Pediatric Intensive Care Unit Setting Research Articles

Necrotizing Enterocolitis Complicating Severe RSV Bronchiolitis in PICU Settings.

This retrospective study aims to analyze the baseline characteristics and factors associated with poor outcomes in patients with necrotizing enterocolitis (NEC) complicating respiratory syncytial virus (RSV) infection. Using the Virtual Pediatric Systems data registry, patients under 2 years admitted to the pediatric intensive care unit (PICU) were screened. Patients with documented RSV infection and NEC, intestinal perforation, noninfectious gastroenteritis/colitis, or pneumatosis intestinalis occurring around the timing of RSV bronchiolitis diagnosis were included. Out of the screened patients, 41 were analyzed. Most patients (93%) were aged 30 days to 2 years, one-third had baseline anatomical cardiac defects, and 20% history of prematurity. Median PICU length of stay was 11.7 days. Seven patients died before hospital discharge. While not statistically significant, nonsurvivors tended to exhibit higher PRISM-3 scores, more acidemia, and lower systolic blood pressure. These findings emphasize the need for cautious assessment of gastrointestinal symptoms in critically ill patients with RSV infection.

Incidence of opioid-induced constipation in the pediatric intensive care unit: A descriptive cohort study.

Opioid-induced constipation (OIC) is a well-known phenomenon, although there is limited literature evaluating the incidence of OIC in children admitted to the pediatric intensive care unit (PICU). The primary aim of this study was to determine the incidence of OIC in the PICU and to determine if it is associated with a higher rate of morbidities or prolonged length of stay (LOS). We conducted a single-center retrospective chart review from July 1, 2014, to June 30, 2015, in our PICU. We included all patients aged ≤18 years with a PICU stay of ≥96 h who received opioids during their admission. Data were collected on the frequency of bowel movements and characteristics of opioid administration. Demographic and clinical data were obtained from Virtual Pediatric Systems, LLC. Of the 94 patients who met the study criteria, 39.4% developed constipation. These patients tended to be older (P = 0.06) and were noted to weigh more (P = 0.03). There was no significant difference in the total or median daily doses, duration of opioid treatment, or mode of administration. Constipation rates did not differ by the severity of illness. There was a higher incidence of constipation in the patients who were admitted for neurological issues or after trauma or abdominal surgery (P = 0.002). Patients with constipation had a longer LOS than patients without constipation, but the difference was not statistically significant. These results indicate that opioid use is not the sole risk factor for constipation in the PICU setting.

Management of iatrogenic acute limb ischaemia in the paediatric intensive care unit population

In the Paediatric Intensive Care Unit (PICU) an arterial line is often inserted in critically unwell children to allow for reliable blood pressure monitoring and access to arterial blood for point-of-care blood gas analysis and laboratory testing. However, arterial catheterisation is a procedure that carries the risk of serious complications including impaired tissue perfusion, thrombotic events and limb ischaemia.1 The typical clinical features of iatrogenic acute limb ischaemia (ALI) in PICU patients include: (1) pallor (pale discolouration, mottling, cyanosis), (2) perishingly cold (cold to touch, use of temperature probe), (3) pulseless (absent distal pulses in affected limb), and (4) 3As (increasing analgesia requirements, anxiety and agitation). Importantly, other classical features of ALI such as pain, paralysis and paraesthesia are less useful in a PICU setting where patients are often sedated and ventilated.

Continuous Prostanoid Initiation in Severe Pulmonary Hypertension in the Pediatric Cardiac Intensive Care Unit.

Limited data exists regarding prostanoid (PGI2) use in critically ill patients with pulmonary hypertension. (PH) in the pediatric cardiac intensive care unit (CICU) setting. Single center, retrospective study of patients with diagnosis of PH who received continuous PGI2 and were admitted to CICU from January/2015 to April/2022. Data collected included patient demographics and clinical characteristics including diagnosis, etiology of PH, vasoactive and ventilatory support, length of stay, and survival. Type, initial, maximum, and final dose of PGI2 as well as hemodynamic data was obtained. Data reported as mean ± standard deviation. Significance taken p value < 0.05. 24 patients received PGI2 therapy at a mean age of 3.1years, range (0-16.6years). PGI2 was in the form of IV epoprostenol in 12 patients, IV treprostinil in 6, and SQ treprostinil in 6 patients. Mean initial dose was 2.79ng/kg/min, max dose 18.75ng/kg/min, and mean duration of therapy was 38.5days. At PGI2 initiation, 21 (87.5%) were on vasoactive infusions, 19 (79.2%) mechanically ventilated (MV), and 6 (25%) were on extracorporeal membrane oxygenation (ECMO). The in-hospital mortality rate was 37.5% (n = 9). Patients MV and on ECMO support had higher risk of death (p = 0.04, and < 0.01, respectively). PGI2 therapy was tolerated in approximately 50% of patients with the most common side effect being hypotension leading to discontinuation in 1/3rd of patients. Ongoing evaluation of the benefits of PGI2 for patients in the CICU setting will help better identify patient selection, type, and dosing of PGI2.

