Clinical Pearls

Abstract

About 4 million cases of pediatric/neonatal sepsis occur globally each year, resulting in significant morbidity and mortality. The World Health Organization has prioritized innovative research in sepsis management. Monitoring the inadequate oxygen delivery (IDo2) index as a predictor of adverse events is an emerging area of interest that has primarily been used in pediatric cardiac surgery but not with children with sepsis.Roy and colleagues evaluated the relationship between IDo2 dose (mean IDo2 index during a specified time interval) and major adverse events (MAEs) in children admitted to the pediatric intensive care unit (PICU) with sepsis or septic shock. They found Children with MAEs had significantly higher IDo2 doses over multiple time intervals than did children without MAEs.Significant positive correlations between the IDo2 dose for 0 to 12 hours from admission and day 2 vasoactive-inotropic scores, organ dysfunction scores, PICU length of stay, and days of invasive ventilation.Although more studies are needed, findings suggest monitoring of the IDo2 dose can facilitate early recognition of children at highest risk of having MAEs and poor outcomes.See Article, pp 220-228Change-of-shift hand-off, also called shift report, is a complex social interaction considered a central part of patient safety by The Joint Commission. Structured formats improve information transfer in handoffs on medical-surgical units, but data on the perspectives of critical care nurses are limited.Rhudy and colleagues conducted focus groups with nurses from 4 types of adult intensive care units to understand their perceptions of the structure and organization of shift handoff. They identified 3 themes: Although further study is needed at other health care organizations, the findings validate a systematic approach to shift report that is flexible in accommodating specific populations of patients.See Article, pp 181-188Visitor restrictions during the COVID-19 pandemic dramatically changed end-of-life care, causing moral and psychological distress to both clinicians and families. Use of telecommunication technologies increased to support patient-family communication and care; however, little research has addressed providers’ experience with these technologies.Elma and colleagues interviewed clinicians on their experience using videoconferencing when caring for dying patients early in the pandemic. They found both benefits and limitations: Clinicians were positive about the value of virtual visits but felt the loss of physical family presence. Recommendations include improved access and advanced training for video-conferencing technology.See Article, pp 240-248Adult intensive care patients often require a surrogate decision maker when they cannot make decisions regarding their own care, yet clinician-family communication about treatment decisions in intensive care units can be limited. The US National Academy of Medicine has made improving clinicians’ serious illness communication skills a national priority. Although research shows training programs can improve these skills, there is currently no program that can be readily scaled to train thousands of clinicians.Gautier and colleagues developed and user tested a web- and videoconference-based training platform and found that This web-based program was developed with key stakeholder input and has the potential for scalability. The authors state that they will next evaluate the program for effects on improving nurse communication and family support skills.See Article, pp 189-201