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Dissertations / Theses on the topic 'Critically ill children'
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Branco, Ricardo Garcia. "Stress response in critically ill children." Thesis, University of Cambridge, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.609718.
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Robertson, Gillian. "Hypernatraemic gastroenteritis in critically ill children." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/9261.
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Ullman, Amanda. "The oral health of critically ill children." Thesis, Queensland University of Technology, 2009. https://eprints.qut.edu.au/31765/1/Amanda_Ullman_Thesis.pdf.
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Introduction. In adults, oral health has been shown to worsen during critical illness as well as influence systemic health. There is a paucity of paediatric critical care research in the area of oral health; hence the purpose of the Critically ill Children’s Oral Health (CCOH) study is to describe the status of oral health of critically ill children over time spent in the paediatric intensive care unit (PICU). The study will also examine the relationship between poor oral health and a variety of patient characteristics and PICU therapies and explore the relationship between dysfunctional oral health and PICU related Healthcare-Associated Infections (HAI).
Method. An observational study was undertaken at a single tertiary-referral PICU. Oral health was measured using the Oral Assessment Scale (OAS) and culturing oropharyngeal flora. Information was also collected surrounding the use of supportive therapies, clinical characteristics of the children and the occurrence of PICU related HAI.
Results. Forty-six participants were consecutively recruited to the CCOH study. Of the participants 63% (n=32) had oral dysfunction while 41% (n=19) demonstrated pathogenic oropharyngeal colonisation during their critical illness. The potential systemic pathogens isolated from the oropharynx and included Candida sp., Staphylococcus aureus, Haemophilus influenzae, Enterococcus sp. and Pseudomonas aeruginosa. The severity of critical illness had a significant positive relationship (p=0.046) with pathogenic and absent colonisation of the oropharynx. Sixty-three percent of PICU-related HAI involved the preceding or simultaneous colonisation of the oropharynx by the causative pathogen.
Conclusion. Given the prevalence of poor oral health during childhood critical illness and the subsequent potential systemic consequences, evidence based oral hygiene practices should be developed and validated to guide clinicians when nursing critically ill children.
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Jones, P. R. "Haemodynamic instability during the intubation of critically-ill children." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1370569/.
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Haemodynamic instability is common during critical illness when homeostatic mechanisms are attenuated or already at the limit of their efficacy. Intubation is a crucial life-saving intervention which seeks to stabilize respiratory and cardiovascular function, but itself represents an additional, short-term haemodynamic challenge. This thesis aimed to investigate changes in heart rate during intubation of critically ill children. Heart rate was chosen as a crude measure of haemodynamic stability because it is most readily available even in time-critical pre-hospital settings. Focusing on heart rate also raised the question of the benefits of atropine pre-medication The first study was an international survey of Paediatric Intensivists using the Delphi methodology. There was agreement that there is a risk of death during intubation. There was no agreement about the capacity of atropine to reduce the incidence of bradycardia, hypotension or death. An observational study of 414 intubations in critically ill children was used to provide data for the thesis. Reductions in heart rate were common amongst first intubations in neonates, children between 28 days of age and eight years and further intubations in both groups. The limitations of using the minimum heart rate as a measure of haemodynamic disturbance were considered. An alternative measure of the change in heart rate, or ‘lost-beats’, was proposed and investigated. Atropine use was associated with less of a fall in heart rate and fewer lost heart beats during intubation. There was a strong association between a low heart rate and an increased incidence of arrhythmias and conduction abnormalities during intubation. Arrhythmias and conduction abnormalities were reduced, but not eliminated, by atropine pre-medication. Sinus tachycardia was not observed to convert to ventricular tachycardia or fibrillation when atropine was used. Mortality during critical care intubation was low (<0.5%). Atropine could not be statistically proven to have an effect on mortality during intubation although was associated with reduced intensive care mortality in children over 28 days of age but not in neonates. The association of atropine pre-medication with reduced PICU mortality in children over one month is unexpected and requires further investigation. A rabbit model of endotracheal intubation was used to investigate the consequences of vagal activation on blood pressure in hypovolaemia and endotoxaemia. Hypovolaemic rabbits observed a significantly smaller decrease in blood pressure after vagal stimulation than that in control rabbits. The relative change in blood pressure after vagal stimulation was similar between the endotoxaemic rabbits and controls. This finding suggests that different disease states may influence the haemodynamic function during intubation.
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Waardenburg, Dirk Adriaan van. "Protein metabolism and nutritional requirements in critically ill children." Maastricht : Maastricht : Maastricht University ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=15092.
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Agbeko, R. S. "Characterization of the acute phase response in critically ill children." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1421089/.
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Humans come into contact and interact with potential infective agents. The innate immune system is the first line of response to ward off infection. Innate immunity is, in part, under genetic control. This genetic control may help us understand the differences between individuals in preventing infection or limiting infectious and inflammatory illness. Systemic inflammation is a complex disorder that is difficult to define. Current definitions are derived from consensus meetings. A need has been expressed for a more useful definition of systemic inflammation. The work presented here identifies some of the underlying hereditability in limiting or being more vulnerable to severe infectious and injurious insults. Individual differences in complement activation potential and endotoxin recognition underlie part of the observed differences in a systemic inflammatory response to severe infection and injury. An exploratory study using heart rate variability as a non-invasive method to distinguish infectious systemic inflammation from sterile systemic inflammation was inconclusive. Chapter 1 gives the background to this study and an introduction to the approaches taken in this thesis. Chapter 2 describes in detail the methods used in the genetic association study and physiological systems analysis. Chapter 3 goes into some detail about the potential pitfalls in genotyping association studies and how these were addressed in the current study. The areas of genotypi ng quality, linkage disequilibrium, ethnicity, sample size and validation of previously done work are discussed using MBL-2 and ACE as examples. Chapter 4 is a description of the work done on genetic variability in the endotoxin receptor complex and how in may result in the host response to severe infection and physical insults. TLR4 polymorphisms were associated with lower platelet counts in severe inflammation. The reasons for this are unclear but may point to a direct effect of the TLR4 pathways on platelets or indicate that platelet counts are a more sensitive marker of systemic inflammation than SIRS criteria. These data support the view that variation in TLR4 function influences the early inflammatory response. This phenomenon may be one aspect of reduced fitness in the capacity to respond appropriately to an insult. Chapter 5 reports the central role of complement in the acute phase response. Polymorphisms in two out of the three complement activation pathways were shown to have potential modifying effects in paediatric systemic inflammation. This chapter reports that polymorphisms in the CFH gene may modulate the acute inflammatory response and corroborates the previously reported finding that MBL-2 variant genotypes are a risk factor for the early occurrence of SIRS/sepsis in a large cohort of paediatric critical care patients, independent of other potentially important functional polymorphisms in the complement and innate immunity system. A better understanding of how these polymorphisms operate at the pathophysi ol ogi cal level is needed before these findings can be translated to clinically useful therapeutic modalities. This study demonstrates that genetic polymorphisms associated with reduced complement activation may be associated with early SIRS/sepsis. This is consistent with a view that appropriate complement activation occurring early following an infectious or inflammatory insult protects children from early SIRS/sepsis. Chapter 6 assesses the usefulness of full MBL-2 genotyping and compares the MBL-2 genotype and M BL serum levels between a cohort of healthy children and a cohort of critically ill paediatric patients. MBL2 genotyping did not render more information with regards to M BL serum level when all promoter and structural polymorphisms were identified over and above structural polymorphisms and the XY promoter polymorphism. The children admitted with infection did not have a surplus of M BL deficient genotypes as compared with healthy children. This suggests that M BL deficient genotypes do not predispose to severe infection. M BL serum levels in SIRS or sepsis were lower compared with critically ill children without systemic inflammation. M BL levels were most reduced in the acute phase response in those genotypes with intermediate serum levels, which may reflect a consumption of M BL in critical illness and an inability to maintain pre-insult M BL serum levels. Chapter 7 explores a novel way to discriminate SIRS from sepsis by means of heart rate variability analysis. In this small paired sample study no differences were seen in LF metrics to differentiate sterile SIRS from sepsis. Neither was there a difference in LF metrics between those children who went on to develop a nosocomial infection and those who did not. Normalised HF was significantly higher in sterile SIRS vs. sepsis. These preliminary finding require further validation and a longitudinal approach in a larger cohort. Finally, Chapter 8 discusses the findings of this thesis in the context of interpretation and of the findings and potential future approaches. This thesis supports the view that better metrics are required to discriminate systemic inflammation as well as the concept that in children control of an inflammatory threat is aided by a vigorous capacity to respond.
