Coping with the stress in the cardiac intensive care unit: Can mindfulness be the answer?

Mothers of infants with complex congenital heart disease are exposed to increased stress which has been associated with numerous adverse health outcomes. The coping mechanisms these mothers use critically effect the familial illness adaptation and most likely infant outcomes | Journal of Pediatric Nursing

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Currently no data-based strategies have been developed for mothers to facilitate their coping, and proactively promote their adaptation in the critical care settings. A potential strategy is mindfulness which is currently used in other clinical settings with stress-reduction effects.

Highlights:

  • Mothers use emotion-regulatory coping mechanisms during the CICU stay.
  • Both active and passive strategies are used by mothers to cope with the stress.
  • Mindfulness is an acceptable and feasible approach to reduce mothers’ stress.
  • Early, tailored interventions can potentially provide long-term stress relief.

Full reference: Golfenshtein, N. et al. (2017) Coping with the stress in the cardiac intensive care unit: Can mindfulness be the answer? Journal of Pediatric Nursing. Published online: August 11, 2017

Ear Care for the Most Vulnerable Infants

Each year, approximately 6,000 newborns-of the nearly 4 million births in the U.S.-are diagnosed with permanent hearing loss, and premature infants are 50 percent more likely than full-term infants to develop hearing loss | ASHA Leader

Infants’ experiences in the neonatal intensive care unit (NICU) are highly variable, depending on the complexity of their cases and degree of prematurity. Those with more severe or chronic medical and neurodevelopmental conditions present particular challenges to the audiology team.

Complications of their conditions can delay hearing screening, and the medical equipment helping to support them may interfere with the screening itself. The NICU environment can also be noisy for this vulnerable population. Yet another challenge is the emotional fragility of these infants’ parents.

Although audiology isn’t part of the primary NICU care team, every infant receives a hearing screen, and any infant with a failed screen receives diagnostic audiological testing. This means the hearing-screening staff and audiology team play an important role, particularly after a baby does not pass the hearing screening. Audiologists can also play a key role in the development, implementation and oversight of the newborn hearing program (see more on newborn hearing screening on the ASHA Practice Portal: on.asha. org/newborn-screening). In these cases, the audiologist serves as the primary source of hearing-related information for the parents and the medical team.

To address the particular challenges of the NICU population, audiologists need to communicate and work closely with the NICU staff as soon as it’s appropriate, consider the effects of medical equipment, communicate with parents with a great deal of sensitivity, and work at coordinating discharge planning and follow-up care with the infant’s parents and other providers.

Full reference: McGrath, A. P., & Vohr, B. R. (2017). Ear care for the most vulnerable infants. ASHA Leader, 22(8), 20-22.

 

Risk Stratification in Pediatric Acute Respiratory Distress Syndrome

This study aims to describe the epidemiology of patients with PARDS across Asia and evaluate whether the Pediatric Acute Lung Injury Consensus Conference risk stratification accurately predicts outcome in PARDS | Critical Care Medicine

Objectives: The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specific definition for acute respiratory distress syndrome (PARDS). In this definition, severity of lung disease is stratified into mild, moderate, and severe groups. We aim to describe the epidemiology of patients with PARDS across Asia and evaluate whether the Pediatric Acute Lung Injury Consensus Conference risk stratification accurately predicts outcome in PARDS.

 

Measurements and Main Results: Data on epidemiology, ventilation, adjunct therapies, and clinical outcomes were collected. Patients were followed for 100 days post diagnosis of PARDS. A total of 373 patients were included. There were 89 (23.9%), 149 (39.9%), and 135 (36.2%) patients with mild, moderate, and severe PARDS, respectively. The most common risk factor for PARDS was pneumonia/lower respiratory tract infection (309 [82.8%]). Higher category of severity of PARDS was associated with lower ventilator-free days (22 [17-25], 16 [0-23], 6 [0-19]; p < 0.001 for mild, moderate, and severe, respectively) and PICU free days (19 [11-24], 15 [0-22], 5 [0-20]; p < 0.001 for mild, moderate, and severe, respectively). Overall PICU mortality for PARDS was 113 of 373 (30.3%), and 100-day mortality was 126 of 317 (39.7%). After adjusting for site, presence of comorbidities and severity of illness in the multivariate Cox proportional hazard regression model, patients with moderate (hazard ratio, 1.88 [95% CI, 1.03-3.45]; p = 0.039) and severe PARDS (hazard ratio, 3.18 [95% CI, 1.68, 6.02]; p < 0.001) had higher risk of mortality compared with those with mild PARDS.

