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, low...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.展开更多
BACKGROUND:With beta-lactam drugs and immunosuppressants widely used,the infection caused by Acinetobacter baumannii(Ab) has become more and more serious with multidrug resistant Acinetobacter baumannii(MDRAb) emergin...BACKGROUND:With beta-lactam drugs and immunosuppressants widely used,the infection caused by Acinetobacter baumannii(Ab) has become more and more serious with multidrug resistant Acinetobacter baumannii(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.METHODS: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.RESULTS:In 176 clinical strains of Acinetobacter baumannii isolated,there were 128 strains of MDRAb,accounting for 72.73%.Drug susceptibility tests showed that the resistance rates of β-lactam 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.CONCLUSIONS: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.展开更多
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 complica...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.展开更多
Objective:To explore the effects of psychological nursing in the pediatric intensive care unit.Methods:110 cases of intensive care of children from January 2014 to January 2015 were selected and randomly divided into ...Objective:To explore the effects of psychological nursing in the pediatric intensive care unit.Methods:110 cases of intensive care of children from January 2014 to January 2015 were selected and randomly divided into the observation group(n=55)and the control group(n=55).The children of the control group were given usual nursing care,the patients of the observation group were given psychological nursing.On two groups of patients before and after the intervention of the SAS scores and SDS scores、compliance、parents care quality satisfaction are compared.Results:Before intervention,the observation group of patients and the control group of patients with SAS scores and SDS scores difference no statistical significance(P>0.05),and after the intervention,the observation group patients'scores of SAS and SDS were significantly better than the control group,and the observation group below the control group(P<0.05).The observation group of compliance rate was 96.36%,and the control group of compliance rate was 69.09%,it below the observation(P<0.05).Parents care quality satisfaction of observation group was obviously better than that of control group with that difference is statistically significant(P<0.05).Conclusion:psychological nursing measures used in pediatric intensive care unit has certain feasibility and is worth popularizing clinically.展开更多
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 highes...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.展开更多
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, ne...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.展开更多
AIM:To quantify cumulative effective dose of intensive care unit(ICU)patients attributable to diagnostic imaging.METHODS:This was a prospective,interdisciplinary study conducted in the ICU of a large tertiary referral...AIM:To quantify cumulative effective dose of intensive care unit(ICU)patients attributable to diagnostic imaging.METHODS:This was a prospective,interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center.Demographic and clinical data including age,gender,date of ICU admission,primary reason for ICU admission,APACHE Ⅱ score,length of stay,number of days intubated,date of death or discharge,and re-admission data was collected on all patients admitted over a 1-year period.The overall radiation exposure was quantified by the cumulative effective radiation dose(CED)in millisieverts(mS v)and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board.Pediatric patients were selected for subgroupanalysis.RESULTS:A total of 2737 studies were performedin 421 patients.The total CED was 1704 m Sv with a median CED of 1.5 mS v(IQR 0.04-6.6 mS v).Total CED in pediatric patients was 74.6 mS v with a median CED of 0.07 mS v(IQR 0.01-4.7 mS v).Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED.Computed tomography(CT)accounted for 16% of all studies performed and contributed 97% of total CED.Trauma patients received a statistically significant higher dose [median CED 7.7 mS v(IQR 3.5-13.8 mS v)] than medical [median CED 1.4 m Sv(IQR 0.05-5.4 m Sv)] and surgical [median CED 1.6 mS v(IQR 0.04-7.5 mS v)] patients.Length of stay in ICU [OR = 1.12(95%CI:1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mS v.CONCLUSION:Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs.CED should be minimized where feasible,especially in young patients.展开更多
