 26 survivors, and we failed to identify an association between use of PTP monitoring and survival.

Conclusions: In this cohort of moderate to severe PARDS cases undergoing MV with PEEP greater than or equal to 8 cm H2O, we have identified some favorable associations of oxygenation status when PTP-guided MV was used vs. not. Larger studies are required.

研究目的在这项研究中,我们回顾了中重度儿科急性呼吸窘迫综合征(PARDS)患者中,食管压力引导下的呼气末正压(PEEP)设置与传统机械通气(MV)策略的氧合和肺力学之间的关联:设计:回顾性队列,2018-2021年:三级 PICU.患者:需要使用 PEEP 大于或等于 8 cm H2O 的 MV 的中重度 PARDS 患者:干预措施:食管压力(即跨肺压 [PTP])引导 MV 与不引导 MV:我们确定了 26 例 PARDS 病例,并将其分为采用 PTP 引导下 MV 的病例(PTP 组)和采用传统通气策略的病例(非 PTP 组)。比较了两组患者在基线(0 小时)和 MV 24、48 和 72 小时时的氧合和肺力学情况。在最初的 24 小时内,每组各有 13 名患者。48 小时和 72 小时时,PTP 组有 11 人,非 PTP 组有 12 人。比较这些组别,首先,使用 PTP 监测与 24 小时(18 小时 [18-20 小时] 与 15 小时 [13-18 小时];P = 0.01)和 48 小时(19 小时 [17-19 小时] 与 15 小时 [13-17 小时];P = 0.01)平均气道压中位数(四分位间范围)较高有关。其次,使用 PTP 与 24、48 和 72 小时 PEEP 值升高有关(均 p <0.05)。第三,使用 PTP 与 72 小时时较低的 Fio2 和较高的 Pao2 与 Fio2 比率有关。最后,26 例患者中有 18 例存活,但我们未能发现使用 PTP 监测与存活之间存在关联:结论:在这组接受 PEEP 大于或等于 8 cm H2O MV 治疗的中重度 PARDS 病例中,我们发现使用 PTP 引导 MV 与不使用 PTP 引导 MV 对氧合状态有一些有利的关联。需要进行更大规模的研究。
{"title":"Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in PICU: Single-Center Retrospective Study in North India, 2018-2021.","authors":"Anil Sachdev, Anil Kumar, Bharat Mehra, Neeraj Gupta, Dhiren Gupta, Suresh Gupta, Parul Chugh","doi":"10.1097/PCC.0000000000003609","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003609","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, we have reviewed the association between esophageal pressure-guided positive end-expiratory pressure (PEEP) setting and oxygenation and lung mechanics with a conventional mechanical ventilation (MV) strategy in patient with moderate to severe pediatric acute respiratory distress syndrome (PARDS).</p><p><strong>Design: </strong>Retrospective cohort, 2018-2021.</p><p><strong>Setting: </strong>Tertiary PICU.</p><p><strong>Patients: </strong>Moderate to severe PARDS patients who required MV with PEEP of greater than or equal to 8 cm H2O.</p><p><strong>Interventions: </strong>Esophageal pressure (i.e., transpulmonary pressure [PTP]) guided MV vs. not.</p><p><strong>Measurements and main results: </strong>We identified 26 PARDS cases who were divided into those who had been managed with PTP-guided MV (PTP group) and those managed with conventional ventilation strategy (non-PTP). Oxygenation and lung mechanics were compared between groups at baseline (0 hr) and 24, 48, and 72 hours of MV. There were 13 patients in each group in the first 24 hours. At 48 and 72 hours, there were 11 in PTP group and 12 in non-PTP group. On comparing these groups, first, use of PTP monitoring was associated with higher median (interquartile range) mean airway pressure at 24 hours (18 hr [18-20 hr] vs. 15 hr [13-18 hr]; p = 0.01) and 48 hours (19 hr [17-19 hr] vs. 15 hr [13-17 hr]; p = 0.01). Second, use of PTP was associated with higher PEEP at 24, 48, and 72 hours (all p < 0.05). Third, use of PTP was associated with lower Fio2 and greater Pao2 to Fio2 ratio at 72 hours. Last, there were 18 of 26 survivors, and we failed to identify an association between use of PTP monitoring and survival.</p><p><strong>Conclusions: </strong>In this cohort of moderate to severe PARDS cases undergoing MV with PEEP greater than or equal to 8 cm H2O, we have identified some favorable associations of oxygenation status when PTP-guided MV was used vs. not. Larger studies are required.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adolescents and Young Adults With Respiratory Failure in U.S. PICUs: A Pediatric Health Information System Database Study, 2011-2022. 美国儿童重症监护病房中呼吸衰竭的青少年和年轻成人:儿科健康信息系统数据库研究,2011-2022 年。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-09-18 DOI: 10.1097/PCC.0000000000003610
Kevin S Gochenour, Melissa H Ross, Heidi R Flori, Joseph G Kohne

Objectives: To examine the clinical characteristics, outcomes, and resource use of adolescents and young adults (AYAs) admitted to PICUs in the United States with respiratory failure.

Design: Retrospective cohort study.

Setting: De-identified data from 48 U.S. children's hospitals contributing to the Pediatric Health Information System (PHIS) database.

Patients: All patients older than 30 days old with respiratory failure, defined as encounters with clinical transaction codes for noninvasive or invasive mechanical ventilation, admitted to PHIS database PICUs from January 2011 to December 2022. Patients were categorized into five cohorts (< 15, 15-18, 19-21, 22-25, and > 25 yr old).

Interventions: None.

