Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States

BACKGROUND There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit(NICU)to the pediatric intensive care unit(PICU)without an interim discharge home.These infants are often medically complex and have higher mortality relative to NICU or PICUonly admissions.Given an absence of data surrounding practice patterns for nonemergent NICU to PICU transfers,we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.AIM To characterize non-emergent NICU to PICU transfer practices across the United States and query PICU providers’evaluations of their effectiveness.METHODS A cross-sectional survey was drafted,piloted,and sent to one physician representative from each of 115 PICUs across the United States based on membership in the PARK-PICU research consortium and membership in the Children’s Hospital Association.The survey was administered via internet(REDCap).Analysis was performed using STATA,primarily consisting of descriptive statistics,though logistic regressions were run examining the relationship between specific transfer steps,hospital characteristics,and effectiveness of transfer.RESULTS One PICU attending from each of 81 institutions in the United States completed the survey(overall 70%response rate).Over half(52%)indicated their hospital transfers patients without using set clinical criteria,and only 33%indicated that their hospital has a standardized protocol to facilitate non-emergent transfer.Fewer than half of respondents reported that their institution’s nonemergent NICU to PICU transfer practices were effective for clinicians(47%)or patient families(38%).Respondents evaluated their centers’transfers as less effective when they lacked any transfer criteria(P=0.027)or set transfer protocols(P=0.007).Respondents overwhelmingly agreed that having set clinical criteria and standardized protocols for non-emergent transfer were important to the patient-family experience and patient safety.CONCLUSION Most hospitals lacked any clinical criteria or protocols for non-emergent NICU to PICU transfers.More positive perceptions of transfer effectiveness were found among those with set criteria and/or transfer protocols.

National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic

The coronavirus disease pandemic caught many pediatric hospitals unpreparedand has forced pediatric healthcare systems to scramble as they examine and planfor the optimal allocation of medical resources for the highest priority patients.There is limited data describing pediatric intensive care unit (PICU) preparednessand their health worker protections.AIMTo describe the current coronavirus disease 2019 (COVID-19) preparedness effortsamong a set of PICUs within a simulation-based network nationwide.METHODS A cross-sectional multi-center national survey of PICU medical director(s) fromchildren’s hospitals across the United States. The questionnaire was developedand reviewed by physicians with expertise in pediatric critical care, disasterreadiness, human factors, and survey development. Thirty-five children’shospitals were identified for recruitment through a long-established nationalresearch network. The questions focused on six themes: (1) PICU and medicaldirector demographics;(2) Pediatric patient flow during the pandemic;(3)Changes to the staffing models related to the pandemic;(4) Use of personalprotective equipment (PPE);(5) Changes in clinical practice and innovations;and(6) Current modalities of training including simulation.RESULTSWe report on survey responses from 22 of 35 PICUs (63%). The majority of PICUswere located within children’s hospitals (87%). All PICUs cared for pediatricpatients with COVID-19 at the time of the survey. The majority of PICUs (83.4%)witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicatedunits, and 74.6% pivoted to accept adult COVID-19 patients. All PICUsimplemented changes to their staffing models with the most common changesbeing changes in COVID-19 patient room assignment in 50% of surveyed PICUsand introducing remote patient monitoring in 36% of the PICU units. Ninety-fivepercent of PICUs conducted training for donning and doffing of enhanced PPE.Even 6 months into the pandemic, one-third of PICUs across the United Statesreported shortages in PPE. The most common training formats for PPE werehands-on training (73%) and video-based content (82%). The most commonconcerns related to COVID-19 practice were changes in clinical protocols andguidelines (50%). The majority of PICUs implemented significant changes in theirairway management (82%) and cardiac arrest management protocols in COVID-19patients (68%). Simulation-based training was the most commonly utilizedtraining modality (82%), whereas team training (73%) and team dynamics (77%)were the most common training objectives.CONCLUSIONSA substantial proportion of surveyed PICUs reported on large changes in theirpreparedness and training efforts before and during the pandemic. PICUsimplemented broad strategies including modifications to staffing, PPE usage,workflow, and clinical practice, while using simulation as the preferred trainingmodality. Further research is needed to advance the level of preparedness,support staff assuredness, and support deep learning about which preparednessactions were effective and what lessons are needed to improve PICU care andstaff protection for the next COVID-19 patient waves.

Improvement of the nutritional support management system for patients in intensive care units

BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.