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Hatherill, Mark. "Transport of critically ill children in a resource-limited setting." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/10987.
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Includes bibliographical references.Transportation of critically ill children by inexperienced personnel may be associated with increased risk of transfer-related adverse events and mortality. To audit paediatric intensive care unit (PICU) transfer activity and transfer-related adverse events in a resource-limited setting. Twenty-two bed regional PICU of a university children's hospital in Cape Town, South Africa. Prospective one-year audit of all children transferred directly to PICU from other hospitals. Data were collected for patient demographics and diagnostic category, referring hospital, transferring personnel, mode of transport, and the incidence of technical, clinical, and critical adverse events. Data are median (interquartile range, IQR). The transfers of 202 children, median age 2.8 months (1.1-14), median weight 3.5 kg (2.5-8.1) were analysed.
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Ista, Willem Gerrit. "Comfortably calm soothing sedation of critically ill children without withdrawal symptoms /." [S.l. : Rotterdam : The Author] ; Erasmus University [Host], 2008. http://hdl.handle.net/1765/13430.
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Ramelet, Anne-Sylvie. "The development of a multidimensional pain assessment scale for critically ill preverbal children." Thesis, Curtin University, 2006. http://hdl.handle.net/20.500.11937/1524.
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Adequate pain assessment is a pre-requisite for appropriate pain management. If pain remains untreated in critically ill young children, it can have dramatic short- and long-term consequences on their health and development. Apart from humanitarian reasons, the assessment of pain has been recognised in some parts of the world as the fifth vital sign and thus should be part of standard practice of pain management. The evaluation of pain in preverbal children is, nevertheless, challenging for health professionals, as they cannot rely on self-report when making their assessment. Observational pain instruments have been developed to facilitate this task, but none of these existing instruments are appropriate for the postoperative critically ill young child. The aim of this research was to provide a clinically valid pain instrument for health professionals to use in practice for the evaluation of the pain and the effectiveness of pain treatment in critically ill young children. This thesis presents research that was conducted in three phases to (a) describe pain, (b) develop, and (c) test the pain instrument. Conceptualisation of pain and psychometric theory informed the conceptual framework for this study. An observational design was used in Phase One of the study to define pain behaviour in critically ill infants. Correlational design was used in Phase Two and Three to determine the association between the newly developed pain scale and other pain assessment instruments. Phase One of the study was conducted in the paediatric intensive care units of two tertiary referral hospitals. Eight hundred and three recorded segments were generated from recordings of five critically ill infants, aged between 0 and 9 months, who had undergone major surgery.Results indicated significant physiological and behavioural changes in response to postoperative pain and when postoperative pain was exacerbated by painful procedures. Using the pain indicators observed in Phase One, in Phase Two the Multidimensional Assessment Pain Scale (MAPS) was developed and tested for reliability and validity in 43 postoperative preverbal children from the same settings. Internal consistency and interrater reliability were moderate and good, respectively. Concurrent and convergent validity was good. In Phase Three, the MAPS' response to analgesics and clinical utility was demonstrated in a convenience sample of 19 postoperative critically ill children aged between 0 and 3 1 months of age at a tertiary referral hospital in Western Australia. Development of a pain instrument is a complex and lengthy process. This study presents the preliminary psychometric properties that support the validity and clinical utility of the Multidimensional Assessment Pain Scale. The MAPS is a promising tool for assessing postoperative pain in critically ill young children, and its clinical validity will be strengthened with further testing and evaluation.
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Ramelet, Anne-Sylvie. "The development of a multidimensional pain assessment scale for critically ill preverbal children." Curtin University of Technology, School of Nursing and Midwifery, 2006. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=17177.
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Adequate pain assessment is a pre-requisite for appropriate pain management. If pain remains untreated in critically ill young children, it can have dramatic short- and long-term consequences on their health and development. Apart from humanitarian reasons, the assessment of pain has been recognised in some parts of the world as the fifth vital sign and thus should be part of standard practice of pain management. The evaluation of pain in preverbal children is, nevertheless, challenging for health professionals, as they cannot rely on self-report when making their assessment. Observational pain instruments have been developed to facilitate this task, but none of these existing instruments are appropriate for the postoperative critically ill young child. The aim of this research was to provide a clinically valid pain instrument for health professionals to use in practice for the evaluation of the pain and the effectiveness of pain treatment in critically ill young children. This thesis presents research that was conducted in three phases to (a) describe pain, (b) develop, and (c) test the pain instrument. Conceptualisation of pain and psychometric theory informed the conceptual framework for this study. An observational design was used in Phase One of the study to define pain behaviour in critically ill infants. Correlational design was used in Phase Two and Three to determine the association between the newly developed pain scale and other pain assessment instruments. Phase One of the study was conducted in the paediatric intensive care units of two tertiary referral hospitals. Eight hundred and three recorded segments were generated from recordings of five critically ill infants, aged between 0 and 9 months, who had undergone major surgery.Results indicated significant physiological and behavioural changes in response to postoperative pain and when postoperative pain was exacerbated by painful procedures. Using the pain indicators observed in Phase One, in Phase Two the Multidimensional Assessment Pain Scale (MAPS) was developed and tested for reliability and validity in 43 postoperative preverbal children from the same settings. Internal consistency and interrater reliability were moderate and good, respectively. Concurrent and convergent validity was good. In Phase Three, the MAPS' response to analgesics and clinical utility was demonstrated in a convenience sample of 19 postoperative critically ill children aged between 0 and 3 1 months of age at a tertiary referral hospital in Western Australia. Development of a pain instrument is a complex and lengthy process. This study presents the preliminary psychometric properties that support the validity and clinical utility of the Multidimensional Assessment Pain Scale. The MAPS is a promising tool for assessing postoperative pain in critically ill young children, and its clinical validity will be strengthened with further testing and evaluation.
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Sherman, Sandra Anne. "Healing effects of the built environment." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2008. http://wwwlib.umi.com/cr/ucsd/fullcit?p3321036.
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Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2008.Title from first page of PDF file (viewed Aug. 1, 2008). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 120-127).
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Saxena, Rohit. "An assessment of two novel tools for advanced haemodynamic monitoring in critically ill children." Thesis, King's College London (University of London), 2016. http://kclpure.kcl.ac.uk/portal/en/theses/an-assessment-of-two-novel-tools-for-advanced-haemodynamic-monitoring-in-critically-ill-children(f246dfbb-72ed-4b2e-a394-b9d28444ccec).html.
