Pediatric Intensive Care Setting Research Articles

Feasibility of non-invasive neuro-monitoring during extracorporeal membrane oxygenation in children.

Detection of neurological complications during extracorporeal membrane oxygenation (ECMO) may be enhanced with non-invasive neuro-monitoring. We investigated the feasibility of non-invasive neuro-monitoring in a paediatric intensive care (PIC) setting. In a single centre, prospective cohort study we assessed feasibility of recruitment, and neuro-monitoring via somatosensory evoked potentials (SSEP), electroencephalography (EEG) and near infrared spectroscopy (NIRS) during venoarterial (VA) ECMO in paediatric patients (0-15years). Measures were obtained within 24h of cannulation, during an intermediate period, and finally at decannulation or echo stress testing. SSEP/EEG/NIRS measures were correlated with neuro-radiology findings, and clinical outcome assessed via the Pediatric cerebral performance category (PCPC) scale 30days post ECMO cannulation. We recruited 14/20 (70%) eligible patients (median age: 9months; IQR:4-54, 57% male) over an 18-month period, resulting in a total of 42 possible SSEP/EEG/NIRS measurements. Of these, 32/42 (76%) were completed. Missed recordings were due to lack of access/consent within 24h of cannulation (5/42, 12%) or PIC death/discharge (5/42, 12%). In each patient, the majority of SSEP (8/14, 57%), EEG (8/14, 57%) and NIRS (11/14, 79%) test results were within normal limits. All patients with abnormal neuroradiology (4/10, 40%), and 6/7 (86%) with poor outcome (PCPC ≥4) developed indirect SSEP, EEG or NIRS measures of neurological complications prior to decannulation. No study-related adverse events or neuro-monitoring data interpreting issues were experienced. Non-invasive neuro-monitoring (SSEP/EEG/NIRS) during ECMO is feasible and may provide early indication of neurological complications in this high-risk population.

Screening for pediatric abusive head trauma: Are three variables enough?

BackgroundThe PediBIRN 4-variable clinical decision rule (CDR) detects abusive head trauma (AHT) with 96% sensitivity in pediatric intensive care (PICU) settings. Preliminary analysis of its performance in Pediatric Emergency Department settings found that elimination of its fourth predictor variable enhanced screening accuracy. ObjectiveTo compare the AHT screening performances of the “PediBIRN-4” CDR vs. the simplified 3-variable CDR in PICU settings. Participants and settings973 acutely head-injured children <3 years hospitalized for intensive care across 18 sites between February 2011 and March 2021. MethodsRetrospective, secondary analysis of the combined, prospective PediBIRN data sets. AHT definitional criteria and physicians' diagnoses were applied iteratively to sort patients into abusive vs. other head trauma cohorts. Outcome measures of CDR performance included sensitivity, specificity, predictive values, likelihood ratios, ROC AUC, and the correlation between each CDR's patient-specific estimates of AHT probability and the overall positive yield of patients' completed abuse evaluations. ResultsApplied accurately and consistently, both CDR's would have performed with sensitivity ≥93% and negative predictive value ≥91%. Eliminating the PediBIRN-4's fourth predictor variable resulted in significantly higher specificity (↑′d ≥19%), positive predictive value (↑′d ≥8%), and ROC AUC (↑′d ≥5%), but a 3% reduction in sensitivity. Both CDRs provided patient-specific estimates of abuse probability very strongly correlated with the positive yield of patients' completed abuse evaluations (Pearson's r = 0.95 and 0.91, p = .13). ConclusionThe PediBIRN 3-variable CDR performed with greater AHT screening accuracy than the 4-variable CDR. Both are good predictors of the results of patients' subsequent completed abuse evaluations.

Red blood cell transfusion in critically-ill children and its association with outcome.

