Brazilian Pediatric Intensive Care Units Research Articles

End-of-life care in Brazilian pediatric intensive care units: challenges and opportunities

End-of-life care in Brazilian pediatric intensive care units: challenges and opportunities

End-of-life care in Brazilian Pediatric Intensive Care Units

ObjectiveMost deaths in Pediatric Intensive Care Units involve forgoing life-sustaining treatment. Such deaths required carefully planned end-of-life care built on compassion and focused on palliative care measures. This study aims to assess topics related to the end of life care in Brazilian pediatric intensive care units from the perspective of a multidisciplinary team. MethodThe authors used a tested questionnaire, utilizing Likert-style and open-ended questions. After ethics committee approval, it was sent by email from September to November/2019 to three Pediatric Intensive Care Units in the South and Southeast of Brazil. One unit was exclusively dedicated to oncology patients; the others were mixed units. ResultsFrom 144 surveys collected (23% response rate) 136 were analyzed, with 35% physicians, 30% nurses, 21% nurse technicians, and 14% physiotherapists responding. Overall, only 12% reported enough end-of-life care training and 40% reported never having had any, albeit this was not associated with the physician's confidence in forgoing life-sustaining treatment. Furthermore, 60% of physicians and 46% of other professionals were more comfortable with non-escalation than withdrawing therapies, even if this could prolong suffering. All physicians were uncomfortable with palliative extubation; 15% of all professionals have witnessed it. The oncologic team uniquely felt that “resistance from the teams of specialists” was the main barrier to end-of-life care implementation. ConclusionMost professionals felt unprepared to forego life-sustaining treatment. Even for terminally ill patients, withholding is preferred over the withdrawal of treatment. Socio-cultural barriers and the lack of adequate training may be contributing to insecurity in the care of terminally ill patients, diverging from practices in other countries.

Knowledge regarding extracorporeal membrane oxygenation management among Brazilian pediatric intensivists: a cross-sectional survey.

To assess Brazilian pediatric intensivists' general knowledge of extracorporeal membrane oxygenation, including evidence for its use, the national funding model, indications, and complications. This was a multicenter cross-sectional survey including 45 Brazilian pediatric intensive care units. A convenience sample of 654 intensivists was surveyed regarding their knowledge on managing patients on extracorporeal membrane oxygenation, its indications, complications, funding, and literature evidence. The survey addressed questions regarding the knowledge and experience of pediatric intensivists with extracorporeal membrane oxygenation, including two clinical cases and 6 optional questions about the management of patients on extracorporeal membrane oxygenation. Of the 45 invited centers, 42 (91%) participated in the study, and 412 of 654 (63%) pediatric intensivists responded to the survey. Most pediatric intensive care units were from the Southeast region of Brazil (59.5%), and private/for-profit hospitals represented 28.6% of the participating centers. The average age of respondents was 41.4 (standard deviation 9.1) years, and the majority (77%) were women. Only 12.4% of respondents had taken an extracorporeal membrane oxygenation course. Only 19% of surveyed hospitals have an extracorporeal membrane oxygenation program, and only 27% of intensivists reported having already managed patients on extracorporeal membrane oxygenation. Specific extracorporeal membrane oxygenation management questions were responded to by only 64 physicians (15.5%), who had a fair/good correct response rate (median 63.4%; range 32.8% to 91.9%). Most Brazilian pediatric intensivists demonstrated limited knowledge regarding extracorporeal membrane oxygenation, including its indications and complications. Extracorporeal membrane oxygenation is not yet widely available in Brazil, with few intensivists prepared to manage patients on extracorporeal membrane oxygenation and even fewer intensivists recognizing when to refer patients to extracorporeal membrane oxygenation centers.

A nationwide survey of Antimicrobial Stewardship in Pediatric Intensive Care Unit: implementation notes from the Brazilian underground.

A multicenter diagnostic study was conducted to investigate the implementation of an Antimicrobial Stewardship Program in Brazilian Pediatric Intensive Care Units. The analysis unveiled the main implementation impediments of the Antimicrobial Stewardship Program such as the lack of professionals and resources available to the program.