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Background: Critically ill children require accurate haemodynamic assessment to evaluate the severity of illness or response to therapy. Clinical estimation of cardiac output is inaccurate. Hence, advanced haemodynamic monitoring devices may help guide physicians towards the most appropriate treatment strategy. However, none of the currently available monitors for children fulfil all the criteria of an ideal device. Methods: We evaluated two novel minimally invasive haemodynamic monitoring devices in 100 critically ill children. The transpulmonary ultrasound dilution (TPUD) method is a validated indicator dilution based technique for measuring cardiac output in children. Pressure recording analytical method (PRAM) is an arterial pulse contour based method and is not yet validated in children. We compared PRAM with TPUD both in terms of agreement with absolute values of CO and also quantified the ability of PRAM to track changes in CO in response to therapy. We also evaluated the ability of TPUD to identify, and quantify, small anatomic shunts. Finally, a range of variables measured by TPUD and PRAM were assessed for their ability to predict response to fluid bolus administration. The contribution of baseline myocardial contractility towards that response was also evaluated. Results: PRAM showed unacceptable level of error for estimation of absolute values of CO and was unable to accurately track changes in CO. TPUD could identify small anatomic shunts. All of the volumetric variables were unable to predict accurately for fluid responsiveness. Myocardial contractility was found to be an important determinant of the response of stroke volume to fluid bolus administration. Conclusion: A revision of the current algorithm of PRAM is recommended for measurement of CO in children. The predictive ability of the studied variables was poor to moderate for determining response of stroke volume to fluid bolus administration.
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Morrow, Brenda May. "An investigation into nonbronchoscopic bronchoalveolar lavage and endotracheal suctioning in critically ill infants and children." Doctoral thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/3023.
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Includes bibliographical references.This thesis investigated the effects on critically ill, mechanically ventilated paediatric patients of two related, frequently performed physiotherapy procedures: nonbronchoscopic bronchoalveolar lavage (NB-BAL) and endotracheal (ET) suctioning. General aims: To investigate un- or poody-documented complications of paediatric NBBAL and ET suctioning, and to test a method for each procedure of reducing the incidence and/or severity of these complications.
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Menzies, Julie Christine. "Designing and conducting feasible and acceptable pharmacokinetic research in critically ill children : a mixed methods study." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8153/.
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Introduction: Despite the importance of pharmacokinetic (PK) information for patient management there are low numbers of paediatric PK studies and little guidance available on optimum study design and conduct. Method: Drawing on Implementation Science, a mixed-methods study was conducted, including a scoping review (SR) (PK literature: 1990-2015) and quantitative and qualitative inquiry (stakeholders: lay population, service users and health-care professionals). Aim: to explore the feasibility and acceptability of paediatric PK research. Results: The SR (203 papers) highlighted significant problems with participant recruitment, retention and sampling. Stakeholders (n=240) added insight into these phenomenon, with lack of research staff, additional blood-sampling and appointments highlighted as significant barriers to recruitment and conduct. Facilitators included sensitivity and timeliness of approach, communication, involvement of child/young person (CYP) in decision-making, engagement between research and clinical teams, reassurance of safety, pain minimisation, and avoidance/reduction of burden to the CYP and family. Dedicated research support was viewed as critical to success. Discussion: PK research was viewed as feasible and acceptable by service users and health professionals, even in the context of critical illness. Novel, evidence-based, patient-centred, recommendations for future PK study conduct and design have been generated which are applicable for those designing, approving and implementing PK research.
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Harari, Sarah Hobson 1959. "Relationship of social support and spirituality to the coping effort of mothers of critically ill children." Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/558126.
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Maxton, Fiona, University of Western Sydney, College of Social and Health Sciences, and of Nursing Family and Community Health School. "Sharing and surviving the resuscitation : parental presence during resuscitation of a child in PICU : the experiences of parents and nurses." THESIS_CSHS_NFC_Maxto_F.xml, 2005. http://handle.uws.edu.au:8081/1959.7/593.
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Parents’ presence and participation in their child’s care in the paediatric intensive care unit (PICU) is now commonplace. Despite parents expressing a deep need to be with their child particularly during periods of crisis, it is precisely at these times that they are often prevented from staying. The growing debate regarding family presence during a cardiopulmonary (CPR) resuscitation attempt continues to be controversial and conflicting. Current knowledge is mostly derived from quantitative studies conducted in the adult intensive care or emergency environments. The experiences of parents of children in the PICU, and the nurses caring for them are unknown. Using van Manen’s hermeneutic phenomenological approach, this study describes the phenomenon of parental presence during resuscitation of a child in PICU for eight Australian parent couples and six nurses. Experiential descriptions, obtained in tape-recorded unstructured interviews were subjected to two layers of analysis. Thematic analysis provided the phenomenological description in seven themes. Four themes refer to the parents’ experience in Being only for a child; Making sense of a living nightmare; Maintaining hope: facing reality and Living in a relationship with staff. Three themes describe the nurses’ experience: Under the parents’ gaze; Walking in their shoes and Holding parents in mind. A second layer of hermeneutic analysis revealed parents’ and nurses’ collective experience to have their being in four elements of the phenomenon. These elements are Being in chaos; Struggling to connect; Being for another and Being complete. The final description of the parents’ and nurses’ experience of parental presence during resuscitation in PICU as Sharing and surviving the resuscitation is drawn from the findings from each of these layers of meaning. The findings from this study conclude that the parents’ inherent need to be with their child overrode their anxieties of the resuscitation scene, curbing their feelings of chaos. Parental presence however, was a complex and dynamic concept that required a new relationship between parents and nurses. Implications of this study include recommendations for improving staff knowledge and education, as well as practical interventions for enhanced support for both parents and nursesDoctor of Philosophy (PhD)
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SPOLIDORO, GIULIA CARLA IMMACOLATA. "NUTRITIONAL STATUS, ENERGY REQUIREMENTS AND METABOLIC MONITORING IN CRITICALLY ILL CHILDREN: THE NEW PERSPECTIVE OF ARTIFICIAL NEURAL NETWORKS." Doctoral thesis, Università degli Studi di Milano, 2021. http://hdl.handle.net/2434/829333.
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Nutrition plays a pivotal role in all humans. As early as during foetal life, a correct nutrition has the power to influence the development of organs and tissues, ultimately setting the basis for a healthy life. In critically ill children the risk of malnutrition is of particular importance. Accordingly, an appropriate monitoring of nutritional status and metabolic response, along with the correct assessment of energy requirements and energy balance, is gaining growing clinical relevance as a fundamental prognostic factor and should be considered a specific target in the management of critically ill children. The first step for a tailored nutritional support is the knowledge of patients’ resting energy expenditure (REE). Indirect calorimetry (IC) is the gold standard for REE measurement, however, its clinical use is limited across the world for both logistic and technical limitations. Alternatively, REE can be estimated using predictive equations, but this method has been found to be highly inaccurate in pediatric patients. Recent data pointed out that artificial neural networks (ANN) might represent a precise and accurate method to estimate REE in healthy and obese children. However, specific data regarding the applicability of the methodology on critically ill subjects are still missing. This thesis aimed to investigate the potential role of ANN on REE prediction for critically ill children by applying ANN to a dataset containing data on IC performed in our pediatric intensive care unit (PICU). We prospect that data derived from our observations could lead to a more accurate estimation of REE and to a better understanding of the energy requirements of critically ill children.
