Sepsis is a common, complex condition that requires early recognition and aggressive management t... more Sepsis is a common, complex condition that requires early recognition and aggressive management to improve outcomes. There has been significant improvement in the management of sepsis and septic shock in the last decade; however, it continues to be a leading cause of mortality, morbidity and burden on healthcare services globally. Several guidelines with evidence-based recommendations for the management of children with septic shock and associated organ dysfunction have been produced with the objective of helping clinicians in various settings to provide standardised high-quality care. This article aims to increase awareness among all clinicians, including those working in emergency departments, general paediatric wards and primary care physicians, about the management of sepsis in children.
Abstract Background Data reviewing the use of laryngeal mask airways in critically unwell childre... more Abstract Background Data reviewing the use of laryngeal mask airways in critically unwell children is limited. Aim The primary aim of our study was to report the number of children who were transferred to tertiary paediatric centres using laryngeal mask airways in the last 11 years and identify any potential adverse effects during the transfer. Methods The Children's Acute Transport Service (CATS) retrieval database was searched retrospectively for patients transported between 2009 and 2020 where a laryngeal mask airway was used for ventilation. Results Seven patients were transported using an LMA for ventilation in an 11-year time period. There were no significant adverse effects during the transfers. Conclusion The incidence of impossible intubation in children is low. A laryngeal mask airway may be used to safely transfer a child to specialist tertiary paediatric centre.
OBJECTIVES Bronchiolitis is a leading cause of PICU admission and a major contributor to resource... more OBJECTIVES Bronchiolitis is a leading cause of PICU admission and a major contributor to resource utilization during the winter season. Management in mechanically ventilated patients with bronchiolitis is not standardized. We aimed to assess whether variations exist in management between the centers and then to assess if differences in PICU outcomes are found. DESIGN Retrospective cohort study. SETTING Three tertiary PICUs (Centers A, B, and C) in London, United Kingdom. PATIENTS Patients under 1 year of age (n = 462) who received invasive mechanical ventilation for acute viral bronchiolitis from 2012-2016. INTERVENTIONS None. DESIGN Retrospective cohort study. MEASUREMENTS AND MAIN RESULTS Data collected include all sedative agents administered, 48 hour cumulative fluid balance and location of endotracheal tube (oral or nasal). Primary outcome was duration of invasive mechanical ventilation. A generalized linear model was used to test for differences in duration of invasive mechanical ventilation between centers after adjustment for confounders: corrected gestational age, oxygen saturation index, bacterial coinfection, prematurity, respiratory syncytial virus status, risk of mortality score and comorbidity. Baseline characteristics were similar, other than a higher risk of mortality score at center A and higher admission oxygen saturation index at center C. Center A was associated with utilization of the most benzodiazepine and opiate sedation, the fewest nasal endotracheal tubes, and the highest mean cumulative fluid balance at 48 hours. Center A had an adjusted mean duration of invasive mechanical ventilation that was 44% longer than center C (95% CI, 25-66%; p < 0.001). The majority of confounders had an association with the duration of invasive mechanical ventilation; all were biologically plausible. Corrected gestational age was negatively associated with the duration of invasive mechanical ventilation for preterm infants less than 32 weeks, but not for term or 32-37 week infants (interaction effect). This meant that at a corrected age of 0 months, a less than 32-week infant had a mean duration that was 55% greater than a term infant: this effect had disappeared by 8 months old. CONCLUSIONS Between-center variations exist in both practices and outcomes. The relationship between these two findings could be further tested through implementation science with "optimal care bundles."
Sepsis is a common, complex condition that requires early recognition and aggressive management t... more Sepsis is a common, complex condition that requires early recognition and aggressive management to improve outcomes. There has been significant improvement in the management of sepsis and septic shock in the last decade; however, it continues to be a leading cause of mortality, morbidity and burden on healthcare services globally. Several guidelines with evidence-based recommendations for the management of children with septic shock and associated organ dysfunction have been produced with the objective of helping clinicians in various settings to provide standardised high-quality care. This article aims to increase awareness among all clinicians, including those working in emergency departments, general paediatric wards and primary care physicians, about the management of sepsis in children.
Abstract Background Data reviewing the use of laryngeal mask airways in critically unwell childre... more Abstract Background Data reviewing the use of laryngeal mask airways in critically unwell children is limited. Aim The primary aim of our study was to report the number of children who were transferred to tertiary paediatric centres using laryngeal mask airways in the last 11 years and identify any potential adverse effects during the transfer. Methods The Children's Acute Transport Service (CATS) retrieval database was searched retrospectively for patients transported between 2009 and 2020 where a laryngeal mask airway was used for ventilation. Results Seven patients were transported using an LMA for ventilation in an 11-year time period. There were no significant adverse effects during the transfers. Conclusion The incidence of impossible intubation in children is low. A laryngeal mask airway may be used to safely transfer a child to specialist tertiary paediatric centre.
OBJECTIVES Bronchiolitis is a leading cause of PICU admission and a major contributor to resource... more OBJECTIVES Bronchiolitis is a leading cause of PICU admission and a major contributor to resource utilization during the winter season. Management in mechanically ventilated patients with bronchiolitis is not standardized. We aimed to assess whether variations exist in management between the centers and then to assess if differences in PICU outcomes are found. DESIGN Retrospective cohort study. SETTING Three tertiary PICUs (Centers A, B, and C) in London, United Kingdom. PATIENTS Patients under 1 year of age (n = 462) who received invasive mechanical ventilation for acute viral bronchiolitis from 2012-2016. INTERVENTIONS None. DESIGN Retrospective cohort study. MEASUREMENTS AND MAIN RESULTS Data collected include all sedative agents administered, 48 hour cumulative fluid balance and location of endotracheal tube (oral or nasal). Primary outcome was duration of invasive mechanical ventilation. A generalized linear model was used to test for differences in duration of invasive mechanical ventilation between centers after adjustment for confounders: corrected gestational age, oxygen saturation index, bacterial coinfection, prematurity, respiratory syncytial virus status, risk of mortality score and comorbidity. Baseline characteristics were similar, other than a higher risk of mortality score at center A and higher admission oxygen saturation index at center C. Center A was associated with utilization of the most benzodiazepine and opiate sedation, the fewest nasal endotracheal tubes, and the highest mean cumulative fluid balance at 48 hours. Center A had an adjusted mean duration of invasive mechanical ventilation that was 44% longer than center C (95% CI, 25-66%; p < 0.001). The majority of confounders had an association with the duration of invasive mechanical ventilation; all were biologically plausible. Corrected gestational age was negatively associated with the duration of invasive mechanical ventilation for preterm infants less than 32 weeks, but not for term or 32-37 week infants (interaction effect). This meant that at a corrected age of 0 months, a less than 32-week infant had a mean duration that was 55% greater than a term infant: this effect had disappeared by 8 months old. CONCLUSIONS Between-center variations exist in both practices and outcomes. The relationship between these two findings could be further tested through implementation science with "optimal care bundles."
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