Conhecimento do manejo da oxigenação por membrana extracorpórea de intensivistas pediátricos brasileiros: um inquérito transversal

OBJECTIVE: To assess Brazilian pediatric intensivists’ general knowledge of extracorporeal membrane oxygenation, including evidence for its use, the national funding model, indications, and complications. METHODS: This was a multicenter cross-sectional survey including 45 Brazilian pediatric intensive care units. A convenience sample of 654 intensivists was surveyed regarding their knowledge on managing patients on extracorporeal membrane oxygenation, its indications, complications, funding, and literature evidence. RESULTS: The survey addressed questions regarding the knowledge and experience of pediatric intensivists with extracorporeal membrane oxygenation, including two clinical cases and 6 optional questions about the management of patients on extracorporeal membrane oxygenation. Of the 45 invited centers, 42 (91%) participated in the study, and 412 of 654 (63%) pediatric intensivists responded to the survey. Most pediatric intensive care units were from the Southeast region of Brazil (59.5%), and private/for-profit hospitals represented 28.6% of the participating centers. The average age of respondents was 41.4 (standard deviation 9.1) years, and the majority (77%) were women. Only 12.4% of respondents had taken an extracorporeal membrane oxygenation course. Only 19% of surveyed hospitals have an extracorporeal membrane oxygenation program, and only 27% of intensivists reported having already managed patients on extracorporeal membrane oxygenation. Specific extracorporeal membrane oxygenation management questions were responded to by only 64 physicians (15.5%), who had a fair/good correct response rate (median 63.4%; range 32.8% to 91.9%). CONCLUSION: Most Brazilian pediatric intensivists demonstrated limited knowledge regarding extracorporeal membrane oxygenation, including its indications and complications. Extracorporeal membrane oxygenation is not yet widely available in Brazil, with few intensivists prepared to manage patients on extracorporeal membrane oxygenation and even fewer intensivists recognizing when to refer patients to extracorporeal membrane oxygenation centers.

Physical rehabilitation in Brazilian pediatric intensive care units: a multicenter point prevalence study

Physical rehabilitation in Brazilian pediatric intensive care units: a multicenter point prevalence study

Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units.

To validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2. Observational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve - AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013-2015, 2015-2017, and 2017-2019. 41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2-5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94-1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83-0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%-3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%-46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%-100% mortality risk). Both scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied.

Telemedicine in Pediatric Intensive Care Units: Perspectives From a Brazilian Experience

Purpose of ReviewTo present the implementation of a telemedicine project (TeleICU) in pediatric intensive care units (ICU) throughout different Brazilian regions.Recent FindingsAlthough telemedicine in pediatric ICUs has shown evidence of benefit in numerous studies with potential to 18 mitigate existing disparities, in Brazil, its use is still under development. Brazil has several opportunities for implementing this resource since, according to the National Registry of Healthcare 20 Establishments (NRHE), there is a discrepancy in the density of pediatric intensive care physicians per patient and the availability 21 of pediatric ICU beds per number of inhabitants.SummaryHealth technologies are being widely used to fill gaps in the healthcare system. Telemedicine has been an important tool to meet demands in intensive care units, especially the demand for specialized assistance. TeleICU is a Brazilian model of telemedicine that performs multidisciplinary telerounds in remote pediatric ICUs and develops continuing education activities for the healthcare teams. The project aims to systematize and to qualify care, as well as to reduce risks for patients admitted to pediatric ICUs engaged in the project. Preliminary results have demonstrated a positive impact regarding this approach, providing medical care to 6640 inpatients-day in two Brazilian pediatric ICUs, for 616 patients during 946 daily telerounds.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40124-021-00242-z.

Admission factors associated with nutritional status deterioration and prolonged pediatric intensive care unit stay in critically ill children: PICU‐ScREEN multicenter study