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Durrette, Monica. "Uncertainty and Primary Appraisal as Predictors of Acute Stress Disorder in Parents of Critically Ill Children: A Mediational Model." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/3023.
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This study examined illness-related uncertainty and primary appraisals of threat, centrality, and challenge as predictors of acute stress disorder (ASD) symptoms in parents of children hospitalized in a pediatric intensive care unit (PICU). Ultimately, a mediational pathway was tested to determine if primary appraisal was a mechanism that accounted for the impact of uncertainty on ASD symptoms. Ancillary study aims were to assess the degree to which parents perceived uncertainty in the PICU environment, and to determine the prevalence of ASD among parents in this setting. Self-report data was collected from 77 parents (57 mothers, 19 fathers) of children hospitalized in a PICU for a minimum of 48 hours. Descriptive analyses showed that parents perceived a high degree of uncertainty and 57% of parents met diagnostic criteria for ASD. Unexpected admission was the only objective medical status variable significantly related to uncertainty, threat appraisal, and ASD symptoms. Consistent with hypotheses, results from hierarchical regression analyses showed that perceived uncertainty and primary appraisals of threat accounted for significant variance in parents’ ASD symptoms; however, neither centrality nor challenge appraisals were related to parents’ ASD symptoms. Because threat was the only appraisal dimension found to be directly related to ASD symptoms, it was the only dimension tested in the mediational model. Consistent with the hypothesis, threat appraisals fully mediated the effect of uncertainty on ASD symptoms; results from a Sobel test confirmed the significance of full mediation. This study is the first to examine uncertainty, primary appraisal, and ASD symptoms in this population. Results clarify that it is not the mere perception of uncertainty that adversely impacts parental adjustment, but rather how it is appraised, and therefore, point to a practical area for in-hospital interventions targeting parents’ pediatric medical traumatic stress symptoms. Although a substantial body of empirical research supports a relation between uncertainty and maladaptive outcomes, studies also link uncertainty to positive outcomes. Future research should include positive indicators of adjustment and examine how appraisals vary according to sources of uncertainty.
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Vosloo, Ruan. "An Assessment of Critically Ill Children admitted to a General High Care Unit in a Regional Hospital in the Western Cape, South Africa." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33077.
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Background Many critically ill children in South Africa are cared for in regional hospitals by general Paediatricians. Critically ill adults and children are usually cared for in the same units. There is limited data on the numbers of children admitted and the outcomes of these children. Objective To describe the patient profile and outcomes of children admitted to a general high care unit (HCU) in a regional hospital in the Western Cape, South Africa. Methods This was a retrospective descriptive study of all children admitted to the HCU of George Regional Hospital during a one year period (2016). Demographic data, HIV, anthropometric data, immunisation status, diagnoses, medical interventions, length of stay, death or survival, and referral data to the tertiary paediatric intensive care unit (PICU) were collected. The PIM3 score and Standardized Mortality Ratio (SMR) was calculated. Results Thirty percent (144/468) of the HCU admissions were children. Most (70%) were admitted after hours. Half were under 9 months (range 3 days to 149 months). Sixty-five percent of the children required respiratory support and 45% needed inotropic support. Twenty percent of the children were transferred to the PICU. Twelve children (8,5%) died with most deaths (75%) occurring at regional level. Half of the deaths were due to sepsis with pneumonia (25%) and diarrhoea with shock (25%) accounting for the rest. The cumulative PIM3 score was 9.049 (95%CI 6.430-11.668) with an SMR of 1.326 (95%CI 1.028-1.866) observed. Conclusion Critically ill children accounted for a third of HCU admissions. Most children needed medical interventions. These require specific training and equipment that are often lacking. After hours admissions also put strain on limited staff. Most children were successfully discharged demonstrating a good outcome. This was achievable with good channels of communication and transport to a tertiary PICU.
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Gruvberger, Åsa, and Charlotte Trossle. "Barns reaktioner när en närstående är allvarligt sjuk." Thesis, Högskolan i Halmstad, Hälsa och omvårdnad, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-34131.
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Children need help to understand and manage when a close relative is critically ill or dying. The purpose of the literature study was to highlight children’s reactions when a close relative is gravely ill. The method used was a general literature study where ten scientific articles where analyzed and reviewed. The results were compiled in two themes: Experiences when life is threatened and To cope when life is threatened. Children with a critically ill relative are in great need of being met and supported by nurses in a professional manner. This is based on knowledge and understanding of how children can experience, and how children cope in difficult situations like these. The results show that children take on great responsibility and often set themselves aside to help the ill and that many of the children experience the threat of loss as a constant fear. The result of the study can be used by nurses, in the clinical setting, who meet children with a critically ill family member to increase knowledge about the subject.
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Jacobson, Judy Rick. "Psychological and social effects of infant heart transplant on families." CSUSB ScholarWorks, 1989. https://scholarworks.lib.csusb.edu/etd-project/501.
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Gidlöf, Madeleine, and Lisbeth Hansson. "Jag är också närstående : Barns upplevelser av att vara närstående till en svårt sjuk person." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-16866.
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Då någon drabbas av allvarlig sjukdom eller skada som hotar livet påverkas inte bara den sjuke utan också alla i den sjukes närhet. Att som närstående vara barn i denna situation kan vara oerhört traumatiskt. För att vi som vårdpersonal ska kunna hjälpa och stötta barnen och familjen behövs kunskap om hur barn upplever denna situation och vilka behov som finns hos dem. Syftet med studien är att beskriva barns upplevelse av att vara närstående till en svårt sjuk person. Med svår sjukdom/skada valdes i denna uppsats någon som vårdas på en intensivvårdsavdelning eller drabbats av cancersjukdom. Metoden som använts är litteraturstudie av vårdvetenskapliga kvalitativa artiklar där barnens upplevelse tydligt framkommer. I resultatet framgår det att barnen upplever oro och osäkerhet över vad som händer, förändrat vardagsliv, otrygghet och utanförskap. Dessa känslor och upplevelser har samlats under tre teman: Berätta för mig, Jag vill att det ska vara som vanligt och Ser ni mig? Med kunskap om barns upplevelser och känslor när någon närstående drabbats av svår sjukdom/skada kan vi som vårdpersonal informera och stötta barn och föräldrar för att möjliggöra en situation där barnen känner delaktighet och trygghet. Studien visar på vikten av att barnen är välinformerade om vad som hänt och hur sjukdomen/skadan utvecklar sig, att vardagen fortsätter i möjligaste mån med trygga rutiner och att barnen får känna delaktighet och blir sedda. Studien visar på hur viktigt det är att vi som vårdpersonal ser och informerar de närstående barnen med tanke på ålder, utveckling och erfarenhet och uppmuntrar och stöttar föräldrarna till att göra barnen delaktiga.Program: Fristående kurs
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Elisabeth, Wimo. "Kritiskt sjuka barns delaktighet : En studie om sjuksköterskans omvårdnad på BIVA." Thesis, Röda Korsets Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-2253.
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Passantino, Andrea. "Master narratives, counterstories and identity mothering in a clinical setting /." Diss., Online access via UMI:, 2009.
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Oualha, Mehdi. "Modélisation pharmacocinétique et pharmacodynamique de l'adrénaline et de la noradrénaline chez l'enfant." Phd thesis, Université René Descartes - Paris V, 2013. http://tel.archives-ouvertes.fr/tel-00955862.
