Pediatric Critical Care Unit Research Articles

Renal Angina Index As A Predictor of Acute Kidney Injury Development in Critically Ill Children Admitted to Pediatric Critical Care Units: A Prospective Observational Study

Renal Angina Index As A Predictor of Acute Kidney Injury Development in Critically Ill Children Admitted to Pediatric Critical Care Units: A Prospective Observational Study

High-flow nasal cannula in Spanish Pediatric Intensive Care Services: A national web survey about its use and indications

ObjectiveTo describe the high-flow nasal cannula (HFNC) indications in the Spanish pediatric critical care units (PICUs). DesignDescriptive cross-sectional observational study. SettingElectronic survey among members of the Spanish Society of Pediatric Intensive Care (SECIP). It was sent weekly from April 10, 2023, to May 21, 2023. ParticipantsAll SECIP members. InterventionsNone. Main variables of interestThe questions focused on workplace, years of experience, use or non-use of HFNC, justification and expectations regarding its application, starting point within each center, clinical criteria for indication, existence of clinical guidelines, evaluation during its use, and criteria and mode of withdrawal. ResultsTwo hundred and two participants, 176 were from Spain. Of these, 87/176 had over ten years of experience. One hundred sixty two use HFNC and 66/162 have HFNC clinical guidelines. Acute bronchiolitis (138/162) and respiratory assistance after extubation (106/56) are the two main indications. For 62/162 HFNC may reduce therapeutic escalation. Neuromuscular diseases (105/162) and anatomical airway diseases (135/162) are the two main contraindications. The reasons to do not use HFNC were the absence of evidence about it effectiveness (8/14) and its inadequate cost/effectiveness balance (8/14). ConclusionsA majority of Spanish pediatric intensivists use HFNC. Its application and withdrawal appears to be primarily based on clinical experience. Besides, those who use HFNC are aware of its limitations and the lack of evidence in some cases. It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children.

AF among Nurses Working in Neonatal and Paediatric Intensive Care Units: A Cross-Sectional Study.

Aim: This research study aims to determine nurses' alarm fatigue (AF) levels in paediatric critical care units in two governmental hospitals and to examine the significant differences in the mean between nurses' attributes, nurses' working environment, and nurses' alarm management with the level of fatigue caused by the alarm. Background: In recent years, AF has become a significant and growing concern among nurses. However, in the Saudi Arabian paediatrics context, the impact of AF on nurses working in intensive care units remains unexplored. Method: A descriptive cross-sectional survey was conducted using a non-probability purposive sampling method. Data were collected from 216 nurses in two governmental hospitals through self-administered questionnaires comprised of four sections: individual attributes, work environment, alarm management, and AF scale. Data analysis: The Statistical Package of Social Science (SPSS) was used to analyse the data, and ANOVA was utilised to describe the sample's demographic characteristics and determine any differences. Results: Most participants were female, held a bachelor's degree, and were aged 31 to 35. Of the participants, 62.5% reported experiencing a medium level of AF, 29.2% reported a low level, and 8.3% reported a high level. Participants expressed that recurrent false alarms disrupt patient care and decrease trust in alarm systems. Significant differences in AF levels were observed based on marital status and the percentage of non-actionable alarms. Conclusions: Nurses working in paediatric critical units with high rates of false alarms, the frequent de-activation of alarms, and decreased trust in alarm systems are more likely to experience AF. Addressing AF is crucial for patient safety; nurse training on alarm management, the collaboration between biomedical and nursing staff, and technological advancements can help mitigate this issue. Implications for Practice: To minimise the adverse effects of AF, policymakers, biomedical experts, and nursing administrators must establish comprehensive policies and protocols concerning alarms. These measures aim to ensure secure and efficient care for the well-being of patients and nurses.

Single centre observational study evaluating the impact of introducing High Flow Nasal Cannula outside of Paediatric Critical Care Unit.