Assessing Fluid Responsiveness Using Noninvasive Hemodynamic Monitoring in Pediatric Shock: A Review

AbstractNoninvasive hemodynamic monitoring devices have been introduced to better quantify fluid responsiveness in pediatric shock; however, current evidence for their use is inconsistent. This review aims to examine available noninvasive hemodynamic monitoring techniques for assessing fluid responsiveness in children with shock. A comprehensive literature search was conducted using PubMed and Google Scholar, examining published studies until December 31, 2022. Articles were identified using initial keywords: [noninvasive] AND [fluid responsiveness]. Inclusion criteria included age 0 to 18, use of noninvasive techniques, and the emergency department (ED) or pediatric intensive care unit (PICU) settings. Abstracts, review papers, articles investigating intraoperative monitoring, and non-English studies were excluded. The methodological index for nonrandomized studies (MINORS) score was used to assess impact of study bias and all study components were aligned with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Our review yielded 1,353 articles, 17 of which met our inclusion criteria, consisting of 618 patients. All were prospective observational studies performed in the ED (n = 3) and PICU (n = 14). Etiologies of shock were disclosed in 13/17 papers and consisted of patients in septic shock (38%), cardiogenic shock (29%), and hypovolemic shock (23%). Noninvasive hemodynamic monitors included transthoracic echocardiography (TTE) (n = 10), ultrasonic cardiac output monitor (USCOM) (n = 1), inferior vena cava ultrasonography (n = 2), noninvasive cardiac output monitoring (NICOM)/electrical cardiometry (n = 5), and &gt;2 modalities (n = 1). To evaluate fluid responsiveness, most commonly examined parameters included stroke volume variation (n = 6), cardiac index (CI) (n = 6), aortic blood flow peak velocity (∆V peak) (n = 3), and change in stroke volume index (n = 3). CI increase &gt;10% predicted fluid responsiveness by TTE in all ages; however, when using NICOM, this increase was only predictive in children &gt;5 years old. Additionally, ∆SV of 10 to 13% using TTE and USCOM was deemed predictive, while no studies concluded distensibility index by transabdominal ultrasound to be significantly predictive. Few articles explore implications of noninvasive hemodynamic monitors in evaluating fluid responsiveness in pediatric shock, especially in the ED setting. Consensus about their utility remains unclear, reiterating the need for further investigations of efficacy, accuracy, and applicability of these techniques.

Y-site simulation compatibility study of 10% calcium salts with various injectable solutions during toxicological resuscitation

PurposeTo determine the physical compatibility of 10% calcium chloride and 10% calcium gluconate in combination with injectable solutions, administered in the paediatric and adult intensive care unit setting during toxicological...

Multimodality Video Acquisition System for the Assessment of Vital Distress in Children.

In children, vital distress events, particularly respiratory, go unrecognized. To develop a standard model for automated assessment of vital distress in children, we aimed to construct a prospective high-quality video database for critically ill children in a pediatric intensive care unit (PICU) setting. The videos were acquired automatically through a secure web application with an application programming interface (API). The purpose of this article is to describe the data acquisition process from each PICU room to the research electronic database. Using an Azure Kinect DK and a Flir Lepton 3.5 LWIR attached to a Jetson Xavier NX board and the network architecture of our PICU, we have implemented an ongoing high-fidelity prospectively collected video database for research, monitoring, and diagnostic purposes. This infrastructure offers the opportunity to develop algorithms (including computational models) to quantify vital distress in order to evaluate vital distress events. More than 290 RGB, thermographic, and point cloud videos of each 30 s have been recorded in the database. Each recording is linked to the patient's numerical phenotype, i.e., the electronic medical health record and high-resolution medical database of our research center. The ultimate goal is to develop and validate algorithms to detect vital distress in real time, both for inpatient care and outpatient management.