Measurements and main results: A total of 430,238 patients were identified. AYA (≥ 15 yr old) accounted for 15% (65,740) of all PICU admissions with respiratory failure. Forty-nine percent (32,232/65,740) of AYA older than 25 years had medical technology dependence compared with 39% in those younger than 15 years (p < 0.001). Sixty-one percent of AYA older than 25 years had a cardiovascular comorbidity compared with 35% of those younger than 15 years (p < 0.001). Forty percent of AYA older than 25 years had a neurologic comorbidity, and 27% a gastrointestinal comorbidity, compared with 27% and 31%, respectively, in those younger than 15 years (all p < 0.001). Compared with those younger than 15 years, AYA median hospital crude mortality rate was higher at 7.7% compared with 5.2%, as were median hospital charges per encounter at $163K (interquartile range [IQR], $77K-$350K) vs. $121K (IQR, $53K-$278K; all p < 0.001). Median ventilator days and hospital length of stay in survivors were similar for all age cohorts.

Conclusions: AYA represent a substantial proportion of patients admitted to the PICU with respiratory failure. These individuals have unique comorbidities and are at risk for increased mortality and resource utilization compared with younger patients during hospitalization. Medical complexity and sequelae of pediatric illness may delay the transition of AYA to adult care, necessitating collaboration between adult and pediatric critical care physicians to increase research across the age spectrum and develop and implement appropriate evidence-based guidelines.

目的:研究美国因呼吸衰竭入住 PICU 的青少年和年轻成人(AYAs)的临床特征、治疗效果和资源使用情况:研究美国青少年和年轻成人(AYAs)因呼吸衰竭入住PICU的临床特征、结果和资源使用情况:设计:回顾性队列研究:来自儿科健康信息系统(PHIS)数据库的 48 家美国儿童医院的去身份化数据:2011年1月至2022年12月期间,PHIS数据库儿科重症监护病房收治的所有30天以上呼吸衰竭患者,定义为临床交易代码为无创或有创机械通气的患者。患者被分为五个组群(小于 15 岁、15-18 岁、19-21 岁、22-25 岁和大于 25 岁):干预措施:无:共发现 430 238 名患者。青壮年(≥ 15 岁)占所有入住呼吸衰竭重症监护病房患者的 15%(65,740 人)。49%(32232/65740)的 25 岁以上亚健康患者依赖医疗技术,而 15 岁以下亚健康患者的这一比例为 39%(P < 0.001)。61%的 25 岁以上亚裔青少年合并心血管疾病,而 15 岁以下青少年的这一比例为 35%(P < 0.001)。40%的 25 岁以上青少年患有神经系统合并症,27%患有胃肠道合并症,而 15 岁以下青少年的这一比例分别为 27% 和 31%(P 均小于 0.001)。与 15 岁以下的患者相比,青少年患者的住院粗死亡率中位数为 7.7%,高于 5.2%;每次就诊的住院费用中位数为 16.3 万美元(四分位数间距 [IQR],7.7 万美元-35 万美元),高于 12.1 万美元(四分位数间距 [IQR],5.3 万美元-27.8 万美元;所有数据均为 P <0.001)。各年龄组幸存者的中位呼吸机天数和住院时间相似:结论:在因呼吸衰竭入住 PICU 的患者中,青壮年占了很大比例。这些患者具有独特的合并症,与年轻患者相比,他们在住院期间面临着死亡率和资源使用率增加的风险。医疗的复杂性和儿科疾病的后遗症可能会延迟亚健康患者向成人护理的过渡,因此成人和儿科重症监护医生有必要合作,增加跨年龄段的研究,并制定和实施适当的循证指南。
{"title":"Adolescents and Young Adults With Respiratory Failure in U.S. PICUs: A Pediatric Health Information System Database Study, 2011-2022.","authors":"Kevin S Gochenour, Melissa H Ross, Heidi R Flori, Joseph G Kohne","doi":"10.1097/PCC.0000000000003610","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003610","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the clinical characteristics, outcomes, and resource use of adolescents and young adults (AYAs) admitted to PICUs in the United States with respiratory failure.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>De-identified data from 48 U.S. children's hospitals contributing to the Pediatric Health Information System (PHIS) database.</p><p><strong>Patients: </strong>All patients older than 30 days old with respiratory failure, defined as encounters with clinical transaction codes for noninvasive or invasive mechanical ventilation, admitted to PHIS database PICUs from January 2011 to December 2022. Patients were categorized into five cohorts (< 15, 15-18, 19-21, 22-25, and > 25 yr old).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 430,238 patients were identified. AYA (≥ 15 yr old) accounted for 15% (65,740) of all PICU admissions with respiratory failure. Forty-nine percent (32,232/65,740) of AYA older than 25 years had medical technology dependence compared with 39% in those younger than 15 years (p < 0.001). Sixty-one percent of AYA older than 25 years had a cardiovascular comorbidity compared with 35% of those younger than 15 years (p < 0.001). Forty percent of AYA older than 25 years had a neurologic comorbidity, and 27% a gastrointestinal comorbidity, compared with 27% and 31%, respectively, in those younger than 15 years (all p < 0.001). Compared with those younger than 15 years, AYA median hospital crude mortality rate was higher at 7.7% compared with 5.2%, as were median hospital charges per encounter at $163K (interquartile range [IQR], $77K-$350K) vs. $121K (IQR, $53K-$278K; all p < 0.001). Median ventilator days and hospital length of stay in survivors were similar for all age cohorts.</p><p><strong>Conclusions: </strong>AYA represent a substantial proportion of patients admitted to the PICU with respiratory failure. These individuals have unique comorbidities and are at risk for increased mortality and resource utilization compared with younger patients during hospitalization. Medical complexity and sequelae of pediatric illness may delay the transition of AYA to adult care, necessitating collaboration between adult and pediatric critical care physicians to increase research across the age spectrum and develop and implement appropriate evidence-based guidelines.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Pediatric Critical Care Medicine
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