Risk Factors for Mortality in Acute Kidney Injury in Intensive Care Units in Togo

Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.

Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) were observed. Conclusion: The results indicate the benefits of care measures for children admitted to the PICU in terms of a reduction in adverse events and expansion of access.

The trajectories of physical growth in 4 months postnatal corrected age among preterm infants discharged from neonatal intensive care units and associated factors: A prospective study

Objectives Growth retardation is a risk for premature infants.In addition to demographic and perinatal factors,preterm infants’physical growth may be affected by neonatal intensive care unit(NICU)stress,maternal postpartum depression,and mother-infant interaction.This study aimed to investigate the trajectories of physical growth in 4 months corrected age among preterm infants discharged from the NICU and the impactors on these trajectories.Methods A prospective study was conducted among 318 preterm infants from September 2019 to April 2021 in Shanghai,China.Latent growth modeling was applied to identify the weight,length,and head circumference growth trajectories in 4 months corrected age and explore the effects of demographic and medical characteristics,infant stress during NICU stay,maternal postpartum depression,and mother-infant interaction on each trajectory.Results Unconditional latent growth models showed curve trajectories with increasingly slower growth in weight,length,and head circumference until 4 months of corrected age.Conditional latent growth models showed that a longer length of stay in the NICU and more skin punctures were negatively associated with weight at 40 weeks corrected gestational age(β=−0.43 and−0.19,respectively,P<0.05).The maternal postpartum depression between 40 weeks corrected gestational age and 1 month corrected postnatal age was associated with a lower growth rate of length(β=−0.17,P=0.040),while between 2 and 3 months corrected postnatal age,there were lower growth rates of weight and head circumference(β=−0.15 and−0.19,respectively,P<0.05).The mother-infant interaction scores between 40 weeks corrected gestational age and 1 month corrected postnatal age negatively predicted the growth rate of weight(β=−0.19,P=0.020).Conclusion The physical growth trajectories of preterm infants discharged from the NICU were influenced by infant stress during the NICU stay,maternal postpartum depression and mother-infant interaction.

Mortality of Children in the Intensive Care Unit of the Pediatric University Hospital of Bangui

Background: In sub-Saharan Africa, one in 13 children died before their fifth birthday. Objective: To study mortality among children hospitalized in the intensive care unit of the CHUPB. Methodology: This was a retrospective, descriptive study over a 12-month period. Included were children aged 1 month to 15 years hospitalized in the intensive care unit and who died during the period. The data were entered and analyzed through the Epi Info software. The statistical test used was Pearson’s chi2. Results: The overall mortality rate was 21.49%. The sex ratio was 1.14 and the mean age was 3.17 ± 2.21 years. Children 5 years of age accounted for 78.49% (n = 197) of cases. Deaths were more frequent in January, April and December. The mean time to consultation was 6.91 ± 1.8 days. Fever 78.48% (n = 197), diarrhea/vomiting 35.45% (n = 89) and convulsions 26.29% (n = 66) were the main reasons for consultation. Prior to admission, treatment was administered in 73.38% (n = 184) of children. The main diagnoses of death were: septic shock 29.08% (n = 73), hypovolemic shock post AEG 17.13% (n = 43), severe malaria 10.76% (n = 27) and meningitis 6.38% (n = 16). Death was early in 66.53% (n = 167) of cases. It was influenced by male sex, origin of residence, rural residence, herbal medicine and the occurrence of deaths during the shifts after 16 hours. Conclusion: Mortality in pediatrics remains a concern in our practice. It is related to conditions that are mostly preventable by vaccination, information, education and communication.

Clinical decision making on the use of physical restraint in intensive care units

Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients'safety and to prevent unexpected accidents.However,existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales,the negative physical and emotional effects on patients,but the lack of perceived alternatives.This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses.By reviewing the literature,intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases.However,it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint.Besides that,such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated.Therefore,despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint,it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

Professional nurses’facilitation of self-care in intensive care units:A concept analysis

Objective:This article aims to provide an in-depth analysis of the concept of self-care in the intensive care unit and outline its defining attributes,antecedents,consequences and empirical referents.Methods:The literature was searched electronically using databases such as CINAHL,Medline,Psych INFO,ERIC,ScienceDirect,Amed,EBSCO(Health Source:Nursing and Academic Edition),Sage,Ujoogle and Google Scholar.Articles from 2013 to 2020 were searched to target recent and up-to-date information about the definitions,attributes,antecedents and consequences of the concept of self-care.Walker and Avant’s framework was utilised to analyse the concept of self-care.Results:The results of the concept analysis identified seven attributes,namely process,activity,capability,autonomous choice,education,self-control and interaction.The seven identified antecedents are self-motivation,participation,commitment,resources,religious and cultural beliefs,social,spiritual and professional support,and the availability of time.The consequences are the maintenance of health and wellbeing,autonomy,increased self-esteem,disease prevention,empowerment,increased social support and the ability to cope with stress.