AbstractBackgroundEarly identification of patients in the pediatric intensive care unit (PICU) at risk of nutritional status (NS) deterioration and poor outcomes is desirable.We aimed to identify factors associated with NS deterioration and prolonged PICU stay.MethodsProspective cohort study in eight Brazilian PICUs with children <18 years with a PICU stay >72h. We used multivariable logistic regression to identify the clinical, laboratory, and nutrition variables at admission that were associated with outcomes. NS deterioration was defined as the reduction in weight‐for‐age, body mass index–for‐age or mid‐upper arm circumference–for‐age z‐score ≥1 during PICU stay. Prolonged PICU stay was defined as ≥13 days.ResultsWe enrolled 363 eligible patients, median age 11.3 months (interquartile range:3.1–45.6) and 46% had at least one complex chronic condition (CCC). NS deterioration was observed in 23% of participants and was associated with CCC (odds ratio [OR]:2.71; 95% confidence interval [CI]:1.44–5.09), after adjusting for severity risk score, leukocyte count, obesity, and PICU site. Prolonged PICU stay was associated with age <2 years (OR:1.95; 95%CI:1.03–3.66), fluid overload (>10%) over the first 72h (OR:2.66; 95%CI:1.50–4.73), and hypoalbuminemia (<3.0 g/dL) (OR:2.05; 95%CI:1.12–3.76), after adjusting for CCC, severity risk score, undernutrition, early nutrition therapy, and PICU site.ConclusionsCCC at admission was associated with NS deterioration. Age <2 years, fluid overload, and hypoalbuminemia at PICU admission were associated with prolonged PICU stay. These factors must be further evaluated as part of an admission nutrition screening tool for critically ill children.

P0054 / #845: PHYSICAL REHABILITATION IN BRAZILIAN PEDIATRIC ICUS: A MULTICENTER POINT PREVALENCE STUDY

Aims & Objectives: Technological and scientific advances have decreased mortality rates for critically ill children. Along with extended survival, rates of morbidity have risen, and delayed rehabilitation have been involved as contributing factor. Early mobilization (EM) may have a positive impact on prevention of morbidity in the pediatric intensive care unit (PICU). The objective of this study was to determine the prevalence of physical rehabilitation provided by physical and occupational therapists in Brazilian PICUs. Methods: We conducted a two-day point prevalence study of physical rehabilitation practices in 27 Brazil PICUs in April and June 2019. The primary outcome was therapist-provided mobility, defined as the number of patient-days with mobility provided by either a physical or occupational therapist. We also characterized barriers to mobility and potential safety events associated with mobility. Results: Data was collected for 375 patients admitted to the PICU for ≥72 hours; 60% were male and 68% were ≤ 2 years old. Two-thirds of patients days included physical-therapist provided mobility, while 4% received mobility from an occupational therapist. Nurses and family were involved in patient mobility on 58% and 42%. Mechanical ventilation was not associated with decreased therapist-provided mobility. Most common barriers to mobility were no physician order, deep sedation and cardiovascular instability. Of 1,462 documented mobilization activities, 11% were associated with a potential safety event, usually a transient change in vital signs. Conclusions: PICUs in Brazil have a high prevalence of physical-therapist provided mobility and nurse and family engagement, with a low prevalance of occupational therapy involvement in mobility.

Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit.

Children are exposed to drug-drug interactions (DDI) risks due to their organism’s complexity and the need for several medicines prescriptions in pediatric intensive care units (PICU). This study aimed to assess the prevalence of potential DDIs in a Brazilian PICU. We carried out a cross-sectional study at a pediatric teaching hospital from Rio de Janeiro (Brazil) over one year. Potential DDIs (pDDIs) between prescribed medicines for hospitalized children in PICU (n = 143) were analyzed according to severity using Micromedex®. Sex, age group, number of drugs prescribed, vasoactive amines use (a proxy of clinical complexity), and the PICU length of stay were summarized using descriptive statistics. Association between the PICU length stay, and variables sex, age, clinical condition complexity, number of drugs prescribed, and severity of pDDI were examined by univariate and multiple linear regression. Seventy percent of patients aged three days to 14 years old were exposed at least one potential DDIs during PICU stay. Two hundred eighty-four different types of pDDIs were identified, occurring 1,123 times. Nervous system drugs were implicated in 55% of the interactions, and fentanyl (10%) was most involving in pDDIs. Most pDDIs were classified as higher severity (56.2%), with reasonable documentation (64.6%) and unspecified onset time (63.8%). Worse clinical condition, ten or more drugs prescribed, and most severe pDDIs were associated with a longer PICU length of stay. Multiple linear regression analysis showed an increase of 9.83 days (95% confidence interval: 3.61–16.05; p = 0.002) in the PICU length of stay in children with major or contraindicated pDDIs. The results of this research may support the monitoring and prevention of pDDIs related to adverse events in children in intensive care and the design and conduction of new studies.