Italian pediatric intensive care units admitting critically ill cancer children: results from a national survey.

Pediatric patients affected by oncologic disease have a significant risk of clinical deterioration that requires admission to the intensive care unit. This study reported the results of a national survey describing the characteristics of Italian onco-hematological units (OHUs) and pediatric intensive care units (PICUs) that admit pediatric patients, focusing on the high-complexity treatments available before PICU admission, and evaluating the approach to the end-of-life (EOL) when cared in a PICU setting. A web-based electronic survey has been performed in April 2021, involving all Italian PICUs admitting pediatric patients with cancer participating in the study. Eighteen PICUs participated, with a median number of admissions per year of 350 (IQR 248-495). Availability of Extracorporeal Membrane Oxygenation therapy and the presence of intermediate care unit are the only statistically different characteristics between large or small PICUs. Different high-level treatments and protocols are performed in OHUs, non depending on the volume of PICU. Palliative sedation is mainly performed in the OHUs (78%), however, in 72% it is also performed in the PICU. In most centers protocols that address EOL comfort care and treatment algorithms are missing, non depending on PICU or OHU volume. A non-homogeneous availability of high-level treatments and in OHUs is described. Moreover, protocols addressing EOL comfort care and treatment algorithms in palliative care are lacking in many centers.

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.

Retrospective observational study of chloral hydrate use in mechanically-ventilated pediatric intensive care unit (PICU) patients 2012-2017.

Introduction: Chloral hydrate (CH) has long been utilized as a pediatric procedural sedation agent. However, very little is published describing CH use in a pediatric intensive care unit (PICU) setting. The aim of this retrospective observational cohort study was to investigate and describe the use of CH in mechanically-ventilated, critically ill children at a large pediatric tertiary referral hospital. Methods: Data were extracted from the hospital electronic medical record and a locally maintained registry of all children admitted to the PICU between 2012 and 2017. Patients admitted to the cardiovascular ICU were not included in this review. The clinical and pharmacy data for 3806 consecutive PICU admissions of mechanically-ventilated, critically ill children were examined. Results: 283 admissions received CH during their first ICU stay. CH-exposed children were younger (16 months vs. 35 months, p < 0.001), the median total dose of CH (indexed to duration of ventilation) was 11mg/kg/day, the median time to first CH dose was 3 days and more CH doses were administered at night (1112 vs. 958, p < 0.001). We constructed a propensity score to adjust for the differences in patients with and without CH exposure using logistic regression including variables of age, sex, diagnosis, and PRISM3 score. After adjustment, the median length of mechanical ventilation was 5 days longer in the CH-exposed group (95% Confidence Interval [CI] 4-6) compared to unexposed CH patients. Similarly, the median length of ICU duration was 9.4 days longer (95% CI 7.1-11.6) and median length of hospital admission duration was 13.2 days longer (95% CI 7.8-18.6) in CH-exposed patients compared to CH-non-exposed. After adjustment, CH-exposed patients had a 9% higher median exposure to HFOV (95% CI 3.9-14.6), but did not have higher median exposures to new tracheostomy (95% CI -0.4-2.2) or ECMO (95% CI -0.2-5.0). Discussion: As part of an extended sedation regimen in mechanically-ventilated and critically ill children, CH is associated with somewhat higher complexity of illness and longer ICU durations.

Pediatric Delirium: An Overlooked Diagnosis?

BackgroundDelirium is well-recognized in adult inpatient care. However, it is often overlooked in children, being mistaken for pain, anxiety, or age-appropriate agitation. MethodsTo assess the impact of a formal teaching session on the diagnostic rates and management of pediatric delirium (PD) in a tertiary care center, we conducted a retrospective chart review of all hospitalized children diagnosed with PD between August 2003 and August 2018 at the CHU Sainte-Justine (Montreal, Canada). Diagnostic incidence and management were compared before (2003 to 2014) and after (2015 to 2018) a formal teaching session provided to pediatric residents, staff pediatricians, and intensive care physicians in December 2014. ResultsThe two cohorts displayed similar demographics, PD symptomatology, PD duration (median: 2 days), and hospital stay duration (median: 11.0 and 10.5 days). However, we saw a major increase in diagnosis frequency after 2014 (from 1.84 to 7.09 cases/year). This increased diagnostic rate was most striking in the pediatric intensive care unit setting. Although symptomatic treatment with antipsychotics and alpha-2 agonists was similar between the two cohorts, patients diagnosed after 2014 were more often weaned from offending medications (benzodiazepines, anesthetics, and anticholinergics). All patients recovered fully. ConclusionsFormal teaching on the symptoms and management of PD was associated with an increase in diagnostic rate and an improved management of PD in our institution. Larger studies are required to assess standardized screening tools that may further enhance diagnostic rates and improve care for children with PD.

