Children In Intensive Care Unit Research Articles

Infectious disease screening and isolation for pediatric patients in an emergency department

Communicable infectious childhood diseases present special management challenges to the ED nurse. Chickenpox, measles, mumps, respiratory syncytial virus (RSV), and meningitis are all highly contagious diseases that occur frequently in the pediatric population, and a large number of people can be exposed in a brief period of time in a busy emergency department. In the triage process, patients are prioritized according to illness acuity with nonemergent patients allocated to a general waiting area. Close proximity with other ill and possibly immunocompromised patients can increase the likelihood of spreading communicable diseases. The process of diagnosing the child's condition frequently necessitates travel to other departments, thereby further exposing the general hospital population. Recognizing the problem In the fall of 1993, as the emergency department and the pediatric intensive care unit for Children's Hospital of Omaha, Nebraska, anticipated a seasonal influx of patients with RSV, we began reviewing quality assurance data regarding interdepartmenta l transfers of patients with known RSV. The goal was to reduce exposure from these contagious patients. The infectious disease department added new information regarding the time and financial expense of tracking exposures. It became evident that a more sensitive screening process was needed to identify potentially contagious patients. Two multidisciplinary meetings were held to identify the scope of the problem, to identify institutional and systems barriers to the implementation of a new policy and procedure, and to devise a plan of action to minimize the spread of infectious disease. We identified the lack of knowledge regarding disease-specific incubation periods and transmission routes as the first barrier. Information from the

Near drowning

a) To report the neurologic outcome of a series of near-drowning victims treated with supportive management without aggressive cerebral resuscitation; and b) to identify patient characteristics that indicate prognosis and guide therapy at the scene, the Emergency Department, and in the intensive care unit (ICU). Retrospective review of all near-drowning patients requiring admission to the ICU over a 6-yr period (1/1/82 to 12/31/88). Hospital records were examined for the circumstances of submersion and rescue, patient condition on arrival in the Emergency Department and ICU, treatments, hospital course, and ultimate outcome. Emergency departments of the referring hospital and ICU of Children's Hospital. Forty-four pediatric submersion victims were treated with therapy limited to the support of vital functions. Three patients who met cold-water drowning criteria were excluded from the analysis for predictors of neurologic outcome. None. In our warm-water near-drowning patients, 56% survived neurologically intact, 32% survived in a persistent vegetative state, and the remaining 32% died. Unreactive pupils in the Emergency Department and a Glasgow Coma Score of < or = 5 on arrival to the ICU were the best independent predictors of poor neurologic outcome (odds ratio and 95% confidence intervals 374 [17 to 16,000] and 51 [5 to 2,200], respectively). However, no predictor was absolute and two nonhypothermic patients who arrived to the Emergency Department without vital signs, requiring cardiopulmonary resuscitation and cardiotonic medications, had full neurologic recovery. Our results cast further doubt on the utility of aggressive forms of cerebral monitoring and resuscitation and emphasize the need for initial full resuscitation in the Emergency Department.

Failure of intravenous infusions in neonates

The median life expectancy (survival) of 286 peripheral intravenous infusion sites in 105 babies in a children's intensive care unit was 36 h. Unadjusted univariate survival analysis revealed that dextrose infusions and the initial infusions received by a baby had longer survival than total parenteral nutrition (TPN) infusions and later infusions respectively. Also infusions with cloxacillin and penicillin survived for longer than average while infusions with phenytoin had reduced survival. Gestational age, weight, infusion site, other drugs, co-infusion of Intralipid with TPN solutions and neutralization of TPN did not influence survival of infusions. Multivariate survival analysis confirmed the findings for TPN and penicillin but not for cloxacillin, phenytoin or later infusions. Multivariate analysis also suggested that survival was improved with ampicillin and aminophylline and worse for leg sites, for older babies and for infusions in which the fluids were given at greater rates. It also indicated that neutralization of TPN improved survival.

Preparation of parents for the ICU experience: what are we missing?

This study examined the stress experienced by parents of children hospitalized in an intensive care unit (ICU) and explored the degree to which parents are prepared for specific aspects of the ICU environment. Twenty-two mothers and 6 fathers of 22 children hospitalized in a pediatric ICU were interviewed using the Parental Stressor Scale: Pediatric Intensive Care Unit, the Parent Preparation questionnaire designed for this study, and a personal-situational questionnaire. A majority of parents (82%) responded that they had been prepared in some manner and considered the preparation adequate. The dimensions of the ICU that were perceived by parents as most stressful were the child's behavior and the child's emotional response, and parental role alterations. The dimensions of the ICU environment that parents were least likely to have been prepared for or receive help with were these same dimensions. When parents were prepared for or helped with aspects of the ICU, they perceived the adequacy of that help as high. The results of this study suggested that an important focus in parental education and support should be on the parent-child relationship, the most stressful aspect of a child's ICU admission for parents.

Nosocomial bacteremia in patients in a pediatric intensive care unit is related to the duration of central venous catheter placement

The purpose of this study was to identify predisposing factors for and rates of bactcremia associated with central venous catheter (CVC) placement in patients receiving care in a pediatric intensive care unit (PICIJ). This study pmspectively monitored 448 central venous catheters placed in 436 PICU patients over a 12month period. During the study period, 1070 patients were admitted to the PICU which serves as both a surgical and a medical intensive care unit for children. There were 15 nosocomiai bacteremias (1.4% of admissions) and 13 (87%) were associated with CVC. The incidence of CVC-related bacteremias was 13/448 catheters (2.9%). or 5.4 infections per loo0 catheter days. The only factor that was significantly associated with CVC-related bactenemia was duration of CVC placement. Catheters that became infected had been in place longer (mean?SD=9.31-3.8 days) than those that did not become infected (5.3t3.8 days, P=O.o004, t-test). The relative risk for nosocomial bacteremia in patients with a CVC left in place for seven or more days was 7.5 times that for lines left in place for less than seven days. Infected patients also tended to be younger than uninfected patients (age= 1.1 + 1.0 vs. 3.3 +4.2 years) but this difference was not signiiicant (P=O.lO, MannWhitney). Other factors investigated and found not to be related to bactetemia in this study were placement of the CVC in the operating room vs. PICU. type of line. type of dressing applied to CVC site, frcquency of dressing changes, and she of line placement. We conclude that the duration of CVC placement contributes significantly to the risk of nosocomial bactercmia in PICU patients.

Increased funds ease cash problems at liverpool ICU units.

Increased funding has eased the financial problems of two intensive care units for children in Liverpool.

Outbreak of gentamicin-methicillin-resistant Staphylococcus aureus infection in an intensive care unit for children

Hospital infections due to methicillin-resistant Staphylococcus aureus, are increasing (Stamm, 1981), and especially affect patients in intensive care units. In 1968, the first outbreak of methicillin-resistant Staph. aureus infections in the USA was reported (Barrett, McGehee & Finland, 1968). In 1976, the first epidemic of infections due to gentamicin-resistant Staph. aureus was reported, affecting adult patients in a London hospital (Shanson, Kensit & Duke, 1976). We report an outbreak of infections in an intensive care unit for children (ICUC) caused by a gentamicin-methicillin-resistant Staph. aureus. (GMRSA)

Humanizing the intensive care unit for children.

Humanizing the intensive care unit for children.

Parent care in the intensive care unit.

Because of their responsibility for life-support systems, the staff of pediatric intensive care units (ICUs) are increasingly confronted by the kinds of experiences described by Waller and his associates (p 1121 in this issue) in which the concerns of the family, the physician, and the nurse converge in relation to the impending death of a child. The highly sophisticated biomedical care of sick infants and children in ICUs often contrasts starkly with the undeveloped care of their parents. Parent care in many centers seems a sporadic improvisation by the most inexperienced staff. It is almost axiomatic that the higher the intensity of technical care, the less evident the personal concern with families. Indeed, intensive care facilities seem to dictate more of a task than a person orientation. Waller and his colleagues are, therefore, rightly concerned. The questions they raise, and those of others, will, I believe, lead to a new

ACUTE EMERGENCIES IN THE NEWBORN

Medical Journal of AustraliaVolume 1, Issue 24 p. 900-900 Follow–Up ACUTE EMERGENCIES IN THE NEWBORN R. A. Cockington, R. A. Cockington Paediatrician Children's Intensive Care Unit, The Prince of Wales Children's Hospital, Randwick, N.S.W., 2031Search for more papers by this authorJ. B. Vonwiller, J. B. Vonwiller Director Children's Intensive Care Unit, The Prince of Wales Children's Hospital, Randwick, N.S.W., 2031Search for more papers by this author R. A. Cockington, R. A. Cockington Paediatrician Children's Intensive Care Unit, The Prince of Wales Children's Hospital, Randwick, N.S.W., 2031Search for more papers by this authorJ. B. Vonwiller, J. B. Vonwiller Director Children's Intensive Care Unit, The Prince of Wales Children's Hospital, Randwick, N.S.W., 2031Search for more papers by this author First published: 01 June 1977 https://doi.org/10.5694/j.1326-5377.1977.tb131225.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue24June 1977Pages 900-900 RelatedInformation

INTENSIVE CARE UNITS FOR CHILDREN

Medical Journal of AustraliaVolume 2, Issue 14 p. 542-542 Correspondence INTENSIVE CARE UNITS FOR CHILDREN First published: 01 October 1974 https://doi.org/10.5694/j.1326-5377.1974.tb70981.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue14October 1974Pages 542-542 RelatedInformation

INTENSIVE CARE UNITS FOR CHILDREN

Medical Journal of AustraliaVolume 2, Issue 9 p. 341-341 Obituary INTENSIVE CARE UNITS FOR CHILDREN First published: 01 August 1974 https://doi.org/10.5694/j.1326-5377.1974.tb70823.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue9August 1974Pages 341-341 RelatedInformation

Children in intensive care units.

Children in intensive care units.