Effects of parental involvement in infant care in neonatal intensive care units:a meta-analysis

Objective： This meta-analysis aimed to examine the effects of parental involvement in infant care in neonatal intensive care units （NlCUs）. Methods： PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI）, Wanfang database, and VIP database were searched till November 2017. Randomized controlled trials （RCTs） and controlled clinical trials （CCTs） examining the effect of parental involvement in the NICU were considered for inclusion. Resulls： We included 10 studies （three RCTs, seven CCTs） with a total of 1,851 participants. The meta-analysis demonstrated that there were no statistically significant differences on nosocomial infection between two groups （risk ratio [RR] = 0.90, 95% CI 0.63-1.30, P = 0.58）. Compared with no parental involvement groups, parental involvement groups showed more weight gain （mean difference [MD] = 1.47, 95% CI 0.65-2.29, P 〈 0.05）, higher breast-feeding rate （RR = 1.38, 95% CI 1.25-1.53, P 〈 0.05）, lower readmission rate （RR = 0.35, 95% CI 0.15-0.80, P 〈 0.05）, and higher satisfaction rate （RR = 1.09, 95% CI 1.02-1.16, P 〈 0.05）.Conclusions： Parentaiinvolvement in the NICU interventions could not increase the rate of nosocomial infection of neonates, but could improve their weight gain, breast-feeding and parental satisfaction and decrease their readmission. However, since the conclusion of this meta-analysis was drawn based on the limited number of high-quality RCTs, more hioh-quality studies should be conducted in the future to confirm its positive intervention effects.

Indoor Surveillance of Airborne Fungi Contaminating Intensive Care Units and Operation Rooms in Assiut University Hospitals, Egypt

Mycoflora of atmospheric air and dust samples collected from air conditioning systems in 12 of each I.C.U. （intensive care units） and O.R. （operation rooms） were tested using settle and dilution plate methods on four types of agar media and incubated at 25℃. Forty-five fungal species representing 23 genera were isolated and identified. The most prevalent genera recorded were Cladosporium, Aspergillus, Penicillium and Fusarium. The total colony forming units of airborne fungi recovered in I.C.U. and O.R. ranged between 31.13-49.61 colonies/m3 on the four types of media usedl The fungal total catch of the dust samples collected from the air conditioning system filters in I.C.U. and O.R. were ranged from 65.5-170 colonies/mg dust. Since, the interest to replace synthetic xenobiotics by natural compounds with low environmental persistence and biodegradable to control such airborne fungal contaminants is needed. In this respect, essential oils showed to possess a broad spectrum of antifungal activity. Fungal static ability of six oils was tested on 30 different fungal isolates. Vapors of common thyme oil exhibited the strongest inhibitory effects on the tested isolates, whereas the headspace vapors of blue gum and ginger had no inhibitory effects on the tested fungal isolates. These data revealed that the air conditioning systems may be an important source of contamination in I.C.U. and O.R. of Assiut university hospitals. Thus, patients may be in risk of being exposed to contaminated atmospheric air by opportunistic fungi and the use of essential oils as an alternative option to control hospital wards from fungal contaminants needs further studies.

Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Distribution and antibiotic resistance of pathogens isolated from ventilator-associated pneumonia patients in pediatric intensive care unit

BACKGROUND： With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia （VAP） has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children.METHODS： From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children＇s Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed. RESULTS：A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli （G-） were the most （65.55%）, followed by fungi （21.01%） and gram-positive cocci （G~, 13.45%）. Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G- and G＋to antibiotics were serious. Most of G- was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G＋ to vancomycin, teicoplanin and linezolid were 100%. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G-, and their multiple drug-resistances were serious. CONCLUSION： In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings

AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units(ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network(CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection(CLABSI) rate was 6.5 per 1000 central line(CL)-days, the ventilator-associated pneumonia(VAP) rate was 44.3 per 1000 mechanical ventilator(MV)-days, and the catheterassociated urinary tract infection(CAUTI) rate was 5.7 per 1000 urinary catheter(UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9(CLABSI) and 5.3(CAUTI)] and higher than NHSN rates [0.8(CLABSI) and 1.3(CAUTI)]- although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC(16.5) and NHSN's rates(1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates.