To determine the indications and threshold of haemoglobin levels for packed red blood cell transfusion and its association with outcomes in a paediatric intensive care setting. The retrospective study was conducted in the paediatric intensive care unit of the Aga Khan University Hospital, Karachi, and comprised medical records of all inpatients with age between 1 month and 16 years who received packed red blood cell transfusions between January and December 2017. Data was retrieved from the hospital database and was analyzed using SPSS 22. Of the 147 subjects with a mean age of 67.89±65.8 months, 76(51.7%) were males. Mean paediatric risk of mortality score was 11.72±7.86. Major admitting diagnosis included sepsis and multiorgan dysfunction 50(34%), respiratory diseases 26(17.7%) and haematology/oncology diseases 22(15%). The indications for transfusion was low haemoglobin in 90(61.2%) patients, shock 29(19.7%) and hypoxia 28(19%). Acute transfusion reaction was observed in 1(0.7%) patient; 120(82%) required mechanical ventilation; and 94(64%) required inotropic support. Of the total, 88(59.9%) patients survived. Paediatric risk of mortality score, need for inotropic support and mechanical ventilation were associated with mortality (p<0.05). Packed red blood cell transfusion, which is frequently prescribed in intensive care settings, was not found to be associated with favourable outcome.

Prediction of central venous catheter-associated deep venous thrombosis in pediatric critical care settings

BackgroundAn increase in the incidence of central venous catheter (CVC)-associated deep venous thrombosis (CADVT) has been reported in pediatric patients over the past decade. At the same time, current screening guidelines for venous thromboembolism risk have low sensitivity for CADVT in hospitalized children. This study utilized a multimodal deep learning model to predict CADVT before it occurs.MethodsChildren who were admitted to intensive care units (ICUs) between December 2015 and December 2018 and with CVC placement at least 3 days were included. The variables analyzed included demographic characteristics, clinical conditions, laboratory test results, vital signs and medications. A multimodal deep learning (MMDL) model that can handle temporal data using long short-term memory (LSTM) and gated recurrent units (GRUs) was proposed for this prediction task. Four benchmark machine learning models, logistic regression (LR), random forest (RF), gradient boosting decision tree (GBDT) and a published cutting edge MMDL, were used to compare and evaluate the models with a fivefold cross-validation approach. Accuracy, recall, area under the ROC curve (AUC), and average precision (AP) were used to evaluate the discrimination of each model at three time points (24 h, 48 h and 72 h) before CADVT occurred. Brier score and Spiegelhalter’s z test were used measure the calibration of these prediction models.ResultsA total of 1830 patients were included in this study, and approximately 15% developed CADVT. In the CADVT prediction task, the model proposed in this paper significantly outperforms both traditional machine learning models and existing multimodal deep learning models at all 3 time points. It achieved 77% accuracy and 90% recall at 24 h before CADVT was discovered. It can be used to accurately predict the occurrence of CADVT 72 h in advance with an accuracy of greater than 75%, a recall of more than 87%, and an AUC value of 0.82.ConclusionIn this study, a machine learning method was successfully established to predict CADVT in advance. These findings demonstrate that artificial intelligence (AI) could provide measures for thromboprophylaxis in a pediatric intensive care setting.

The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey.

Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n=303/497) of the physicians and 45.2% (n=99/219) of the non-physician healthcare staff (P<.001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P<.01, P<.001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P<.001, P<.001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P=.047, P=.003). The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.

Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021.

Patients with haematological malignancies, haemopoietic stem cell transplant recipients and patients requiring admission to intensive care settings are at high risk for invasive candidiasis (IC). Over the past decade, there has been increased reporting of non-albicans species and fluconazole resistance in Australia. These guidelines provide updated evidence-based recommendations for the diagnosis and management of IC in adult and paediatric haematology, oncology and intensive care settings. Optimal pharmacological and non-pharmacological management are discussed. Recent studies strengthen the recommendation for an echinocandin agent as first-line therapy for high-risk patients with IC. Mortality benefit has also been demonstrated for non-pharmacological management, including removal of central venous catheters, infectious diseases consultation and use of care bundles. Healthcare facilities managing immunocompromised patient populations should therefore adopt implementation strategies for these multimodal interventions.