Conclusions: Mortality from PARDS is high in Asia. The Pediatric Acute Lung Injury Consensus Conference definition of PARDS is a useful tool for risk stratification.

Full reference: Wong, J, J-M. et al. (2017) Risk Stratification in Pediatric Acute Respiratory Distress Syndrome: A Multicenter Observational Study. Critical Care Medicine. Published online: July 26 2017

 

Early management of paediatric burn injuries

Gill, P. & Falder, S. Paediatrics and Child Health | Published online: 21 April 2017

B0006880 Skin cells from a scald

Image source: Anne Weston, LRI, CRUK – Wellcome Images // CC BY-NC-ND 4.0

Image shows skin cells from a scald

Burns are a common form of trauma in children, resulting most frequently from scalds but also contact, flame, electrical and chemical sources. Burn patients have a wide spectrum of injury severity and diverse outcome, ranging from superficial burns with no lasting physical signs to deep, large body surface area burns which are profoundly life-changing, affecting all physiological systems. Size, site and depth are important factors affecting treatment and outcome.

There are important anatomical, physiological and psychosocial differences between adults and children. Their body proportions are different, they have thinner skin, smaller airways, reduced blood volume and high levels of distress. They are vulnerable to non-accidental injury.

Children require formal fluid resuscitation and maintenance fluids for burns more than 10% total body surface area. Complications include infection, toxic shock syndrome, adverse scarring and psychological sequelae. This paper discusses how correct assessment and management in the acute stage can reduce later morbidity and mortality.

Read the full abstract here

Transport of the critically ill child

Sarfatti, A. & Ramnarayan, P. Paediatrics and Child Health | Published online: 5 March 2017

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With the centralization of specialist services into a limited number of hospitals across the UK, an increasing number of children require an inter-hospital transfer. In 2014, 6000 critically ill or injured children were transferred between hospitals in the UK. While most of the transfers are done by specialist teams, as many as 23% are done by non-specialist teams.

These patients are some of the sickest children. It is while in transit that these patients are most at risk, and the transferring team is most exposed. To achieve a smooth and safe transfer it is important that the appropriate team with the relevant skills undertakes such transfers. The patient’s condition should be optimised before transfer and any likely difficulties are anticipated, and that the transferring team is prepared to act to resolve any complications swiftly and effectively. In this review we will attempt to offer our approach to the safe transfer of the critically ill child.

Read the abstract here

Delirium in Critically Ill Children

Traube, Chani et. al. Delirium in Critically Ill Children: An International Point Prevalence Study.
Critical Care Medicine. published online ahead of print January 10th 2017

Objectives: To determine prevalence of delirium in critically ill children and explore associated risk factors.

Design: Multi-institutional point prevalence study.

Setting: Twenty-five pediatric critical care units in the United States, the Netherlands, New Zealand, Australia, and Saudi Arabia.

Patients: All children admitted to the pediatric critical care units on designated study days (n = 994).

Intervention: Children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the bedside nurse. Demographic and treatment-related variables were collected.

Measurements and Main Results: Primary study outcome measure was prevalence of delirium. In 159 children, a final determination of mental status could not be ascertained. Of the 835 remaining subjects, 25% screened positive for delirium, 13% were classified as comatose, and 62% were delirium-free and coma-free. Delirium prevalence rates varied significantly with reason for ICU admission, with highest delirium rates found in children admitted with an infectious or inflammatory disorder. For children who were in the PICU for 6 or more days, delirium prevalence rate was 38%. In a multivariate model, risk factors independently associated with development of delirium included age less than 2 years, mechanical ventilation, benzodiazepines, narcotics, use of physical restraints, and exposure to vasopressors and antiepileptics.

Conclusions: Delirium is a prevalent complication of critical illness in children, with identifiable risk factors. Further multi-institutional, longitudinal studies are required to investigate effect of delirium on long-term outcomes and possible preventive and treatment measures. Universal delirium screening is practical and can be implemented in pediatric critical care units.

New blood draw protocol could minimize risk for critically ill children

Checklist-style guidelines decreased unnecessary blood culture collection by nearly half in study

Investigators say that safely reducing the frequency of blood draws in hospitalized children with fevers has historically not been a hospital priority despite the stress, pain and high rate of false positives associated with the procedure.

The researchers found that fostering cross-departmental collaboration and offering guidelines to clinicians helped reduce the number of unnecessary blood draws on some of the smallest and most vulnerable patients at the Johns Hopkins Children’s Center. Clinicians were able to accomplish an immediate reduction in unnecessary blood draws using the newly designed checklist protocols, and they were able to sustain the reduction over time.

Read the full overview here

Read the original research abstract here