Incremental value of thoracic ultrasound in intensive care units:Indications,uses,and applications

Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations. B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago. Its application in the diagnosis of thoracic diseases has always been considered limited, due to the presence of air in the lung and the presence of the bones of the thoracic cage, which prevent the progression of the ultrasound beam. However, the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly "water-rich" or "air-rich". The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.

Predictive risk scales for development of pressure ulcers in pediatric patients admitted to general ward and intensive care unit

BACKGROUND More than ten special scales are available to predict the risk of pressure ulcers in children.However,the performances of those scales have not yet been compared in China.AIM To compare the Waterlow,Braden Q,and Glamorgan scales,and identify more suitable pressure ulcer evaluation scale for the pediatric intensive care unit(PICU).METHODS Trained nurses used the Waterlow,Braden Q,and Glamorgan scales to assess pediatric patients at Sun Yat-sen Memorial Hospital(China)within 24 h of admission from May 2017 to December 2020 in two stages.Skin examination was carried out to identify pressure ulcers every 3 d for 3 wk.RESULTS The incidence of pressure ulcers was 3/28(10.7%)in the PICU and 5/314(1.6%)in the general pediatric ward.For children in the general ward,the Waterlow,Braden Q,and Glamorgan scales had comparable area under the operating characteristic curve(AUC)of 0.870,0.924,and 0.923,respectively,and optimal cut-off values of 14,14,and 29 points.For PICU,the Waterlow,Braden Q,and Glamorgan scales had slightly lower AUC of 0.833,0.733,and 0.800,respectively,and optimal cut-off values of 13,16,and 27 points.Braden Q demonstrated a satisfactory specificity,and during the second stage of the study for PICU patients,the AUC of the Braden Q scale was 0.810,with an optimal cut-off value of 18.35 points.CONCLUSION The Waterlow,Braden Q,and Glamorgan scales have comparable performance while the Braden Q scale demonstrates a better specificity and can be successfully used by pediatric nurses to identify patients at high risk of pressure ulcers in PICU.

Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit

With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannfi （Ab） has become more and more serious with multidrug resistant Acinetobacter baumannfi （MDRAb） emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children. A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb （NMDRAb） pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children＇s Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression. In 176 clinical strains of Acinetobacter baumannfi isolated, there were 128 strains of MDRAb, accounting for 72.73%. Drug susceptibility tests showed that the resistance rates of 13-1actam antibiotics were more than 70% except for cefoperazone sulbactam. The rates to carbapenems were higher than 90%. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates （〈20%）. Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia. MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it.

Psychological needs of parents of children with complicated congenital heart disease after admitting to pediatric intensive care unit: A questionnaire study

BACKGROUND Parents of children with complicated congenital heart disease(CHD)have different needs after surgery.Little literature reports the impact factors for psychological needs of parents of children with complicated CHD.AIM To investigate the status quo of the needs of parents of children after surgery for complex CHD,and analyze the influencing factors,in order to provide a theoretical basis for formulating corresponding nursing countermeasures.METHODS A modified Chinese version of the Critical Care Family Needs Inventory(MCCFNI)was used to select 200 parents of children with complex CHD after surgery within 72 h after admission to the intensive care unit in our hospital to conduct an online questionnaire survey.The aim was to understand the needs of parents in relation to the following five aspects:The support from medical staff,comfort of the parents themselves,the acquisition of information,their closeness to the children,and assurance of the child’s condition.RESULTS Parents of children with complex CHD had a higher degree of demand,especially in terms of condition assurance,acquisition of information,and closeness to the children.The age,education level,and residence of the parents were related to the five dimensions of the needs of parents of children with complex CHD who had undergone surgery.CONCLUSION In practice,nurses should formulate corresponding nursing strategies based on the different cultural and social backgrounds of parents of children after complex CHD surgery to meet their different needs,and improve satisfaction.These findings provide a theoretical basis for constructing a family participatory nursing model for children in the intensive care unit in the future.

Physician staffing pattern in intensive care units:Have we cracked the code?

Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffingmay be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.