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Les effets des catécholamines en réanimation sont peu prédictibles. La variabilité interindividuelle des observations est d'origine multifactorielle dont des facteurs pharmacocinétiques et pharmacodynamiques, dépendant de caractéristiques constitutionnelles et acquises de chaque individu. Les posologies de l'adrénaline et de la noradrénaline chez l'enfant sont extrapolées des données adultes. Pourtant l'âge est une source de grande variabilité liée au développement. Un modèle pharmaco- statistique de l'adrénaline et de la noradrénaline a été établi chez l'enfant en insuffisance circulatoire aigüe. Il a permis d'identifier des facteurs de variabilité entre les individus ainsi que de proposer des schémas de prescription des deux molécules en fonction de l'effet souhaité et des caractéristiques de l'enfant. La pharmacocinétique de l'adrénaline chez 39 enfants en prévention du syndrome de bas débit cardiaque postopératoire suivait un modèle monocompartimental. La clairance augmentait avec le poids selon le principe de l'allométrie. Les augmentations résultantes de la fréquence cardiaque et de la pression artérielle moyenne suivaient un modèle d'effet direct Emax. Elles étaient influencées par l'âge et la gravité des patients. Les augmentations de glycémie et lactatémie suivaient un modèle d'effet indirect. Pour la noradrénaline, chez 38 enfants atteints d'hypotension artérielle systémique, la pharmacocinétique était mono-compartimentale. La clairance était influencée par le poids (allométrie). L'augmentation induite de la pression artérielle moyenne suivait un modèle direct Emax. Elle était fonction de l'âge et de la gravité des patients. Les posologies de l'adrénaline et de la noradrénaline chez l'enfant devraient tenir compte du poids, de l'âge et de la gravité du patient : plus jeune est l'enfant et plus grave est son état, plus la posologie doit être élevée pour satisfaire les objectifs hémodynamiques.
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Bonaconsa, Candice Hilda. "Optimising stabilisation of the critical ill child in the medical emergency unit at the Red Cross War Memorial Children's Hospital : an enthnographic study." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2940.
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Ostojic, Jovana. "United Nations’ Naming and Shaming of Children’s Rights Abusers in Conflict: A Critical Assessment." Thesis, Malmö universitet, Fakulteten för kultur och samhälle (KS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-22235.
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Naming and shaming is a widely used strategy by the transnational advocacy network (TAN) to prevent human rights abuses and increase compliance to international humanitarian law (IHL). However, existing research demonstrates controversial results about the efficacy of naming and shaming as a method to increase compliance to IHL. To add new insights to the ongoing IR debate, this paper investigates United Nations’ (UN’s) naming and shaming of children’s rights abusers in conflict. A quantitative analysis of UN’s Annual Reports on Children and Armed Conflict between 2013-2018 provides an assessment of the assumed link between public condemnation of state actors and armed non-state actors (ANSAs) who commit children’s rights violations in conflict, and an increase in compliance to IHL and protection of children. This paper aims to investigate the results of UN’s shaming policy through the theoretical framework of Constructivism and thus provide a critical assessment of the issue. The results of this thesis indicate that there seems to be a convincing link between the number of state actors listed on UN’s “lists of shame” and the number of parties who put in place measures to improve protection of children and increase compliance to IHL. On the other hand, the link seems to be weak when it comes to the number of publicly exposed ANSAs who subsequently commit to UN action plans and increase compliance to IHL.
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Amaral, Mariana Nunes Gonçalves Afonso. "Immunoparalysis in critically ill children." Master's thesis, 2021. http://hdl.handle.net/10316/98414.
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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntrodução: A imunoparalisia está associada a um pior prognóstico no contexto de cuidados intensivos pediátricos. A diminuição da expressão de HLA-DR e a diminuição da produção de citocinas têm sido usados na sua caracterização. Este estudo teve como objetivo determinar o grupo de doentes com maior probabilidade de imunoparalisia, correlacionando este estado com um risco aumentado de infeção nosocomial e pior prognóstico.Métodos: Foi realizado um estudo exploratório incluindo doentes com o diagnóstico de falência multiorgânica, durante um período de seis meses. Após admissão no serviço de cuidados intensivos pediátricos, determinou-se, por citometria de fluxo, a expressão de HLA-DR pelos monócitos (expressa em “intensidade de fluorescência média” – IFM) e a frequência de monócitos a produzir citocinas intracelulares (TNF-α e IL-6), em três momentos distintos (T1 = 1-2º dia; T2 = 3-5º dia; T3 = 6-8º dia). Com base na gravidade inicial da doença, estabelecida pelo score PELOD-2, foram calculados os valores ‘cut-off’ que permitiram identificar o grupo de doentes com risco aumentado de imunoparalisia. A análise comparativa entre os dois grupos teve em conta os parâmetros demográficos e clínicos dos doentes.Resultados: Foram incluídos quinze doentes, 60.0% do sexo masculino, com uma idade média de 4.1 anos. Considerando a presença de dois critérios em T1 (IFM de HLA-DR nos monócitos clássicos ≤1758.5; e frequência de monócitos a produzir IL-6 ≤68.5%) ou dois critérios em T3 (IFM de HLA-DR nos monócitos clássicos ≤2587.5; e frequência de monócitos a produzir TNF-α ≤93.5%), obtivemos uma variável para definir o estado de imunoparalisia, com 100% de sensibilidade e 81.5% de especificidade. No grupo com imunoparalisia, foram incluídos 40% dos doentes. Neste grupo, observou-se uma frequência superior de infeção nosocomial (p = 0.011), uma mediana superior de score de drogas vasoativas (p = 0.014) e uma mediana superior de internamento hospitalar (p = 0.036). Uma frequência aumentada de monócitos não-clássicos foi observada no subgrupo de doentes com o diagnóstico de sépsis (p = 0.004). Não se registaram óbitos.Discussão: A diminuição na expressão de HLA-DR pelos monócitos, em combinação com a diminuição na frequência de monócitos a produzir TNF-α e IL-6, aparenta ser um bom marcador de imunoparalisia, tanto em fases precoces da doença como em fases tardias, e associa-se a piores prognósticos. Por outro lado, a frequência aumentada de monócitos não-clássicos nos doentes com sépsis é sugestiva de melhor prognóstico.Conclusão: A imunoparalisia parece definir-se por uma expressão diminuída de HLA-DR pelos monócitos e por baixas frequências de monócitos a produzir citocinas, ao longo da primeira semana de internamento, estando estes achados relacionados com um risco aumentado de infeção nosocomial e com maior gravidade clínica.
Introduction: Immunoparalysis is associated with poorer outcomes in the paediatric intensive care unit (PICU) setting. Downregulation of human leukocyte antigen (HLA)-DR and reduced cytokine production have been used to characterize it. 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.Methods: We conducted an exploratory study including PICU patients with multiple organ dysfunction, over a period of six months. Monocyte HLA-DR expression (determined by the mean fluorescence intensity – MFI) and the frequency of monocytes producing intracellular cytokines (TNF-α and IL-6) after in vitro activation with LPS and IFNγ were measured by flow-cytometry at three distinct time points (T1=1-2 days; T2=3-5 days; T3=6-8 days) following PICU admission. Using the Paediatric Logistic Organ Dysfunction (PELOD)-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 suffering from immunoparalysis. A comparative analysis based on demographic and clinical parameters was performed between them.Results: Fifteen patients, 60.0% males, with a median age of 4.1 years were included. Considering the presence of two criteria in T1 (classical monocytes MFI for HLA-DR ≤1758.5, AUC 0.775; and frequency of monocytes producing IL6 ≤68.5%, AUC 0.905) or two criteria 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 the immunoparalysis group, a higher frequency of nosocomial infection (p=0.011), a higher median vasoactive inotropic score (p=0.014) and a higher median length of hospital stay (p=0.036) was observed compared to the no immunoparalysis group. 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.Discussion: A reduction in classical monocytes HLA-DR expression, combined with lower frequencies of monocytes producing TNF-α and IL-6 at both early and later stages of critical illness appears to be a good marker of immunoparalysis and is associated with worse outcomes. On the other hand, increased frequency of non-classical monocytes in patients with sepsis/septic shock is suggestive of a better prognosis.Conclusion: Immunoparalysis seems to be defined by low levels of monocytes HLA-DR expression and low frequencies of monocytes producing cytokines during the first week of critical illness and these findings relate to an increased risk of nosocomial infection and deleterious outcomes.