Clinical and Radiological Features of Seizures in Children Admitted in the PICU at a Tertiary Care Hospital in North-eastern India: A Retrospective Study

Introduction: A seizure is a brief change in normal electrical brain activity resulting in alterations in awareness, perception, behaviour, or movement, which affect persons of all ages, but are particularly common in childhood. Seizure is a serious neurological symptom in the Paediatric Intensive Care Unit (PICU), yet data on the clinical spectrum of seizures occurring in the PICU setting in India are scarce. Aim: To determine the aetiology, clinical and radiological features of seizures in critically ill children admitted to PICU at a tertiary care hospital. Materials and Methods: This retrospective study was conducted at Gauhati Medical College and Hospital, Guwahati, Assam, India, from April 2017 to September 2018. A total of 253 children aged between 29 days to 12 years, admitted to PICU with seizures were enrolled in the study. Data regarding demographics, diagnosis, clinical seizures, associated diagnosis, Electroencephalogram (EEG) features, imaging, length of stay in PICU, and in-hospital mortality were collected. Data was presented in frequencies, mean, standard deviation. Results: In present study, male to female ratio was 1.5:1 with mean age of 48.9±44.5 months. The most common causes of seizures in PICU setting were acute symptomatic in 185 (73.1%) and epileptic in 68 (26.9%) patients. Central Nervous System (CNS) infections constituted 15.8% of the PICU admissions following seizures. Most frequent co-existent diagnosis at admission was infectious diseases in 96 (38%) patients, followed by pulmonary diseases in 28 (11%) and cardiologic diseases in 14 (5.5%). Conclusion: CNS infections are the most common cause of acute symptomatic seizure, while non infectious diseases such as metabolic disorders, epilepsy and immune disorders also contribute to seizure occurrence in PICU. Identification of common seizure aetiologies in PICU is important step for a prompt and effective treatment.

2146. Impact of MRSA colonization pressure on MRSA acquisition and MRSA infection in pediatric intensive care unit

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) colonization pressure (CP) is a useful indicator for measuring the extent of MRSA reservoir in healthcare settings. The purpose of this study is to determine the MRSA colonization rate and invasive MRSA infection rate in severely ill pediatric patients requiring pediatric intensive care unit (PICU) stay, and to evaluate the association between MRSA CP and MRSA acquisition/invasive infection. Methods From January 2016 to December 2020, pediatric patients admitted to 2 PICUs with a total of 25 beds were retrospectively analyzed. Routine nasal and/or endotracheal cultures were performed on MRSA at the time of PCIU admission and thereafter, every week. MRSA CP was defined as the ratio of the monthly MRSA positive number of patients to 100 patient days. Among MRSA colonizers, MRSA obtained after 2 days of PICU admission was defined as an acquired colonizer, and imported colonizer was defined when it was confirmed as an MRSA colonizer at the time or within 2 days of entry. When MRSA was cultured in a normally sterile body fluids, it was defined as an invasive MRSA infection. Results Of the total 6,907 patients admitted to the PICUs during this study period, 8.4% (487/6,907) were MRSA colonizers; 30% (139/487) were acquired colonizers, and invasive MRSA infections occurred in 3.3% (16/487). During the stay in the PICUs, the MRSA acquisition rate was 4.1%. A total of 22 invasive MRSA infections occurred during this study period, with an incidence rate of 3.1/1,000 patient days, of which 72.7% (n=16) occurred to the patients with MRSA colonization. Invasive MRSA infection occurred in 2.4% (8/348) of imported colonizers, and 5.2% (8/139) of acquired colonizers (p=0.108). The median duration from the time of colonization to invasive infection was 24 days(IQR; 2.25-49.75). Although MRSA CP was not correlated with the incidence of invasive MRSA infection (p=0.101), MRSA CP itself affected MRSA acquisition in PICU (p&amp;lt; 0.001). Conclusion MRSA CP influenced the new acquisition of MRSA during PICU stay, and newly acquired colonizers are more likely to experience invasive MRSA infection. Continuous multi-faceted efforts to minimize MRSA CP can provide opportunities for reducing MRSA colonization and infections rates in PICU settings. Disclosures All Authors: No reported disclosures.