To evaluate the impact of High Flow Nasal Cannula (HFNC) introduction outside of Paediatric Critical Care Units (PCCU), on PCCU admissions and intubation rates. Secondarily, to identify escalation predictors. Retrospective observational study with matched PCCU admissions and intubation rates, 2-years before (Group 1) and 2-years after (Group 2) HFNC introduction outside of PCCU. Within Group 2, we compared those admitted to PCCU (escalation) and those who did not (non-escalation). Observations, change in observations and time to starting HFNC were analysed. Pre- and post-introduction comparison: Of 980 admissions in Group 1, 55 were admitted to PCCU, whereas of 1209 admission in Group 2, there were 85 admissions, P = 0.188. Group 1 had 25 intubations compared to 23 in Group 2, P = 0.309. Over twice as many children had some form of respiratory support in Group 2. Post-introduction: 104 children commenced HFNC, 72% for bronchiolitis. Median age was 4 months in the non-escalation group and 6.5 months in the escalation group, P = 0.663. Thirty-eight children escalated to PCCU: 33 required CPAP/BiPAP, 4 were intubated with 1 remaining on HFNC. Comparisons of age, gender, comorbidities, observations, change in observations and time to starting HFNC showed no significant escalation predictors. This study identified no statistically significant predictors of escalation. There was an observed increase in PCCU admissions with decreased intubations. The resource implications of this therapy are significant and further studies should examine cost effectiveness of HFNC use outside of PCCU.

Confirmation of correct placement of nasogastric / orogastric tube on Point of Care Ultrasound (POCUS) in pediatric critical care unit patients.

Objective: To determine frequency of correct placement of nasogastric /orogastric tube on POCUS in pediatric critical care unit patients. Study Design: Descriptive cross-sectional. Setting: High Dependency Unit and Pediatric Intensive Care Unit, Indus Hospital Health Network, Karachi, Pakistan. Period: November 2022 to April 2023. Methods: Patients of age 1 months to 15 years of age requiring NGT placement were enrolled into the study. Patients with nasal surgery, fracture of skull base/ face, bleeding, coagulopathy, esophageal varices, stricture, upper gastrointestinal surgery were excluded from this study. NG tube was passed by principal investigator after evaluating correct size and length measurement. After passing the NG tube, gastric aspiration and gastric auscultation were also performed by principal investigator. Results: In this study we enrolled 147children with median age of patient was 3 (IQR=0.75-07) years. Majority of patient in our study were male (63.9%). Gastric aspiration and gastric auscultation was seen in all of the study patients. Based on POCUS, frequency of correct placement of nasogastric tube in children admitted in PICU was 83%. Sensitivity of POCUS against gastric aspiration and gastric auscultation was 82.5% with 100% positive predictive value (PPV). Specificity was unable compute as there was no negative finding in reference standard and hence there was also no false positive case. Conclusion: POCUS seems to be helpful and could help with the placement of NGT in paediatric clinical settings. Nevertheless, NGT envision in the stomach was difficult, and if the operator is not skilled or there is abdominal distention, it may go unnoticed.

Customized Mobile App for Residents Rotating Through Pediatric Critical Care Unit.

Physicians often use mobile apps for patient care, but few apps are dedicated to pediatric critical care medicine (PCCM). This study developed a mobile app specifically for Pediatric Critical Care Unit (PICU) residents to aid their onboarding process and aimed to assess whether it could enhance their confidence and comfort levels. From March 2020 to April 2021, 90 residents participated and completed pre- and post-rotation quizzes with 20 questions each. Quiz score differences between the control and app groups were analyzed using t-tests. A survey was also administered at the end of the rotation to compare comfort level and confidence in PCCM knowledge pre- and post-rotation. Enrollment included 50 residents in the control group and 40 in the app group. The participation rate was 100%, but not all participants completed both quizzes and survey. The app group showed a significantly greater improvement in quiz scores from pre- to post-rotation compared to the control group (increase of 0.23 questions vs 1.67, p = 0.045). However, the two groups had no significant differences in confidence in PCCM knowledge (p = 0.246) or comfort levels (p = 0.776) in the PICU. This study found no significant difference in confidence levels between the App and control groups at the end of the PICU rotation. However, the App group outperformed the control group in knowledge assessments. Frequent use of the app likely reinforced essential concepts and facilitated adaptation to the PICU service. Overall, the app's positive impact on knowledge and adaptation indicates it is a valuable tool for enhancing medical residents' educational experiences in busy clinical environments.

Challenges to well-being in critical care.