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Roumeliotis, Nadezhda. "Trauma in critically ill children : transfusion and osmotherapy practices." Thèse, 2016. http://hdl.handle.net/1866/16271.
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Les accidents sont la cause la plus fréquente de décès chez l’enfant, la plupart du temps à cause d’un traumatisme cranio-cérébrale (TCC) sévère ou d’un choc hémorragique. Malgré cela, la prise en charge de ces patients est souvent basée sur la littérature adulte.
Le mannitol et le salin hypertonique (3%) sont des traitements standards dans la gestion de l’hypertension intracrânienne, mais il existe très peu d’évidence sur leur utilité en pédiatrie. Nous avons entrepris une revue rétrospective des traumatismes crâniens sévères admis dans les sept dernières années, pour décrire l’utilisation de ces agents hyperosmolaires et leurs effets sur la pression intracrânienne. Nous avons établi que le salin hypertonique est plus fréquemment utilisé que le mannitol, qu’il ne semble pas y avoir de facteurs associés à l’utilisation de l’un ou l’autre, et que l’effet sur la pression intracrânienne est difficile à évaluer en raison de multiples co-interventions. Il faudra mettre en place un protocole de gestion du patient avec TCC sévère avant d’entreprendre des études prospectives.
La transfusion sanguine est employée de façon courante dans la prise en charge du patient traumatisé. De nombreuses études soulignent les effets néfastes des transfusions sanguines suggérant des seuils transfusionnels plus restrictifs. Malgré cela, il n’y a pas de données sur les transfusions chez l’enfant atteint de traumatismes graves. Nous avons donc entrepris une analyse post-hoc d’une grosse étude prospective multicentrique sur les pratiques transfusionnelles des enfants traumatisés. Nous avons conclu que les enfants traumatisés sont transfusés de manière importante avant et après l’admission aux soins intensifs. Un jeune âge, un PELOD élevé et le recours à la ventilation mécanique sont des facteurs associés à recevoir une transfusion sanguine aux soins intensifs. Le facteur le plus prédicteur, demeure le fait de recevoir une transfusion avant l’admission aux soins, élément qui suggère probablement un saignement continu.
Il demeure qu’une étude prospective spécifique des patients traumatisés doit être effectuée pour évaluer si une prise en charge basée sur un seuil transfusionnel restrictif serait sécuritaire dans cette population.Trauma is the leading cause of death of children, with the burden of mortality related both to traumatic brain injury and hemorrhagic shock. Despite the frequency of trauma in the pediatric population, the management of these patients is often based on adult literature due the sparse amount of literature in pediatric trauma. The studies presented below were intended to establish current practice, and prepare for future prospective studies in pediatric trauma. The management of raised intracranial pressure (ICP) following traumatic brain injury (TBI) involves intracranial monitoring and the escalation of care to prevent secondary insults to the brain. Hyperosmolar therapy with mannitol (20%) and hypertonic saline (3%) are standard of care for the reduction of ICP, despite little evidence for their use. Our retrospective, single center study aimed to describe the clinical practice of hyperosmolar therapy in pediatric severe TBI, and its effect on ICP. We found that both mannitol and hypertonic saline are frequently used without a clear indication for one agent over another. There was insufficient power to confirm an effect on ICP, and multiple co-interventions given after boluses of hyperosmolar therapy may have contributed this lack of effect. In order to prospectively evaluate the effect of hyperosmolar therapy on ICP, a standardized approach to TBI care and hyperosmolar agents is necessary. Red blood cell transfusion is a key component of the management of the unstable trauma patient. Literature now suggests that transfusion is associated with increased mortality, and practices have shifted toward restrictive transfusion strategies in many clinical populations. We sought to describe the transfusion practices in pediatric trauma patients based on a secondary analysis of a large prospective study on blood loss in pediatric intensive care unit (PICU) patients. Compared to non-trauma patients, trauma patients were more likely to be transfused and transfused early in their course of stay. Younger age, higher PELOD and mechanical ventilation were associated with receiving a red blood cell transfusion in the PICU. Receiving a blood transfusion prior to PICU admission was most strongly associated with receiving a transfusion after PICU admission, suggesting ongoing bleeding in those transfused early. Future prospective studies geared specifically for trauma patients are necessary to determine whether osmotherapy for high ICP, and restrictive transfusion strategies can be applied to them, in order to improve the quality of the evidence based care provided to children.
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Rocha, Ana Cláudia Sousa. "The prognostic value of lactate kinetics in critically ill children." Master's thesis, 2020. http://hdl.handle.net/10316/97734.