Staff perception of the implementation, enablers and barriers to pediatric intensive care unit diary writing: A qualitative study

ObjectivesTo explore how the multi-professional pediatric intensive care unit staff experienced the implementation of the diary. Research Methodology/DesignQualitative study using the implementation research approach.Setting: a six-bed pediatric intensive care unit at a large Italian tertiary care pediatric hospital, treating patients with acute conditions from the Emergency Department or hospital wards. Main outcome measuresHealthcare providers’ experiences of the implementation of the diaries. Data was collected by focus groups and interviews and thematic analysis was performed. FindingsThree focus groups and four interviews with staff were conducted after the implementation of thediaries from August 2020 to June 2021. Staff describe an initial disbelief towards the effectiveness of diaries followed by an increasing perception of their relevance for parents’ emotional expression through shared narration. Diaries are reported as a beneficial communication tool between the family, the child, and health care providers, increasing staff understanding of parents’ experiences of their child’s admission and parents’ sense of the care received by their child. For staff, barriers for diary writing were logistics, lack of time, limited sense of ownership, fear of legal retaliation and fear of emotional labor. ConclusionHealth care providers perceived diaries as beneficial for parents and the healthcare team, potentially supporting their partnership as recommended by Family Centered Care models. The enablers and barriers that emerged for diary writing can support the development of implementation strategies to prevent the reported challenges to diary writing in the healthcare team, enhancing their uptake in the pediatric intensive care unit setting.

Ensuring Safe Sleep in the Pediatric Intensive Care Unit: A Systematic Review of Informed Development of Clinical Guidelines for Implementation in Practice

Although general safe sleep guidelines have been established, their utility and implementation have yet to be examined systematically for inpatient populations for application to infants in the pediatric intensive care unit (PICU) setting. This study aimed to complete a systematic review of inpatient safe sleep practices studies to develop then safe sleep clinical guidelines for implementation in the care of medically complex infants in the PICU. This review was registered with PROSPERO and adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses systematic review guidelines. Nineteen articles met the inclusion criteria. A safe sleep guideline algorithm for medically complex infants in the PICU was created for implementation. Consistent and comprehensive safe sleep education and modeling by health care professionals in the inpatient setting is an effective technique to reduce the risk of harm and promote safe sleep behaviors in the home setting.

Immunoparalysis in critically ill children.

Immunoparalysis is associated with poorer outcomes in the paediatric intensive care unit (PICU) setting. We aimed to determine the group of patients with higher chances of immunoparalysis and correlate this status with increased risks of nosocomial infection and adverse clinical parameters. We conducted an exploratory study with prospective data collection in a university-affiliated tertiary medical, surgical, and cardiac PICU. Fifteen patients with multiple organ dysfunction syndrome were included over a period of 6 months. Monocyte's human leucocyte antigen (HLA)-DR expression and tumour necrosis factor (TNF)-α and interleukin (IL)-6 production were measured by flow-cytometry at three time points (T1=1-2 days; T2=3-5 days; T3=6-8 days). Using the paediatric logistic organ dysfunction-2 score to assess initial disease severity, we established the optimal cut-off values of the evaluated parameters to identify the subset of patients with a higher probability of immunoparalysis. A comparative analysis was performed between them. Sixty per cent were males; the median age was 4.1 years. Considering the presence of two criteria in T1 (classical monocytes mean fluorescence intensity [MFI] for HLA-DR ≤ 1758.5, area under the curve (AUC)=0.775; and frequency of monocytes producing IL-6 ≤ 68.5%, AUC=0.905) or in T3 (classical monocytes MFI of HLA-DR ≤ 2587.5, AUC=0.675; and frequency of monocytes producing TNF-α ≤ 93.5%, AUC=0.833), a variable to define immunoparalysis was obtained (100% sensitivity, 81.5% specificity). Forty per cent of patients were assigned to the immunoparalysis group. In this: a higher frequency of nosocomial infection (p= 0.011), vasoactive inotropic score (p= 0.014) and length of hospital stay (p= 0.036) was observed. In the subgroup with the diagnosis of sepsis/septic shock (n= 5), patients showed higher percentages of non-classical monocytes (p= 0.004). No mortality was recorded. A reduction in classical monocytes HLA-DR expression with lower frequencies of monocytes producing TNF-α and IL-6 during the first week of critical illness, appears to be a good marker of immunoparalysis; these findings relate to an increased risk of nosocomial infection and deleterious outcomes. The increased frequency of non-classical monocytes in patients with sepsis/septic shock is suggestive of a better prognosis.