HYPONATREMIA AS A PROGNOSTIC INDICATOR IN LOWER RESPIRATORY TRACT INFECTIONS IN CHILDREN ADMITTED IN PAEDIATRIC INTENSIVE CARE UNIT

Objective: To study the serum sodium levels in patients of lower respiratory tract infections admitted in the paediatric intensive care unit with their prognosis.&#x0D; Study Design: Prospective observational study.&#x0D; Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan to Jun 2018.&#x0D; Methodology: Eighty patients suffering from lower respiratory tract infections who were admitted to the paediatric intensive care unit were selected at consecutive sampling. The outcome was recorded in the form of discharge or mortality. Serum sodium was done at the time of admission and then periodically after every 24-48 hours. The Association of patients’ serum sodium with their prognosis was studied using chi-square test and p-value was calculated.&#x0D; Results: A total of 80 patients were enrolled in our study out of which 50 (62.50%) were males and 30 (37.50%) were females. Out of the total, 48 patients suffered from hyponatremia. These 48 patients had a mean serum sodium concentration of 131.24 ± 3.31 mEq/L. The mean age of patients suffering from hyponatremia was 5.78 ± 3.4 years. Mortality occurred in 5 (80.12%) of patients suffering from severe hyponatremia.&#x0D; Conclusion: There was a significant association of hyponatremia with mortality in children admitted in paediatric intensive care settings with lower respiratory tract infections. Therefore, proper management hence correction of serum sodium levels can improve survival in, particularly children admitted in a pediatric intensive care setting.

Design and reporting characteristics of clinical trials investigating sedation practices in the paediatric intensive care unit: a scoping review by SCEPTER (Sedation Consortium on Endpoints and Procedures for Treatment, Education and Research)

ObjectivesTo conduct a scoping review of sedation clinical trials in the paediatric intensive care setting and summarise key methodological elements.DesignScoping review.Data sourcesPubMed, Embase, Cumulative Index to Nursing and Allied Health...

Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID-19.

ObjectiveAlthough the initial reports of COVID‐19 cases in children described that children were largely protected from severe manifestations, clusters of paediatric cases of severe systemic hyperinflammation and shock related to severe acute respiratory syndrome coronavirus 2 infection began to be reported in the latter half of April 2020. A novel syndrome called “multisystem inflammatory syndrome in children” (MIS‐C) shares common clinical features with other well‐defined syndromes, including Kawasaki disease, toxic shock syndrome and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Our objective was to develop a protocol for the evaluation, treatment and follow‐up of patients with MIS‐C.MethodsThe protocol was developed by a multidisciplinary team. We convened a multidisciplinary working group with representation from the departments of paediatric critical care, cardiology, rheumatology, surgery, gastroenterology, haematology, immunology, infectious disease and neurology. Our protocol and recommendations were based on the literature and our experiences with multisystem inflammatory syndrome in children. After an agreement was reached and the protocol was implemented, revisions were made on the basis of expert feedback.ConclusionChildren may experience acute cardiac decompensation or other organ system failure due to this severe inflammatory condition. Therefore, patients with severe symptoms of MIS‐C should be managed in a paediatric intensive care setting, as rapid clinical deterioration may occur. Therapeutic approaches for MIS‐C should be tailored depending on the patients’ phenotypes. Plasmapheresis may be useful as a standard treatment to control hypercytokinemia in cases of MIS‐C with severe symptoms. Long‐term follow‐up of patients with cardiac involvement is required to identify any sequelae of MIS‐C.

Cluster Randomized Trials in Pediatric Research

In an article published in this volume of The Journal, Hymel et al described the findings of the effectiveness of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR), aimed at improving abuse evaluations and reducing rates of missed abusive head trauma in pediatric intensive care settings.1 The CDR was assessed via a randomized trial, but a specific type of trial, referred to as a cluster randomized trial (CRT). Also known as group randomized trials, there is no shortage of articles that explain CRTs.

Chronic Illness in Pediatric Critical Care.