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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaINTRODUÇÃO: Os níveis séricos de lactato e a sua tendência nas primeiras horas após admissão têm sido reportados como bons preditores de outcome em doentes críticos. O objetivo do presente estudo prendeu-se com testar a aplicabilidade da cinética do lactato como um método de estratificação de risco em crianças gravemente doentes. MÉTODOS: Estudo exploratório com colheita retrospetiva de dados de doentes admitidos na CIPE (unidade de cuidados intensivos pediátricos) entre 2016 e 2019. Os critérios de exclusão incluíram período neonatal, pós-operatório ou tempo de internamento inferior a 48 horas. A diferença entre a concentração máxima de lactato em D1 (dia 1) e a concentração máxima de lactato em D2 (dia 2) de internamento permitiu calcular o Delta-Lactato (ΔL). Dado o cut-off de ΔL, dois grupos foram considerados: baixo risco de mortalidade (LMR - low mortality risk) - descida dos valores de lactato de ≥0.05 mmol/L - e alto risco de mortalidade (HMR - high mortality risk) - subida nos valores de lactato ou descida de <0.05 mmol/L. Os dados clínicos e demográficos foram analisados com recurso ao SPSS ®. O índice Youden foi usado para calcular o cut-off ótimo. RESULTADOS: Dos 1564 doentes admitidos na CIPE nesse período de quatro anos, 249 doentes foram incluidos. A mediana da idade calculou-se em 5.6 anos [AIQ 0.9-13.7], 60.6% eram rapazes e a mediana do tempo de internamento foi de 7.0 dias [AIQ 3.0-10.0]. As doenças respiratórias constituíram o diagnóstico de admissão mais frequente (33.7%), seguidas de trauma (15.7%) e choque (15.3%). A mediana do PIM3 (pediatric index of mortality-3) foi 3.10 [AIQ1.14-6.86]; 7.2% (n=18) dos doentes morreram durante o internamento na CIPE, e mais dois doentes morreram nos 28 dias seguintes. No total, 8.0% dos doentes morreram. A mortalidade, quer durante o internamento na CIPE, quer aos 28 dias, mostrou-se estatística e significativamente associada com níveis séricos elevados de lactato, quer em D1 ou D2. Considerando os 93 casos com o lactato máximo em D1 acima do limite superior da normalidade (≥ 2.0 mmol/L), a área sob a curva ROC foi de 0.698 [IC95% 0.47;0.93], para um cut-off de 0.05 mmol/L para ΔL. Os dados demográficos foram semelhantes entre ambos os grupos (LMR e HMR). Trauma e choque foram importantes diagnósticos de admissão nas faixas etárias com maior mortalidade em ambos os grupos. O HMR provou-se em associação estatisticamente significativa com a mediana do valor máximo de lactato em D2, obteve pontuação superior no PIM3 e não contou altas para o domicílio; estes doentes cumpriram menos dias livres de ventilação e implicaram o recrutamento de técnicas de substituição renal com maior frequência. DISCUSSÃO: Valores de lactato mais elevados, quer em D1 quer em D2, confirmaram-se bons preditores de mortalidade a curto prazo. Para um valor máximo de lactato em D1 acima do limite superior de normalidade, a morte provou-se mais provável. Tendo em conta o cut-off ótimo para ΔL, foi possível prever um risco de mortalidade mais alto, quer durante o internamento na CIPE, quer nos 28 dias após a alta: quando, de D1 para D2, se registou uma subida ou ligeira descida nos valores máximos de lactato (versus uma descida igual ou superior a 0.05 mmol/L), a morte revelou-se perto de oito vezes mais provável. Quanto maior a severidade da doença, menor a probabilidade de alta para o domicílio. CONCLUSÃO: Como descrito para os adultos, em crianças gravemente doentes, a cinética do lactato nas primeiras horas após admissão, mais do que os seus valores absolutos, poderá prever o outcome a curto-prazo. PALAVRAS-CHAVE: gravemente doente, crianças gravemente doentes, Delta-Lactato, clearance do lactato, estratificação de risco
PURPOSE: Serum lactate levels and their trend over the first hours after admission have been reported as good outcome predictors of critically ill patients. We aimed to test the applicability of lactate kinetics as a short-term risk stratification method in critically ill children. METHODS: Exploratory study with retrospective data collection of patients admitted to PICU (pediatric intensive care unit) from 2016 to 2019. Exclusion criteria included neonatal period, post-operative admissions or length of stay shorter than 48 hours. The difference between the maximum lactate concentration in Day1 (D1) and in Day2 (D2) was used to calculate delta-lactate (ΔL). According to ΔL’s cut-off, two groups were considered: low mortality risk (LMR) - decrease in lactate levels of ≥0.05 mmol/L - and high mortality risk (HMR) - increase in lactate levels or a decrease of <0.05 mmol/L. Demographic and clinical data were analyzed using SPSS®. The Youden Index was used to calculate the optimal cut-off. RESULTS: From the 1564 patients admitted to PICU in the mentioned time frame, 249 were selected. The median age was 5.6 years old [IQR 0.9-13.7], 60.6% were males and the median length of stay was 7.0 days [IQR 3.0-10.0]. The most frequent diagnosis on admission was respiratory disorder (33.7%), followed by trauma (15.7%) and shock (15.3%). The median PIM3 (pediatric index of mortality-3) was 3.10 [IQR 1.14-6.86]; 7.2% (n=18) of the patients died during PICU stay and 2 more children died in the following 28 days. Mortality, both during PICU stay and at 28 days, was statistically associated with elevated serum lactate in D1 and in D2. Considering the 93 cases with a maximum lactate in D1 above normal (≥2.0 mmol/L), the area under the ROC curve was 0.698 [CI95% 0.47;0.93], for a ΔL’s cut-off of 0.05 mmol/L. The demographic data were similar between both groups (LMR and HMR). Trauma and shock were important admission diagnoses for the age range with the highest mortality in both groups. HMR had a statistically significant association with the maximum lactate levels in D2, scored higher PIM3 and were never discharged home; they counted fewer ventilation-free-days and needed renal replacement therapy more often. DISCUSSION: Higher lactate levels, both in D1 and in D2 proved to be good predictors for short-term mortality. When maximum lactate level in D1 was higher than normal, death was likelier to occur. With the optimal cut-off for ΔL taken into consideration, it was possible to predict higher mortality risk during PICU stay and at 28 days: if, from D1 to D2, an increase or slight decrease in lactate maximum levels occurred (versus a decrease greater than or equal to 0.05 mmol/L), death was almost eight times more probable. The worse the disease, the less likely was the patient discharged home. CONCLUSION: In critically ill children, as for adults, lactate’s kinetics in the first hours after admission, rather than its absolute values, may predict a short-term outcome. KEYWORDS: critically ill, critically ill children, Delta-Lactate, lactate clearance, risk stratification
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Eddington, Kay Allen. "Relationship between monitored elements and prescribed ventilator setting modifications in critically ill children." Thèse, 2012. http://hdl.handle.net/1866/8363.
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Les pédiatres intensivistes ont plusieurs éléments disponibles pour guider leurs décisions par rapport à la ventilation mécanique. Par contre, aucune étude prospective ne décrit les éléments auxquels les intensivistes se réfèrent pour modifier les paramètres du respirateur.
Objectifs : Décrire la pratique actuelle de la modification des paramètres du respirateur aux soins intensifs du CHU Sainte-Justine, un hôpital pédiatrique tertiaire.
Hypothèse : 80% des modifications des paramètres du respirateur influant sur l’épuration du CO2 sont liées à l’analyse de la PCO2 ou du pH et 80% des modifications des paramètres d’oxygénation sont liés à l’analyse de l’oxymétrie de pouls.
Méthodes : En se servant d’un logiciel de recueil de données, les soignants ont enregistré un critère de décision primaire et tous les critères de décision secondaires menant à chaque modification de paramètre du respirateur au moment même de la modification.
Résultats : Parmi les 194 modifications des paramètres du respirateur influant sur l’épuration du CO2, faites chez vingts patients, 42.3% ±7.0% avaient pour critère primaire la PCO2 ou le pH sanguin. Parmi les 41 modifications de la pression expiratoire positive et les 813 modifications de la fraction d’oxygène inspirée, 34.1% ±14.5% et 84.5% ±2.5% avaient pour critère primaire l’oxymétrie de pouls, respectivement.
Conclusion : Les médecins surestiment le rôle de la PCO2 et du pH sanguins et sousestiment le rôle d’autres critères de décision dans la gestion de la ventilation mécanique. L’amélioration de notre compréhension de la pratique courante devrait aider à l’éboration des systèmes d’aide à la décision clinique en assistance respiratoire.Pediatric intensivists have a multiplicity of elements available to guide them in mechanical ventilator decision-making; however, no prospective studies describe which elements intensivists currently use to make ventilator setting changes. Objectives: We describe the current practice of ventilator setting modification in the intensive care unit at Sainte-Justine Hospital, a tertiary care pediatric hospital. Hypothesis: Eighty percent of ventilator settings affecting carbon dioxide clearance are based on the PCO2 or pH while eighty percent of settings affecting oxygenation are based on pulse oximetry. Methods: Caregivers recorded the primary element and any secondary elements leading to a ventilator setting change at the time of the change via a custom-designed data gathering software. Results: We included twenty patients. Of a combined 194 changes affecting CO2 clearance, 42.3% ±7.0% were in reference to blood PCO2 or pH. Of forty-one changes to positive end-expiratory pressure, 34.1% ±14.5% were in reference to pulse oximetry, as were 84.5% ±2.5% of the 813 changes to the fraction of inspired oxygen. Conclusion: Physicians over-estimate the role of blood pH and PCO2 in their ventilator management, while under-estimating the role of other elements. Improving our understanding of current practice patterns can help in the development of systems to aid in clinical decision-making in mechanical ventilation, improving clinical outcomes.