Paediatric critical care (PCC) is a high-pressure working environment. Staff experience high levels of burnout, symptoms of post-traumatic stress, and moral distress. To understand challenges to workplace well-being in PCC to help inform the development of staff interventions to improve and maintain well-being. The Enhanced Critical Incident Technique (ECIT) was used. ECIT encompasses semi-structured interviews and thematic analysis. We identified 'critical incidents', challenges to well-being, categorized them in a meaningful way, and identified factors which helped and hindered in those moments. Fifty-three nurses and doctors from a large UK quaternary PCC unit were consented to take part. Themes generated are: Context of working in PCC, which examined staff's experiences of working in PCC generally and during COVID-19; Patient care and moral distress explored significant challenges to well-being faced by staff caring for increasingly complex and chronically ill patients; Teamwork and leadership demonstrated the importance of team-belonging and clear leadership; Changing workforce explored the impact of staffing shortages and the ageing workforce on well-being; and Satisfying basic human needs, which identified absences in basic requirements of food and rest. Staff's experiential accounts demonstrated a clear need for psychologically informed environments to enable the sharing of vulnerabilities, foster support, and maintain workplace well-being. Themes resonated with the self-determination theory and Maslow's hierarchy of needs, which outline requirements for fulfilment (self-actualization). Well-being interventions must be informed by psychological theory and evidence. Recommendations are flexible rostering, advanced communication training, psychologically-informed support, supervision/mentoring training, adequate accommodation and hot food. Investment is required to develop successful interventions to improve workplace well-being.

Predictors of mortality in critically ill children hospitalized with laboratory- confirmed COVID-19 pneumonia

BackgroundChildren with COVID-19 infection had fewer severe symptoms, which made it challenging to publish clinical data for this age group. This study aimed to determine the clinical features, laboratory markers, and predictors of mortality in children hospitalized in Pediatric Critical Care Units with COVID-19 pneumonia.MethodsThis retrospective research included all children between the age of ≥ 1 month and 18 years with laboratory-confirmed COVID-19 pneumonia through reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swabs who were admitted to Pediatric Critical Care Units between January 2022 and December 2022.ResultsThe study included 62 patients with confirmed COVID-19 infection. Out of the 62 patients, 43 (69.4%) survived and 19 (30.6%) succumbed. High-grade fever, cough, altered level of consciousness, convulsion, CO-RADS IV, elevated blood CRP, urea, D-dimer, ferritin, and sodium were linked to significantly higher mortality risk. (OR: 15.867, p = 0.001, OR: 1.543, p = 0.044, OR: 7.321, p = 0.026, OR: 15.00, p = 0.017, OR: 10.833, p = 0.001, OR: 1.015, p = 0.032, OR: 1.028, p = 0.040, OR: 3.315, p < 0.0001, OR: 1.004, p = 0.049, OR: 1.111, p = 0.006 respectively).ConclusionOur study revealed high in-hospital mortality among critically ill children with confirmed COVID-19 pneumonia. Identification of critically ill children with risk factors for death, such as high-grade fever, cough, altered consciousness, convulsion, CO-RADS IV and V, and raised inflammatory markers at the time of admission could minimize excess mortality during COVID-19 waves.

Influence of Nurses Workload Regarding Medication Errors Knowledge in Pediatric Critical Care Unit

Influence of Nurses Workload Regarding Medication Errors Knowledge in Pediatric Critical Care Unit

Effectiveness of competency-based training on Nurses’ performance regarding oxygen administration safety for children with respiratory disorders

BackgroundSupplemental oxygen therapy is one of the main therapies used to manage respiratory distress; it must be given in a way that is both safe and efficient. To provide standardized care, competency-based training should be designed to prioritize the practical skills and talents of the nurses over the provision of theoretical knowledge. The study aimed to evaluate the effectiveness of competency-based training on nurses’ performance regarding oxygen administration safety for infants with respiratory disorders. The settingThe study was conducted at the pediatric critical care units at Mansoura University Hospital. Design: The quasi-experimental study was used. The sample: A convenient sampling technique was used for recruiting pediatric critical care nurses and the infants who were admitted in the previous setting. Data collection: three tools were utilized in this study: the first was a structured interview questionnaire encompassing the socio-demographic characteristics of the studied nurses and infants. The second tool is nurses’ knowledge and an observation checklist to assess nurse practices regarding oxygen administration safety. The third tool, the nurse competence scale (NCS). Resultspediatric critical care nurses’ standardization (knowledge, practice, and knowledge application) through pre- and post-intervention. It showed a marked improvement in mean score and standard deviation in the post compared to pre, and the total mean was in the post (15.9 ± 3.8) compared to pre (33.5 ± 7.2) with a p-value < 0.001. ConclusionAfter the implementation of the competency based training program regarding oxygen administration safety.Recommendations.To increase standardization in nursing care practices and produce the best patient outcomes, competency-based training should be applied to all aspects of health care delivery.