Children and Youth with Special Healthcare Needs (CYSHCN), children with medical complexity (CMC), and children with chronic, critical illness (CCI) represent pediatric populations with varying degrees of medical dependance and vulnerability. These populations are heterogeneous in underlying conditions, congenital and acquired, as well as intensity of baseline medical needs. In times of intercurrent illness or perioperative management, these patients often require acute care services in the pediatric intensive care (PICU) setting. This review describes epidemiologic trends in chronic illness in the PICU setting, differentiates these populations from those without significant baseline medical requirements, reviews models of care designed to address the intersection of acute and chronic illness, and posits considerations for future roles of PICU providers to optimize the care and outcomes of these children and their families.

Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal

&#x0D; &#x0D; &#x0D; &#x0D; Justification: Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal.&#x0D; Objective: Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources.&#x0D; Process / Methods: Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources.&#x0D; Recommendations: Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.&#x0D; &#x0D; &#x0D; &#x0D;

The clinical effects of cerebral near-infrared spectroscopy monitoring (NIRS) versus no monitoring: a protocol for a systematic review with meta-analysis and trial sequential analysis

BackgroundMultiple clinical conditions are associated with cerebral hypoxia/ischaemia and thereby an increased risk of hypoxic-ischaemic brain injury. Cerebral near-infrared spectroscopy monitoring (NIRS) is a tool to monitor brain oxygenation and perfusion, and the clinical uptake of NIRS has expanded over recent years. Specifically, NIRS is used in the neonatal, paediatric, and adult perioperative and intensive care settings. However, the available literature suggests that clinical benefits and harms of cerebral NIRS monitoring are uncertain. As rates of clinically significant hypoxic-ischaemic brain injuries are typically low, it is difficult for randomised clinical trials to capture a sufficiently large number of events to evaluate the clinical effect of cerebral NIRS monitoring, when focusing on specific clinical settings. The aim of this systematic review will be to evaluate the benefits and harms of clinical care with access to cerebral NIRS monitoring versus clinical care without cerebral NIRS monitoring in children and adults across all clinical settings.MethodsWe will conduct a systematic review with meta-analysis and trial sequential analysis. We will only include randomised clinical trials. The primary outcomes are all-cause mortality, moderate or severe persistent cognitive or neurological deficit, and proportion of participants with one or more serious adverse events. We will search CENTRAL, EMBASE, MEDLINE, and the Science Citation Index Expanded from their inception and onwards. Two reviewers will independently screen all citations, full-text articles, and extract data. The risk of bias will be appraised using the Cochrane risk of bias tool version 2.0. If feasible, we will conduct both random-effects meta-analysis and fixed-effect meta-analysis of outcome data. Additional analysis will be conducted to explore the potential sources of heterogeneity (e.g. risk of bias, clinical setting).DiscussionAs we include trials across multiple clinical settings, there is an increased probability of reaching a sufficient information size. However, heterogeneity between the included trials may impair our ability to interpret results to specific clinical settings. In this situation, we may have to depend on subgroup analyses with inherent increased risks of type I and II errors.Systematic review registrationPROSPERO CRD42020202986. This systematic review protocol has been submitted for registration in the International Prospective Register of Systematic Reviews (PROSPERO) (http://www.crd.york.ac.uk/prospero) on the 12th of October 2020 and published on the 12th of November 2020 (registration ID CRD42020202986).

A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings

To estimate the impact of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) on abuse evaluations and missed abusive head trauma in pediatric intensive care settings. This was a cluster randomized trial. Participants included 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive patients with acute head injures <3years (n=183 and n=237, intervention vs control). PICUs were stratified by patient volumes, pair-matched, and randomized equally to intervention or control conditions. Randomization was concealed from the biostatistician. Physician-directed, cluster-level interventions included initial and booster training, access to an abusive head trauma probability calculator, and information sessions. Outcomes included "higher risk" patients evaluated thoroughly for abuse (with skeletal survey and retinal examination), potential cases of missed abusive head trauma (patients lacking either evaluation), and estimates of missed abusive head trauma (among potential cases). Group comparisons were performed using generalized linear mixed-effects models. Intervention physicians evaluated a greater proportion of higher risk patients thoroughly (81% vs 73%, P=.11) and had fewer potential cases of missed abusive head trauma (21% vs 32%, P=.05), although estimated cases of missed abusive head trauma did not differ (7% vs 13%, P=.22). From baseline (in previous studies) to trial, the change in higher risk patients evaluated thoroughly (67%→81% vs 78%→73%, P=.01), and potential cases of missed abusive head trauma (40%→21% vs 29%→32%, P=.003), diverged significantly. We did not identify a significant divergence in the number of estimated cases of missed abusive head trauma (15%→7% vs 11%→13%, P=.22). PediBIRN-4 CDR application facilitated changes in abuse evaluations that reduced potential cases of missed abusive head trauma in PICU settings. ClinicalTrials.gov: NCT03162354.