Performance of prognostic markers in pediatric sepsis

ObjectiveTo evaluate the prognostic performance of the Pediatric Index of Mortality 2 (PIM2), ferritin, lactate, C-reactive protein (CRP), and leukocytes, alone and in combination, in pediatric patients with sepsis admitted to the pediatric intensive care unit (PICU). MethodsA retrospective study was conducted in a PICU in Brazil. All patients aged 6 months to 18 years admitted with a diagnosis of sepsis were eligible for inclusion. Those with ferritin and C-reactive protein measured within 48h and lactate and leukocytes within 24h of admission were included in the prognostic performance analysis. ResultsOf 350 eligible patients with sepsis, 294 had undergone all measurements required for analysis and were included in the study. PIM2, ferritin, lactate, and CRP had good discriminatory power for mortality, with PIM2 and ferritin being superior to CRP. The cutoff values for PIM2 (> 14%), ferritin (> 135ng/mL), lactate (> 1.7mmol/L), and CRP (> 6.7mg/mL) were associated with mortality. The combination of ferritin, lactate, and CRP had a positive predictive value of 43% for mortality, similar to that of PIM2 alone (38.6%). The combined use of the three biomarkers plus PIM2 increased the positive predictive value to 76% and accuracy to 0.945. ConclusionsPIM2, ferritin, lactate, and CRP alone showed good prognostic performance for mortality in pediatric patients older than 6 months with sepsis. When combined, they were able to predict death in three-fourths of the patients with sepsis. Total leukocyte count was not useful as a prognostic marker.

Fim de vida em unidades de terapia intensiva pediátrica

Resumo Este artigo analisa as condutas de fim de vida em unidades de terapia intensiva pediátrica brasileiras. Trata-se de estudo observacional, retrospectivo, multicêntrico, incluindo crianças que faleceram entre janeiro e dezembro de 2017. Durante o período ocorreram 149 óbitos, dos quais 54 foram selecionados. Constatou-se que 83,3% dos pacientes apresentavam alguma doença de base, com choque séptico como principal causa de óbito (38,9%). Limitações de suporte de vida foram descritas em 46,3% dos prontuários, e ordem de não reanimar em 37%; porém, 74,1% dos pacientes deixaram de ser reanimados. A prática de não reanimar pacientes com prognóstico reservado tem se disseminado, e aponta-se para melhores cuidados nas últimas 48 horas de vida. No entanto, ainda se verifica uso excessivo de procedimentos invasivos, ventilação mecânica e drogas vasoativas nas horas derradeiras.

Pediatric patients with COVID‐19 admitted to intensive care units in Brazil: a prospective multicenter study

ObjectiveTo describe the clinical characteristics of children and adolescents admitted to intensive care with confirmed COVID‐19. MethodProspective, multicenter, observational study, in 19 pediatric intensive care units. Patients aged 1 month to 19 years admitted consecutively (March–May 2020) were included. Demographic, clinical‐epidemiological features, treatment, and outcomes were collected. Subgroups were compared according to comorbidities, age < 1 year, and need for invasive mechanical ventilation. A multivariable logistic regression model was used for predictors of severity. ResultsSeventy‐nine patients were included (ten with multisystemic inflammatory syndrome). Median age 4 years; 54% male (multisystemic inflammatory syndrome, 80%); 41% had comorbidities (multisystemic inflammatory syndrome, 20%). Fever (76%), cough (51%), and tachypnea (50%) were common in both groups. Severe symptoms, gastrointestinal symptoms, and higher inflammatory markers were more frequent in multisystemic inflammatory syndrome. Interstitial lung infiltrates were common in both groups, but pleural effusion was more prevalent in the multisystemic inflammatory syndrome group (43% vs. 14%). Invasive mechanical ventilation was used in 18% (median 7.5 days); antibiotics, oseltamivir, and corticosteroids were used in 76%, 43%, and 23%, respectively, but not hydroxychloroquine. The median pediatric intensive care unit length‐of‐stay was five days; there were two deaths (3%) in the non‐ multisystemic inflammatory syndrome group. Patients with comorbidities were older and comorbidities were independently associated with the need for invasive mechanical ventilation (OR 5.5; 95% CI, 1.43–21.12; p=0.01). ConclusionsIn Brazilian pediatric intensive care units, COVID‐19 had low mortality, age less than 1 year was not associated with a worse prognosis, and patients with multisystemic inflammatory syndrome had more severe symptoms, higher inflammatory biomarkers, and a greater predominance of males, but only comorbidities and chronic diseases were independent predictors of severity.

Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study

ObjectiveTo describe the clinical characteristics of children and adolescents admitted to intensive care with confirmed COVID-19. MethodProspective, multicenter, observational study, in 19 pediatric intensive care units. Patients aged 1 month to 19 years admitted consecutively (March–May 2020) were included. Demographic, clinical-epidemiological features, treatment, and outcomes were collected. Subgroups were compared according to comorbidities, age < 1 year, and need for invasive mechanical ventilation. A multivariable logistic regression model was used for predictors of severity. ResultsSeventy-nine patients were included (ten with multisystemic inflammatory syndrome). Median age 4 years; 54% male (multisystemic inflammatory syndrome, 80%); 41% had comorbidities (multisystemic inflammatory syndrome, 20%). Fever (76%), cough (51%), and tachypnea (50%) were common in both groups. Severe symptoms, gastrointestinal symptoms, and higher inflammatory markers were more frequent in multisystemic inflammatory syndrome. Interstitial lung infiltrates were common in both groups, but pleural effusion was more prevalent in the multisystemic inflammatory syndrome group (43% vs. 14%). Invasive mechanical ventilation was used in 18% (median 7.5 days); antibiotics, oseltamivir, and corticosteroids were used in 76%, 43%, and 23%, respectively, but not hydroxychloroquine. The median pediatric intensive care unit length-of-stay was five days; there were two deaths (3%) in the non- multisystemic inflammatory syndrome group. Patients with comorbidities were older and comorbidities were independently associated with the need for invasive mechanical ventilation (OR 5.5; 95% CI, 1.43–21.12; p = 0.01). ConclusionsIn Brazilian pediatric intensive care units, COVID-19 had low mortality, age less than 1 year was not associated with a worse prognosis, and patients with multisystemic inflammatory syndrome had more severe symptoms, higher inflammatory biomarkers, and a greater predominance of males, but only comorbidities and chronic diseases were independent predictors of severity.

Which children account for repeated admissions within 1 year in a Brazilian pediatric intensive care unit?

ObjectiveWhile studies have focused on early readmissions or readmissions during the same hospitalization in a pediatric intensive care unit, little is known about the children with recurrent admissions. We sought to assess the characteristics of patients readmitted within 1 year in a Brazilian pediatric intensive care unit. MethodsThis was a retrospective study carried out in a tertiary pediatric intensive care unit. The outcome was the maximum number of readmissions experienced by each child within any 365‐day interval during a 5‐year follow‐up period. ResultsOf the 758 total eligible admissions, 75 patients (9.8%) were readmissions. Those patients accounted for 33% of all pediatric intensive care unit bed care days. Median time to readmission was 73 days for all readmissions. Logistic regression showed that complex chronic conditions (odds ratio 1.07), severe to moderate cognitive disability (odds ratio 1.08), and use of technology assistance (odds ratio 1.17) were associated with readmissions. Multiple admissions had a significantly prolonged duration of mechanical ventilation (8 vs. 6 days), longer length of pediatric intensive care unit (7 vs 4 days) and hospital stays (20 vs 9 days), and higher mortality rate (21.3% vs 5.1%) compared with index admissions. ConclusionThe rate of pediatric intensive care unit readmissions within 1 year was low; however, it was associated with a relevant number of bed care days and worse outcomes. A 30‐day index of readmission may be inadequate to mirror the burden of pediatric intensive care unit readmissions. Patients with complex chronic conditions, poor functional status or technology assistance are at higher risk for readmissions. Future studies should address the impact of qualitative interventions on healthcare and recurrent admissions.