Prevalence of extended-spectrum beta-lactamases producing isolates obtained from patients of pediatric critical care unit in a tertiary care hospital

Background: Over the past decades, antibiotic-resistant Gram-negative bacteria commonly Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae have increased significantly. These microorganisms have great clinical importance because they increase hospital stay of the patients in the intensive care unit (ICU) leading to high morbidity and mortality. Because of their role in increasing morbidity and mortality, this study was performed to isolate extended-spectrum beta-lactamase (ESBL) producing Gram-negative bacilli screened by phenotypical method and further projected into molecular characterization by polymerase chain reaction. Aims and Objectives: The aims and objectives are to isolate the Gram-negative multidrug-resistant strains from clinically suspected bacterial infections in patients of neonatal, sick newborn, and pediatric ICU and to study antibiotic sensitivity pattern of isolated Gram-negative multidrug-resistant strains with special reference to molecular characterization. Materials and Methods: A total of 100 Gram-negative bacilli were isolated. Screening of ESBL positivity was done by double-disk synergy test (combined disc test method). Their antibiogram profile was interpreted. With the use of designed primers, 26 ESBL isolates each of E. coli and Klebsiella spp. were processed for molecular analysis of beta-lactamase family genes TEM and CTX-M. Results: Within the 100 samples, majority of the isolates (45%) were Klebsiella spp. and 40% was E. coli isolates. Highest ESBL-producing organisms were observed within E. coli (65%). Prevalence bla-TEM gene was highest followed by bla-CTX-M. These ESBL-producing organisms were found to be resistant to multiple classes of antibiotics. With extensive ESBL surveillance and proper usage of antibiotics, this threatening rise of antibiotic resistance can be mitigated. Conclusion: Gram-negative isolates showed high resistance to commonly used antibiotics. Significant proportions of them were MDR strains. Such high antibiotic resistance is associated with significant morbidity and mortality among pediatric population. MDR along with possession of ESBL associated resistance genes among Gram-negative bacilli pose a serious problem in therapeutic management of patients. Our study signifies that there is a high probability of Gram- negative bacilli to be multi-drug resistant and ESBL positive and earliest detection of such cases should be made.

Spiritual Care in PICUs: A U.S. Survey of 245 Training Fellows 2020-2021.

To understand the perspectives of pediatric fellows training in critical care subspecialties about providing spiritual care. Cross-sectional survey of United States National Residency Matching Program pediatric fellows training in critical care specialties. Online survey open from April to May 2021. A total of 720 fellows (165 cardiology, 259 critical care, and 296 neonatology) were contacted, with a response rate of 245 of 720 (34%). None. We assessed fellows' survey responses about spiritual care in neonatal and pediatric critical care units. Categorical data were compared using chi-square test or Fisher exact tests. The Wilcoxon rank-sum test was used to compare the percentage correct on ten multiple-choice questions about world religions. Free-text responses were independently coded by two research investigators. A total of 203 of 245 (83%) responding fellows had never received training about spiritual care and 176 of 245 (72%) indicated that they would be likely to incorporate spiritual care into their practice if they received training. Prior training was associated with increased familiarity with a framework for taking a spiritual history ( p < 0.001) and increased knowledge of spiritual practices that could influence medical care ( p = 0.03). Prior training was also associated with increased self-reported frequency of taking a spiritual history ( p < 0.001) and comfort in referring families to spiritual care resources ( p = 0.02). Lack of time and training were the most reported barriers to providing spiritual care. Providing spiritual care for families is important in critical care settings. In 2020-2021, in the United States, 245 pediatric critical care fellows responded to a survey about spiritual care in their practice and reported that they lacked training in this subject. An opportunity exists to implement spiritual care curricula into pediatric fellowship training.