Dystonia in children with acquired brain injury.

To quantify the proportion of children who develop dystonia after acquired brain injury (ABI) admitted to a tertiary paediatric intensive care unit (PICU) and analyse the trajectory of dystonia over a 6 month period. Children's Health Ireland at Temple Street PICU electronic database was searched for key terms related to ABI from January 1, 2016 to March 14, 2021. Individuals meeting inclusion criteria were analysed, and clinical data pertinent to ABI, dystonia, treatment and outcomes were reviewed. Six-hundred and forty-three PICU episodes (580 patients) met search criteria for ABI, with 379 included in the final analysis. Twelve patients developed dystonia following ABI, giving an incidence of 3.2%. The incidence was higher in the hypoxia/anoxia and TBI cohort at 8.3% and 6.2%, respectively. All patients developed dystonia within the first month following ABI (50% by a week). Patients who developed dystonia compared to non-dystonia cohort had a median lower GCS on admission (4.5 versus 7.0, p value 0.032), longer median length of PICU stay (14.0 versus 3.0 days, p value<0.001) and were older (median age 9.08 versus 4.68 years, p value 0.06). Dystonia persisted in the majority at 6 months (10/11), requiring on-going medical therapies. In our retrospective study, the estimated incidence of dystonia following ABI admitted to the PICU was 3.2%, highest in the hypoxia/anoxia (8.3%) and TBI (6.2%) cohorts. Dystonia emerged early and persisted at 6 months in the majority. This is the first review of dystonia, clinical trajectory and outcomes conducted post-PICU admission for ABI. Future prospective studies are required to determine the true prevalence and burden of disease in the PICU setting.

Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence.

Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.

Impact of Pediatric Intensive Care Unit Preadmission Huddle on Perceptions of Interprofessional Communication About Patient Safety.

Preadmission discussions in the study institution's pediatric intensive care unit are not standardized and admission plans were thought to be disjointed, leading to a perceived lack of organization and preparation for the arrival of a critically ill child. To evaluate the impact of a new, formalized preadmission pediatric intensive care unit interdisciplinary huddle on clinician perceptions of interprofessional communication. The hypothesis was that preadmission huddles would improve unit clinicians' perceptions of interprofessional communication. Interprofessional pediatric intensive care unit clinicians (physicians, advanced practice providers, nurses, and respiratory therapists) completed surveys before and 7 months after preadmission interdisciplinary huddle implementation. Huddle compliance and perceptions of interprofessional communication in the unit were evaluated. Of 265 eligible pediatric intensive care unit admissions, 69 huddles (26.0%) occurred. The postintervention survey revealed increased odds (odds ratio [95% CI]) of responding "strongly agree" or "agree" to questions about the opportunity to "communicate effectively with health care team members" (2.42 [1.10-5.34]), "respond to feedback from health care team members" (2.54 [1.23-5.24]), and "convey knowledge to other health care team members" (2.71 [1.31-5.61]) before an admission. This study introduced a formalized huddle that improved pediatric intensive care unit clinicians' perceived communication with other health care team members in the preadmission period. Future studies are needed to determine if this perceived improvement in communication significantly affects health care outcomes of critically ill children or if these results are generalizable to other pediatric intensive care unit settings.

Healthcare-associated viral respiratory infections in paediatric intensive care unit settings: More than just a sneeze

SummaryHealthcare-associated infections (HAIs) affect patient health. Patients with Paediatric Intensive Care Unit (PICU) acquired viral respiratory infections had longer use of respiratory support. We found it's uncommon in ICUs to have high risk HAIs. RSV, parainfluenza, and hMPV are the most common, and 1/3 of patients required escalation in respiratory support and/or escalation in antibiotics. All patients had underlying comorbidities. In our series there were two deaths within 2 weeks of infection.