P0681 / #1615: SIMULATION AS A STRATEGY IN TRAINING OF BASIC SKILLS IN PEDIATRIC CRITICAL RESPIRATORY CARE. STUDENTS PERCEPTION.

Aims & Objectives: The practice of respiratory care in Pediatric Intensive Care settings involves the management of various skills, including assisting in invasive procedures of the airway, managing tracheostomized patients and sampling for diagnosis of respiratory infections. There are variability in the practice of these skills. Simulation involves practicing in a safe environment. Methods: A semi-classroom two-stage course was designed. A first virtual section, with reading materials, videos on procedures, application activities, with the objective of facilitating the review and integration of the contents before the second stage. The face-to-face day, by means of a dialogue presentation, the learning will then be reviewed and integrated using simulation-based teaching, they visited stations where they practiced the different skills. Using low fidelity simulators for the practice, participants were guided through a checklist for each procedure, favoring peer work and teacher feedback. Results: After the course, a virtual opinion survey was carried out on the participants, where the following data were obtained: Of a total of 15 students, 60% considered the activity as very good and the contribution to their professional performance was excellent. 53% of the participants awarded a score of 9, in a valuation from 1 to 10. It is worth mentioning: The skills chosen for training, the possibility of practice with simulation, feedback and debriefing during the scenarios. Conclusions: Given the diversity in the possibility of access to material resources and training in basic skills, this simulation-based learning space was valued as a very good opportunity to standardize procedures in different settings in a safe environment.

Mindful organizing as a healthcare strategy to decrease catheter-associated infections in neonatal and pediatric intensive care units. A systematic review and grading recommendations (GRADE) system.

To explore the clinical evidence available on mindful organizing (MO) that will improve teamwork for positioning and managing central venous catheters in patients admitted to neonatal intensive care and other pediatric intensive care units to decrease central-line-associated and catheter-related bloodstream infections (CLABSI and CRBSI). We searched several databases (PubMed, Embase, CINAHL, CENTRAL, SCOPUS, and Web of Science) up to June 2018. We included studies investigating the effectiveness of MO teamwork in reducing CLABSI and CRBSI. The systematic review followed the PRISMA guidelines. We used validated appraisal checklists to assess quality. Seven studies were included: only one was a non-randomized case-controlled trial (CCT). All the others had a pre-post intervention design, one a time-series design and one an interrupted time-series design. The methodological heterogeneity precluded a meta-analysis. Despite the low certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, three studies including thousands of participants provided numerical data for calculating risk ratios (RR) and 95% confidence intervals (CI) comparing MO with no intervention for decreasing the CLABSI rate in neonatal and pediatric ICUs. The one CCT disclosed no significant difference in the CLABSI rate decrease between groups (RR = 0.96; 95%CI 0.47-1.97). Nor did the pre- and post-intervention interrupted time-series design disclose a significant decrease (RR = 0.80; 95%CI 0.36 1.77). In the study using a before-after study design, the GRADE system found that the CLABSI rate decrease differed significantly in favor of post-intervention (RR = 0.13; 95%CI 0.03 0.57; p = 0.007). Despite the decreased CLABSI rate, the available evidence is low in quality. To reduce the unduly high CLABSI rates in neonatal and pediatric intensive care settings, custom-designed clinical trials should further define the clinical efficacy of MO to include it in care bundles as a new international standard.