Effect of an educational program on pediatric nurses' knowledge, practice, and self-confidence about level of consciousness scales

BackgroundNurses of pediatric acute critical care units routinely assess the Level of Consciousness (LOC). The precise, exact, and restriction-free evaluation tool aids pediatric nurses in LOC assessment and clinical decision-making. This study aimed to examine the effect of an educational program on pediatric nurses' knowledge, practice, and self-confidence about level of consciousness scales. MethodsThis pretest-post, single-group, quasi-experimental, double-site study included 49 pediatric nurses. The Glasgow Coma Scale (GCS)/Pediatric Glasgow Coma Scale (PGCS) and Pediatric Full Outline of UnResponsiveness Score Scale (PFSS) knowledge questionnaire and pediatric nurse practice checklist were developed and adopted. Self-reflection confidence statements were rated 1–5 (not confident–confident). ResultsThe results of the study indicate that there were significant increases in knowledge, practice, and self-confidence after the intervention. The paired samples tests revealed that knowledge scores significantly increased from the pretest to the posttest for both GCS/PGCS (pretest mean:7.91, posttest mean:9.95) and PFSS (pretest mean:2.1, posttest mean:6.79). Practice scores also showed significant improvement for both GCS/PGCS (pretest mean: 4.12, post-test mean: 6.22) and PFSS (pretest mean: 2.46, post-test mean: 5.79). Furthermore, self-confidence significantly improved for GCS/PGCS (pretest mean:16.08, posttest mean:18.79) and PFSS (pretest mean:10.32, posttest mean:17.81). The statistical analyses supported the significance of these improvements (p < 0.001 for all except self-confidence in GCS/PGCS with p < 0.005). ConclusionThe educational program improved pediatric nurses' GCS/PGCS and PFSS knowledge, practice, and self-confidence. Implications to practiceEffective teaching of pediatric nurses is required to address gaps in care practices and improve the use of the Consciousness Level Assessment Scales.

Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study.

To comprehensively classify interventions performed by pediatric critical care clinical pharmacists and quantify cost avoidance (CA) generated through their accepted interventions. A multicenter, prospective, observational study performed between August 2018 and January 2019. Academic and community hospitals in the United States with pediatric critical care units. Pediatric clinical pharmacists. Pharmacist recommendations were classified into one of 38 total intervention categories associated with CA. Nineteen pediatric pharmacists at five centers documented 1,458 accepted interventions during 112 shifts on 861 critically ill pediatric patients. This calculated to an associated CA of $450,590. The accepted interventions and associated CA in the six established categories included as follows: adverse drug event prevention (155 interventions, $118,901 CA), resource utilization (267 interventions; $59,020), individualization of patient care (898 interventions, $217,949 CA), prophylaxis (8 interventions, $453 CA), hands-on care (30 interventions, $35,509 CA), and administrative/supportive tasks (108 interventions, $18,758 CA). The average associated CA was $309 per accepted intervention, $523 per patient day, and $4,023.13 per pediatric clinical pharmacist shift. The calculated potential annualized CA of accepted interventions from a pediatric pharmacist was $965,550, resulting in a potential monetary-associated CA-to-pharmacist salary ratio between $1.5:1 and $5.2:1. There is potential for significant avoidance of healthcare costs when pediatric pharmacists are involved in the care of critically and emergently ill pediatric patients, with a monetary potential CA-to-pediatric pharmacist salary ratio to be between $1.5:1 and $5.2:1.

Measuring growth in critically ill neonates and children.

Critical illness increases the risk of malnutrition in both infants and children. Malnutrition risk is multifactorial and includes premorbid factors as well as changes in nutrient metabolism and energy demands during critical illness. Inadequate nutrition has been linked to poor health outcomes and prolonged length of stay in the intensive care unit, demonstrating the importance of both recognizing and addressing malnutrition in this population. Assessing growth and identifying malnutrition requires methodical measurement of growth and a collaborative, multimodal approach to nutrition assessment. Among the nutrition assessment and growth evaluation tools, neonatal, preterm, pediatric, and disease-specific growth charts remain an important component of growth assessment and should be used along with a nutrition-focused physical examination. Routine measurement promotes the identification of potential growth delays that may require interventions. Indirect calorimetry adds an additional layer of detail for a complete picture of each infant or child's unique nutrition status and progress. Quality improvement research on a national level is urgently needed to assess the adequacy and availability of resources in neonatal and pediatric critical care units and to further the development of standard clinical outcome measures for nutrition assessment and intervention in the critically ill neonate and child.

The impact of central line bundles on the timing of catheter-associated bloodstream infections and their microbiological distribution in critically ill children.