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Kowalske, Kaye. "The process and product of writing for preschoolers my sister is special : report submitted in partial fulfillment ... for the degree of Master of Science (Parent-Child Nursing) ... /." 1994. http://catalog.hathitrust.org/api/volumes/oclc/68797664.html.
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Brown, Devon. "The lived experience of family-centred care by primary caregivers of critically ill children in the pediatric intensive care unit." 2012. http://hdl.handle.net/1993/5111.
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The unexpected admission of a child to the pediatric intensive care unit (PICU) creates feelings of uncertainty, distress, and fear and is a devastating experience for primary caregivers. Health care providers must address primary caregivers` concerns to enhance primary caregivers’ coping abilities. While a family-centred approach to care can assist in diminishing uneasy feelings experienced by primary caregivers, this philosophy of care is not consistently used in everyday practice. The PICU is a unique area of care that focuses on restoring the health of critically ill children with the use of machines and equipment. However, the use of technology for life sustaining measures creates additional responsibilities for health care providers, potentially compromising the quality of patient care. There is evidence to support that the involvement of the primary caregiver in the care of the critically child can address the gap that commonly exists between technology and holistic patient care. Furthermore, involvement in care increases primary caregivers’ satisfaction with the care their child receives and may also improve patient outcomes. Most importantly, the involvement of primary caregivers in the care of the critically ill child encompasses a family-centred approach to care.
By increasing health care provider’s awareness of family-centred care within the PICU, primary caregiver’s needs may be more effectively addressed during this devastating and vulnerable time. Health care providers are key players in the promotion of family-centred care in the PICU; however, they are often faced with multiple challenges and barriers. Increasing health care providers’ awareness around the components of family-centred care can facilitate its implementation into practice by understanding how primary care givers define and experience
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family-centred care. Accordingly, a qualitative study guided by the philosophy of hermeneutic phenomenology was conducted to elicit a detailed description of the lived experience of family-centred care from the perspective of the primary caregiver.
Participants in this study consisted of those primary caregivers who had previously had a child admitted to the PICU. Participants were recruited from a large mid-western hospital. In total nine primary caregivers ranging in age from 33 to 44 years with the mean age being 37 years participated in the study. Nine of the participants were mothers and two were fathers. All participants took part in semi-structured, open-ended interviews. A total of nine interviews were conducted with two of the interviews involving both parents. Demographic data and field notes were recorded. All field notes and interview data were transcribed. The transcripts were reviewed repeatedly for significant statements in an attempt to find meaning and understanding through themes. The data analysis revealed the essence of the lived experience of family-centred care to be being present. Three themes communicated the essence and included: (a) physical presence, (b) participation in care and, (c) advocating. Three themes from the data emerged around how primary caregivers defined family-centred care and included: (a) collaboration, (b) being updated and, (c) continuity of care. Finally, primary caregivers identified four conditions that needed to be in place to experience family-centred in the PICU which included: (a) being present for rounds, (b) caring behaviours, (c) feeling welcomed and, (d) support. The findings from this study may be used to guide policy around family-centred care and improve on, or bring new insights around interventions related to family-centred care. Future recommendation for nursing practice, education and research are presented.
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Maxton, Fiona. "Sharing and surviving the resuscitation : parental presence during resuscitation of a child in PICU : the experiences of parents and nurses." Thesis, 2005. http://handle.uws.edu.au:8081/1959.7/593.
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Parents’ presence and participation in their child’s care in the paediatric intensive care unit (PICU) is now commonplace. Despite parents expressing a deep need to be with their child particularly during periods of crisis, it is precisely at these times that they are often prevented from staying. The growing debate regarding family presence during a cardiopulmonary (CPR) resuscitation attempt continues to be controversial and conflicting. Current knowledge is mostly derived from quantitative studies conducted in the adult intensive care or emergency environments. The experiences of parents of children in the PICU, and the nurses caring for them are unknown. Using van Manen’s hermeneutic phenomenological approach, this study describes the phenomenon of parental presence during resuscitation of a child in PICU for eight Australian parent couples and six nurses. Experiential descriptions, obtained in tape-recorded unstructured interviews were subjected to two layers of analysis. Thematic analysis provided the phenomenological description in seven themes. Four themes refer to the parents’ experience in Being only for a child; Making sense of a living nightmare; Maintaining hope: facing reality and Living in a relationship with staff. Three themes describe the nurses’ experience: Under the parents’ gaze; Walking in their shoes and Holding parents in mind. A second layer of hermeneutic analysis revealed parents’ and nurses’ collective experience to have their being in four elements of the phenomenon. These elements are Being in chaos; Struggling to connect; Being for another and Being complete. The final description of the parents’ and nurses’ experience of parental presence during resuscitation in PICU as Sharing and surviving the resuscitation is drawn from the findings from each of these layers of meaning. The findings from this study conclude that the parents’ inherent need to be with their child overrode their anxieties of the resuscitation scene, curbing their feelings of chaos. Parental presence however, was a complex and dynamic concept that required a new relationship between parents and nurses. Implications of this study include recommendations for improving staff knowledge and education, as well as practical interventions for enhanced support for both parents and nurses
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Chen, Yu-Chun, and 陳玉純. "The relationship between physician case volume and in-hospital mortality of critically ill children with a diagnosis of pneumonia: A cross-sectional observational analytical study." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/5956w2.
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碩士國立陽明大學
急重症醫學研究所
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Purpose: The aim of this study is to examine the relationship between physician case volume and the outcomes of critically ill children with pneumonia. Materials and Methods: This is a population-based cohort study analyzed data provided from the National Health Insurance Research Database of Taiwan, 2006-2009. Children (aged 3 months to 17 years) having records of intensive care unit (ICU) admission and a diagnosis of pneumonia were included. A total of 9754 critically ill children and 1042 attending physicians were enrolled. The children were assigned to 1 of 4 groups based on the physician’s pneumonia case volume. Results: The patients in the very-high case volume group had a significantly lower length of hospital stay, in-hospital mortality rate, and hospitalization expenses, and a significantly higher ratio of ICU to hospital stays than other 3 groups (p < 0.001). The probability of death tended to be lower when the physician’s case volume was higher. The risk-adjusted odds ratio for in-hospital mortality of very–high case volume group was 0.48(95% confidence interval, 0.35-0.65; p < 0.001) compared to low case volume group. Conclusions: A higher physician’s pneumonia case volume is associated with a lower length of hospital stay, lower in-hospital mortality rate, and lower hospitalization expenses among critically ill children with pneumonia.
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Wright, Jennifer J. "The critically ill child's perceived health status a comparison of parents' and children's perceptions : a research report submitted in partial fulfillment ... for the degree of Master of Science (Parent-Child Nursing) ... /." 1991. http://catalog.hathitrust.org/api/volumes/oclc/68796351.html.
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Neven, Ruth Schmidt. "Constructing mental health problems a critical inquiry into the views of professionals working with children, parents and families /." 2007. http://wallaby.vu.edu.au/adt-VVUT/public/adt-VVUT20070514.155102/index.html.
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