Cross-cultural adaptation of the Richmond Agitation-Sedation Scale to Brazilian Portuguese for the evaluation of sedation in pediatric intensive care.

ObjectiveTo perform a cross-cultural adaptation of the Richmond Agitation-Sedation Scale (RASS) to Brazilian Portuguese for the evaluation of sedation in pediatric intensive care.MethodsCross-cultural adaptation process including the conceptual, item, semantic and operational equivalence stages according to current recommendations.ResultsPretests, divided into two stages, included 30 professionals from the pediatric intensive care unit of a university hospital, who administered the translated RASS to patients aged 29 days to 18 years. The pretests showed a content validity index above 0.90 for all items: 0.97 in the first stage of pretests and 0.99 in the second.ConclusionThe cross-cultural adaptation of RASS to Brazilian Portuguese resulted in a version with excellent comprehensibility and acceptability in a pediatric intensive care setting. Reliability and validity studies should be performed to evaluate the psychometric properties of the Brazilian Portuguese version of the RASS.

Prevalence, Proportionality, and Cause of Ventilator Alarms in a Pediatric Intensive Care Setting.

Clinical alarms play an important role in monitoring physiological parameters, vital signs and medical device function in the hospital intensive care environment. Delays in staff response to alarms are well documented as health care providers become desensitized to increased rates of nuisance alarms. Patients can be at increased risk of harm due to alarm fatigue. Current literature suggests alarms from ventilators contribute significantly to nonactionable alarms. A greater understanding of which specific ventilator alarms are most common and the rates at which they occur is fundamental to improving alarm management. A retrospective review was performed on alarms that occurred on the Avea and Servo-i ventilators used in the pediatric ICU and pediatric cardiothoracic ICU at a major metropolitan children's hospital. High- and medium-priority alarms, as classified by the manufacturer, were studied between June 1, 2017, and November 31, 2017. Descriptive data analysis and a 2-proportion z-test were performed to identify proportionality, cause, and prevalence rates in the pediatric ICU and the cardiothoracic ICU. Eleven distinct ventilator alarms were identified during 2,091 d of mechanical ventilation. The Inspiratory Flow Overrange alarm (42.4%) on the Servo-i, Low VTE (20.4%; expiratory tidal volume) and Circuit Integrity alarm (20.0%) on the Avea were the most prevalent causes according to ventilator type. Medium-priority alarms comprised 68.7% of all Servo-i alarms, and high-priority alarms comprised 84% of all Avea alarms. The 2-sample test of proportions was significant for differences between both areas (P < .001). The overall alarm prevalence rate was 22.5 ventilator alarms per ventilator-day per patient. The cause and proportion of alarms varied by ventilator and care unit. High-priority alarms were most common with the Avea and medium-priority alarms for the Servo-i. The overall combined ventilator alarm prevalence rate was 22.5 alarms per ventilator-day per patient.

Rapid testing for respiratory syncytial virus in a resource-limited paediatric intensive care setting.

We analysed the performance characteristics of the respiratory syncytial virus lateral flow rapid antigen assay in use when compared to a multiplex polymerase chain reaction for detection of respiratory viruses. The study was conducted at a tertiary paediatric hospital in Port Elizabeth, South Africa, from 01 January 2017 to 31 December 2018. We found the clinical sensitivity (36.8%) of the rapid test to be too low for routine diagnostic use. Knowledge of assay performance characteristics of rapid tests are important for appropriate interpretation of rapid test results.

Overview of Plasma and Platelet Transfusions in Critically Ill Children.

Critically ill children are a unique population who frequently receive plasma and platelet transfusions for both active bleeding and mitigation of bleeding risk. While these products are frequently administered, transfusion indications in this population remain unclear, and practice varies across institutions and providers. In this manuscript, we will outline the current evidence regarding plasma and platelet transfusions for hemostasis in the pediatric intensive care setting. For both products, we will describe the product composition, epidemiology, and product indications and discuss the potential risks and benefits involved with the transfusion. We will also discuss knowledge gaps and future areas of research.