Catheter-associated bloodstream infection, also known as CLABSI, is the most serious consequence of central venous access devices. These infections increase the risk of mortality and morbidity. The use of central line bundles in clinical settings is increasing worldwide with the purpose of lowering the risk of catheter-associated bloodstream infections. In this study, we investigated the effect of implementing a central line bundle for the prevention of CLABSIs, the distribution of pathogens, and the duration of time it took for CLABSIs to develop in patients who had subclavian-inserted central venous catheters. This research project was a cross-sectional study investigation carried out in a pediatric tertiary teaching hospital. Participants consisted of children who had been admitted to the pediatric critical care unit with subclavian catheters during a period of 13years. We compared the prebundle period with the bundle period for CLABSI specifically focusing on the time to infection, the number of polymicrobial infections, the proportion of Candida parapsilosis, and the percentage of Coagulase-negative staphylococci (CoNS). The "prebundle period" included the period from May 2007 to May 2013, and the "bundle period" included the period from June 2013 to June 2020. Throughout the course of the study, a total of 286 cases of CLABSI were documented. Among these patients, 141 (49.3%) had CLABSIs associated with subclavian catheters. During the prebundle period, 55 CLABSIs were diagnosed in 5235 central line days, with an overall rate of 10.5 CLABSIs per 1000 central line days; after the implementation of central line bundle, 86 CLABSIs were diagnosed in 12,450 CL days, with an overall rate of 3.6 CLABSIs per 1000 CL days. This showed a statistically significantly lower rate in the bundle period (p = 0.0126). In the prebundle period, the mean time to develop CLABSI was 15days, whereas during the bundle period, the mean time to develop CLABSI was 27.9days, a significantly longer time to onset (p = 0.001). While the percentage of other microorganisms was not statistically different between the prebundle and bundle periods (p > 0.05), the percentage of C. parapsilosis was significantly higher in the prebundle period (p = 0.001). Conclusion: The results of this study imply that the use of central line bundles not only reduces the incidence of CLABSI but also delays the time to which CLABSI patients acquire an infection. In addition, as a direct consequence of the CLB, the number of CLABSIs caused by gram-positive cocci did not increase, while the proportion of CLABSIs caused by C. parapsilosis decreased. What is Known: • The most significant negative consequence of central venous access devices is catheter-associated bloodstream infections. • "Care bundles" for CLABSI prevention have been reported to reduce the CLABSI rate. What is New: • Consider what would happen if the "Care bundle" failed to prevent CLABSI. • The findings of this study imply that using central line bundles not only reduces the risk of CLABSI but also extends the time it takes for patients to develop CLABSI. While the number of CLABSIs caused by gram-positive cocci did not increase as a direct result of CLB, the rate of CLABSIs caused by C. parapsilosis, which has recently become a major problem, has decreased.

The truth Hertz—synchronization of electroencephalogram signals with physiological waveforms recorded in an intensive care unit

Objective. The ability to synchronize continuous electroencephalogram (cEEG) signals with physiological waveforms such as electrocardiogram (ECG), invasive pressures, photoplethysmography and other signals can provide meaningful insights regarding coupling between brain activity and other physiological subsystems. Aligning these datasets is a particularly challenging problem because device clocks handle time differently and synchronization protocols may be undocumented or proprietary. Approach. We used an ensemble-based model to detect the timestamps of heartbeat artefacts from ECG waveforms recorded from inpatient bedside monitors and from cEEG signals acquired using a different device. Vectors of inter-beat intervals were matched between both datasets and robust linear regression was applied to measure the relative time offset between the two datasets as a function of time. Main Results. The timing error between the two unsynchronized datasets ranged between −84 s and +33 s (mean 0.77 s, median 4.31 s, IQR25-4.79 s, IQR75 11.38s). Application of our method improved the relative alignment to within ± 5ms for more than 61% of the dataset. The mean clock drift between the two datasets was 418.3 parts per million (ppm) (median 414.6 ppm, IQR25 411.0 ppm, IQR75 425.6 ppm). A signal quality index was generated that described the quality of alignment for each cEEG study as a function of time. Significance. We developed and tested a method to retrospectively time-align two clinical waveform datasets acquired from different devices using a common signal. The method was applied to 33,911h of signals collected in a paediatric critical care unit over six years, demonstrating that the method can be applied to long-term recordings collected under clinical conditions. The method can account for unknown clock drift rates and the presence of discontinuities caused by clock resynchronization events.