目的:探索儿科重症监护室(pediatric intensive care unit,PICU)不同进食方式的患儿误吸发生现状并比较不同特征情况。方法:采用便利抽样法,选取2022年3月-12月医院PICU收治的224例患儿为研究对象。分为鼻胃管喂养、幽门后喂养和经口进...目的:探索儿科重症监护室(pediatric intensive care unit,PICU)不同进食方式的患儿误吸发生现状并比较不同特征情况。方法:采用便利抽样法,选取2022年3月-12月医院PICU收治的224例患儿为研究对象。分为鼻胃管喂养、幽门后喂养和经口进食3种不同进食方式,观察3种不同进食方式的患儿误吸发生情况,并比较不同特征患儿的误吸发生情况。结果:鼻胃管喂养患儿误吸发生率为17.11%,幽门后喂养患儿误吸发生率为12.00%,经口进食患儿误吸发生率为9.18%。不同进食方式的患儿在意识障碍、机械通气、呕吐、胃潴留时误吸发生比较差异有统计学意义(P<0.05)。两两比较结果显示,鼻胃管喂养和幽门后喂养的患儿机械通气和意识障碍时误吸发生的比例比经口进食组高(P<0.001);鼻胃管喂养的患儿胃潴留时误吸发生的比例比经口进食组高(P<0.001);经口进食组患儿呕吐时误吸发生的比例高于幽门后喂养(P<0.05)。结论:PICU患儿鼻胃管喂养的误吸发生率处于较高水平,并且高于幽门后喂养和经口进食的方式。护理人员应该根据患儿不同进食方式和不同特征为预防其误吸提供及时和适当的早期干预措施。展开更多
目的研究儿科重症监护病房(pediatric intensive care unit,PICU)住院医师职业倦怠的现状,探索降低职业倦怠的方法。方法2019年1月—2021年12月,采用问卷调查法、统计学分析方法对上海某三甲医院PICU住院医师的职业倦怠进行分析。结果...目的研究儿科重症监护病房(pediatric intensive care unit,PICU)住院医师职业倦怠的现状,探索降低职业倦怠的方法。方法2019年1月—2021年12月,采用问卷调查法、统计学分析方法对上海某三甲医院PICU住院医师的职业倦怠进行分析。结果回收有效问卷71份。研究对象职业倦怠量表中“情绪衰竭”“玩世不恭”“个人成就感低”三个维度得分分别为(3.55±0.94)分、(2.45±1.10)分、(2.90±0.65)分,有77.5%的医师存在中度职业倦怠,21.1%的医师存在重度职业倦怠。职业倦怠的两个分量表(情绪衰竭、玩世不恭)与内在工作满意度、外在工作满意度、总体工作满意度差异有统计学意义(P<0.05)。学历、年龄、工作时间、收入与PICU住院医生职业倦怠得分的差异有统计学意义(P<0.05)。其中研究生学历者、每周工作时间≥50小时者“情绪衰竭”得分更高,年龄≥30岁者、年收入<10万元者“个人成就感低”得分更高。结论PICU住院医师职业倦怠水平高,职业倦怠与工作满意度呈负相关,学历、年龄、工作时间、收入可影响职业倦怠水平,应采取措施降低职业倦怠,稳定医疗队伍。展开更多
Critically ill children often require mechanical ventilation on the pediatric intensive care unit (PICU) for indications such as severe pneumonia, atelectasis, airway abnormalities, and the presence of a foreign bod...Critically ill children often require mechanical ventilation on the pediatric intensive care unit (PICU) for indications such as severe pneumonia, atelectasis, airway abnormalities, and the presence of a foreign body in the airway. The correct management of the airway is a crucial determinant of a successful outcome. We performed fiber-optic bronchoscopy (FOB) 70 times for 51 mechanically ventilated children between June 2009 and December 2011, and present our results below.展开更多
文摘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.
文摘BACKGROUND:With beta-lactam drugs and immunosuppressants widely used,the infection caused by Acinetobacter baumannii(Ab) has become more and more serious with multidrug resistant Acinetobacter baumannii(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.METHODS: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.RESULTS:In 176 clinical strains of Acinetobacter baumannii isolated,there were 128 strains of MDRAb,accounting for 72.73%.Drug susceptibility tests showed that the resistance rates of β-lactam 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.CONCLUSIONS: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.
文摘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.
文摘Objective:To explore the effects of psychological nursing in the pediatric intensive care unit.Methods:110 cases of intensive care of children from January 2014 to January 2015 were selected and randomly divided into the observation group(n=55)and the control group(n=55).The children of the control group were given usual nursing care,the patients of the observation group were given psychological nursing.On two groups of patients before and after the intervention of the SAS scores and SDS scores、compliance、parents care quality satisfaction are compared.Results:Before intervention,the observation group of patients and the control group of patients with SAS scores and SDS scores difference no statistical significance(P>0.05),and after the intervention,the observation group patients'scores of SAS and SDS were significantly better than the control group,and the observation group below the control group(P<0.05).The observation group of compliance rate was 96.36%,and the control group of compliance rate was 69.09%,it below the observation(P<0.05).Parents care quality satisfaction of observation group was obviously better than that of control group with that difference is statistically significant(P<0.05).Conclusion:psychological nursing measures used in pediatric intensive care unit has certain feasibility and is worth popularizing clinically.
文摘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.
文摘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.
文摘AIM:To quantify cumulative effective dose of intensive care unit(ICU)patients attributable to diagnostic imaging.METHODS:This was a prospective,interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center.Demographic and clinical data including age,gender,date of ICU admission,primary reason for ICU admission,APACHE Ⅱ score,length of stay,number of days intubated,date of death or discharge,and re-admission data was collected on all patients admitted over a 1-year period.The overall radiation exposure was quantified by the cumulative effective radiation dose(CED)in millisieverts(mS v)and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board.Pediatric patients were selected for subgroupanalysis.RESULTS:A total of 2737 studies were performedin 421 patients.The total CED was 1704 m Sv with a median CED of 1.5 mS v(IQR 0.04-6.6 mS v).Total CED in pediatric patients was 74.6 mS v with a median CED of 0.07 mS v(IQR 0.01-4.7 mS v).Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED.Computed tomography(CT)accounted for 16% of all studies performed and contributed 97% of total CED.Trauma patients received a statistically significant higher dose [median CED 7.7 mS v(IQR 3.5-13.8 mS v)] than medical [median CED 1.4 m Sv(IQR 0.05-5.4 m Sv)] and surgical [median CED 1.6 mS v(IQR 0.04-7.5 mS v)] patients.Length of stay in ICU [OR = 1.12(95%CI:1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mS v.CONCLUSION:Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs.CED should be minimized where feasible,especially in young patients.
文摘目的:探索儿科重症监护室(pediatric intensive care unit,PICU)不同进食方式的患儿误吸发生现状并比较不同特征情况。方法:采用便利抽样法,选取2022年3月-12月医院PICU收治的224例患儿为研究对象。分为鼻胃管喂养、幽门后喂养和经口进食3种不同进食方式,观察3种不同进食方式的患儿误吸发生情况,并比较不同特征患儿的误吸发生情况。结果:鼻胃管喂养患儿误吸发生率为17.11%,幽门后喂养患儿误吸发生率为12.00%,经口进食患儿误吸发生率为9.18%。不同进食方式的患儿在意识障碍、机械通气、呕吐、胃潴留时误吸发生比较差异有统计学意义(P<0.05)。两两比较结果显示,鼻胃管喂养和幽门后喂养的患儿机械通气和意识障碍时误吸发生的比例比经口进食组高(P<0.001);鼻胃管喂养的患儿胃潴留时误吸发生的比例比经口进食组高(P<0.001);经口进食组患儿呕吐时误吸发生的比例高于幽门后喂养(P<0.05)。结论:PICU患儿鼻胃管喂养的误吸发生率处于较高水平,并且高于幽门后喂养和经口进食的方式。护理人员应该根据患儿不同进食方式和不同特征为预防其误吸提供及时和适当的早期干预措施。
文摘目的研究儿科重症监护病房(pediatric intensive care unit,PICU)住院医师职业倦怠的现状,探索降低职业倦怠的方法。方法2019年1月—2021年12月,采用问卷调查法、统计学分析方法对上海某三甲医院PICU住院医师的职业倦怠进行分析。结果回收有效问卷71份。研究对象职业倦怠量表中“情绪衰竭”“玩世不恭”“个人成就感低”三个维度得分分别为(3.55±0.94)分、(2.45±1.10)分、(2.90±0.65)分,有77.5%的医师存在中度职业倦怠,21.1%的医师存在重度职业倦怠。职业倦怠的两个分量表(情绪衰竭、玩世不恭)与内在工作满意度、外在工作满意度、总体工作满意度差异有统计学意义(P<0.05)。学历、年龄、工作时间、收入与PICU住院医生职业倦怠得分的差异有统计学意义(P<0.05)。其中研究生学历者、每周工作时间≥50小时者“情绪衰竭”得分更高,年龄≥30岁者、年收入<10万元者“个人成就感低”得分更高。结论PICU住院医师职业倦怠水平高,职业倦怠与工作满意度呈负相关,学历、年龄、工作时间、收入可影响职业倦怠水平,应采取措施降低职业倦怠,稳定医疗队伍。
文摘Critically ill children often require mechanical ventilation on the pediatric intensive care unit (PICU) for indications such as severe pneumonia, atelectasis, airway abnormalities, and the presence of a foreign body in the airway. The correct management of the airway is a crucial determinant of a successful outcome. We performed fiber-optic bronchoscopy (FOB) 70 times for 51 mechanically ventilated children between June 2009 and December 2011, and present our results below.