Abstract P-426: TRANSCULTURAL TRANSLATION AND ADAPTATION IN BRAZILIAN PORTUGUESE TO EMPOWERMENT OF PARENTS IN THE INTENSIVE CARE 30 (EMPATHIC-30)

Aims & Objectives: In view of the lack of validated instruments to evaluate the parental satisfaction with the patients hospitalized in pediatric intensive care units (PICUs) in Brazil, the aim was to translate the Empowerment of Parents in the Intensive Care-30 (EMPATHIC-30) as the first stage in the process of validating the questionnaire for the Portuguese. Methods The translation of the instrument was carried out in accordance with the protocol of the International Society for Pharmacoeconomic Research - ISPOR, 2005, Transcultural Translation and Adaptation Group. It proposes translation in ten stages: preparation, translation, reconciliation and retranslation, revision of retranslation, harmonization, comprehension test, revision and final version. Results There were few differences in the two versions translated into Portuguese, performed by two different translators, about the use of synonyms. In the reconciliation stage, carried out by the authors of the study, the term considered easier to understand and more common to the research population was chosen. There were also changes in the order of the words of some phrases and in the verbal tense, for example, the expression “We had daily talks about our child’s care and treatment with the doctors”, resulted in the translation “Every day we talked with the doctors about our child’s care and treatment “, adapting them to the syntax of the Brazilian Portuguese language. Conclusions This first stage of the study results in the adequate translation of EMPATHIC-30, for later validation, in order to obtain an instrument sufficient of evaluating the parental satisfaction in PICU in Brazil.

Which children account for repeated admissions within 1 year in a Brazilian pediatric intensive care unit?

ObjectiveWhile studies have focused on early readmissions or readmissions during the same hospitalization in a pediatric intensive care unit, little is known about the children with recurrent admissions. We sought to assess the characteristics of patients readmitted within 1 year in a Brazilian pediatric intensive care unit. MethodsThis was a retrospective study carried out in a tertiary pediatric intensive care unit. The outcome was the maximum number of readmissions experienced by each child within any 365-day interval during a 5-year follow-up period. ResultsOf the 758 total eligible admissions, 75 patients (9.8%) were readmissions. Those patients accounted for 33% of all pediatric intensive care unit bed care days. Median time to readmission was 73 days for all readmissions. Logistic regression showed that complex chronic conditions (odds ratio 1.07), severe to moderate cognitive disability (odds ratio 1.08), and use of technology assistance (odds ratio 1.17) were associated with readmissions. Multiple admissions had a significantly prolonged duration of mechanical ventilation (8 vs. 6 days), longer length of pediatric intensive care unit (7 vs 4 days) and hospital stays (20 vs 9 days), and higher mortality rate (21.3% vs 5.1%) compared with index admissions. ConclusionThe rate of pediatric intensive care unit readmissions within 1 year was low; however, it was associated with a relevant number of bed care days and worse outcomes. A 30-day index of readmission may be inadequate to mirror the burden of pediatric intensive care unit readmissions. Patients with complex chronic conditions, poor functional status or technology assistance are at higher risk for readmissions. Future studies should address the impact of qualitative interventions on healthcare and recurrent admissions.

Expectations of the pediatric intensive care unit team for the clinical pharmacist performance

Objective: We aimed to know the expectations of a pediatric intensive care unit staff for the activities to be undertaken by the clinical pharmacist, in order to plan her work along with the multidisciplinary team. Study design: A cross-sectional study, involving the multidisciplinary team of the pediatric intensive care unit of a tertiary-care university hospital. Method: A self-completion questionnaire containing questions regarding expectations of the pediatric intensive care unit staff for the role of the clinical pharmacist in the multidisciplinary team was applied to the team members, using a Likert-type scale response. Results: The nursing assistants/technicians and physiotherapists showed higher expectation for issues related to administration of medications; for nurses, the expectation for the clinical pharmacist performance focused on issues related to prescription drugs, such as evaluation of antibiotic therapy, while physicians considered most important information on drug therapy, as notification of allergies related to drugs, information on period of validity of medicines and evaluation of drug administration by gastric or enteral tubes. Conclusions: Team expectations varied according to the needs and routine of each professional category. The results of this study have contributed to implementation of the clinical pharmacy service in a Brazilian pediatric intensive care unit

Relação entre o uso seguro de medicamentos e Serviços de Farmácia Clínica em Unidades de Cuidados Intensivos Pediátricos

ObjectiveClinical Pharmacy Services (CPS) are considered standard of care and they are endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU). MethodsThis is a cross‐sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. ResultsOf 53 patients accompanied, we detected 141 preventable drug‐related problems (DRPs) which were solved within clinicians (89% acceptance of all interventions). The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21%) and a composite of inadequate doses (17% due to low, high and non‐optimized doses). Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. ConclusionsAdverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence‐based strategies to reduce morbidity related to medications.