A Research Study on Prompt Results and Physical Assessment of Mechanically Ventilated Children

Objective: There is alarming information on the usage of MV in PICUs from Asian nations. The goals of this research were to identify the patients' clinical profiles, traits, frequent causes of breathing problems, complications connected to ventilation problems, and ultimate outcomes. For admittance to the pediatric critical care unit, the criterion for mechanical ventilation (MV) is rigorous (ICU). It may be difficult to manage children in impoverished nations with minimal resources that need invasive ventilation. Methods: The information gathered included epidemiological trends, ventilation indications, problems, duration of use of the ventilator, and results. From January 2022 to December 2022, a retrospective analysis of kids who needed ventilator support in the Liaqaut National Hospital, Karachi was conducted. Results: The most frequent indications for ventilation in this research were impending respiratory arrest (34.6%) and a low Glasgow coma rating (17.8%). Of the 1172 patients who were brought to the PICU, 101 (8.6%) needed mechanical ventilation. 75% of the patients on mechanical ventilation were male, and 42% were newborns. We discuss the epidemiological patterns, prevalence, causes, and results of pediatric intensive care unit ventilator support cases. Planning better treatment plans in the future may assist improve outcomes, which can be achieved by analysis of this data. The average MV lasted 2.1 days. These kids had a 38.6% death rate. Conclusions: In summary, there is little MV activity in our PICU. The most frequent justification for mechanical ventilation was respiratory failure. Keywords: Respiratory Failure, Mechanically Ventilated, Pediatrics Intensive Care Unit.

303 Burn Rehabilitation Training for the Pediatric Burn Critical Care RN

Abstract Introduction New registered nurses (RNs) in the burn pediatric intensive care unit (PICU) need extensive pediatric, critical care, and wound care training. Each of these specialties present a challenging learning curve to the new RN and can overshadow the RN’s focus on burn rehabilitation. Our goal was to improve the RN’s understanding of the importance of early rehabilitative care and their role in the provision of burn rehabilitation in the burn PICU setting. Methods We developed an interdisciplinary program which allowed the RN to work alongside burn physical and occupational therapists. The aim of the program was to teach the participants the importance of early and consistent splinting, positioning, mobilization, and other therapeutic interventions and to learn how to incorporate these techniques into their nursing plan of care. Over two years, nine RNs participated in a four-hour shadow program with a senior physical and occupational therapist. The therapists provided direct hands-on training with patients across the care continuum focusing on competencies aligned with the American Burn Association’s Burn Nurse Competencies. The RNs completed a self-assessment tool to score their self-perceived knowledge related to burn rehabilitation. The self-assessment included a 10-question Likert-scale survey, based on Benner’s Novice to Expert Model. Scoring aligned with the Benner Stages of Clinical Competence: 10 = Novice, 20 = Advanced Beginner, 30 = Competent, 40 = Proficient, and 50 = Expert. The survey was completed pre-intervention, immediately post-intervention, and 3-6 months post-intervention. Results Nine RNs completed the serial surveys. The median years of nursing experience was 2.5 (2-3.5) years. The training was provided at a median time of 4 (3.1-4.6) months after orientation completion. The median score for the pre-intervention assessment was 19 (16-25). The immediate post-intervention score significantly increased to a median of 30 (25-31) (p=0.006) and was maintained at 3-6 months post-intervention (32 (29-37) p=0.0002). There was no significant difference in assessment scores between the immediate post intervention and the 3-6 month post intervention assessment (p=0.25). All median values are median (interquartile range) and significance level was set at a p&amp;lt; 0.05. Conclusions New RNs in the burn pediatric critical care unit have a tremendous learning curve. Our training model demonstrates that there may be improved competency when learning is introduced in staged approaches. Additionally, burn rehabilitation in the PICU requires a transdisciplinary understanding of the patient’s needs. Our training program demonstrates that collaboration across professional disciplines to provide nursing education can improve the clinical competency of new RNs. Applicability of Research to Practice Identifying more efficient and effective methods of new RN training can improve the delivery of nursing care and improve patient outcomes.

Mitigating Moral Distress: Pediatric Critical Care Nurses' Recommendations.

In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) "I'm sorry, there's nothing else": increasing supports for patients and families; (2) "someone will commit suicide": improving supports for nurses: (3) "Everyone needs to be heard": improving patient care communication; and (4) "I didn't see it coming": providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions.