Simulating a Vertical Evacuation of a NICU and PICU to Examine the Relationship Between Training and Preparedness

2021 ◽  
pp. 1-3
Author(s):  
Ramon E. Gist ◽  
Pia Daniel ◽  
Nizar Tejani ◽  
Andrew Grock ◽  
Adam Aluisio ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Disaster Preparedness ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Full Scale ◽  
University Hospital ◽  
Evaluation Tool ◽  
Vertical Evacuation

Abstract Objective: The aim of this study was to implement pediatric vertical evacuation disaster training and evaluate its effectiveness by using a full-scale exercise to compare outcomes in trained and untrained participants. Methods: Various clinical and nonclinical staff in a tertiary care university hospital received pediatric vertical evacuation training sessions over a 6-wk period. The training consisted of disaster and evacuation didactics, hands-on training in use of evacuation equipment, and implementation of an evacuation toolkit. An unannounced full-scale simulated vertical evacuation of neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) patients was used to evaluate the effectiveness of the training. Drill participants completed a validated evaluation tool. Pearson chi-squared testing was used to analyze the data. Results: Eighty-four evaluations were received from drill participants. Forty-three (51%) of the drill participants received training and 41 (49%) did not. Staff who received pediatric evacuation training were more likely to feel prepared compared with staff who did not (odds ratio, 4.05; confidence interval: 1.05-15.62). Conclusions: There was a statistically significant increase in perceived preparedness among those who received training. Recently trained pediatric practitioners were able to achieve exercise objectives on par with the regularly trained emergency department staff. Pediatric disaster preparedness training may mitigate the risks associated with caring for children during disasters.

scholarly journals Criteria for referral of pediatric SARS-CoV-2 infection: a real-life experience in the pandemic era

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Carlotta Montagnani ◽  
Elisabetta Venturini ◽  
Manuela L’Erario ◽  
Chiara Tersigni ◽  
Barbara Bortone ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Experience ◽  
Tertiary Care ◽  
Real Life ◽  
Pediatric Intensive Care ◽  
University Hospital ◽  
Children At Risk ◽  
Referral Criteria ◽  
Practical Guidance

AbstractA practical guidance on the management of children with COVID-19 to insure homogeneous criteria for referral to a higher-level facility, according to the disease severity, is pivotal in the pandemic era. A panel of experts in pediatric infectious diseases and intensive care at the tertiary-care Meyer Children’s University Hospital, Florence, Italy, issued a practical document shared with Tuscany hospitals. The rationale was to target the referral for those children at risk of requiring an intensive support, since the above mentioned hospital has the pediatric intensive care unit. Overall, 378 patients between 0 and 19 years of age were diagnosed with COVID-19 infection in the Tuscany region with 24 (6.3%) hospitalizations. Only three children were centralized to Meyer Children’s University Hospital according to reported criteria. Considering that appropriate referral criteria have been associated with reduced mortality in other conditions, our document might be useful to improve outcomes of children with COVID-19.

Epidemiologic Investigation ofBurkholderia cepaciaAcquisition in Two Pediatric Intensive Care Units

2003 ◽  
Vol 24 (9) ◽  
pp. 707-710 ◽  
Author(s):  
Chawki Loukil ◽  
Carole Saizou ◽  
Catherine Doit ◽  
Philippe Bidet ◽  
Patricia Mariani-Kurkdjian ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Burkholderia Cepacia ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Respiratory Therapy ◽  
University Hospital ◽  
Heated Humidifier ◽  
Epidemiologic Investigation ◽  
Source Of Infection

AbstractObjectives:To investigate and describe an outbreak ofBurkholderia cepaciain a neonatal intensive care unit (NICU) and a pediatric intensive care unit (PICU), and to report the interventions leading to the cessation of the outbreak.Design:We conducted an epidemiologic investigation of an outbreak ofB. cepaciacolonization or infection in two clinical wards during a 35-month period (December 1998 to October 2001).Setting:A 500-bed, university hospital-affiliated, tertiary-care pediatric institution in Paris, France, with a 22-bed PICU and 31-bed NICU.Methods:Ribotyping was used to determine the genotypes ofB. cepaciaisolates. Procedures for the maintenance and disinfection of respiratory therapy devices were reviewed.Results:Thirty-two children were colonized (n = 14) or infected (n = 18) byB. cepaciain 2 wards (28 in the PICU and 4 in the NICU). In the PICU, a single ribotype was found among the isolates obtained from all of the patients except 1, and from the 6 isolates obtained from respiratory therapy devices (ie, heated humidifier water). In the NICU, the isolates obtained from the patients harbored a single ribotype unrelated to that of the epidemic strain isolated in the PICU; no environmental source of infection was found.Conclusion:Two different outbreaks appeared to be associated with 2 ribotypes, 1 of which was linked to patient-to-patient transmission via respiratory therapy devices. Complete elimination of the outbreak was achieved only when disposable, sterilizable, or easy-to-disinfect materials were used in the PICU. The source of infection in the NICU was not found.

scholarly journals Prediction of mortality by pediatric risk of mortality (PRISM III) score in teriary care rural hospital in India

2017 ◽  
Vol 4 (2) ◽  
pp. 322
Author(s):  
Ashish Varma ◽  
Sachin Damke ◽  
Revat Meshram ◽  
Jayant Vagha ◽  
Anjali Kher ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Rural Hospital ◽  
Pupillary Reflex ◽  
Prediction Of Mortality ◽  
Wbc Count

Background: The mortality in pediatric and neonatal critical care units can be predicted using scores. Prediction of mortality using (PRISM III) score in first 24 hours of admission in pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU).Methods: Pediatric cases below 14 years with necessary investigations admitted in PICU and neonates in NICU during the period 1st August 2009 to 31 July 2011. Post-operative and patients with malformations or malignancy were excluded. A prospective observational study carried out at tertiary care rural hospital having 10 bedded well equipped PICU and NICU each. In subjects fulfilling inclusion criteria, PRISM III score which includes 17 variables was calculated within 24 hours of admission. The outcome at discharge was determined as non-survival or survival.Results: With increasing PRISM III score there was increase in mortality. PRISM III score offered a good discriminative power with the areas under the ROC curve > 0.86 (95% CI). Among different variables minimum systolic blood pressure, pupillary reflex, mental status (GCS), acidic pH, total co2, BUN, platelet count and PTT showed very high significant association with the mortality and Pco2, PaO2, temperature, potassium and creatinine showed significant association with mortality. Variables like Heart rate, Glucose, Alkaline pH and WBC count showed no significant association with the mortality.Conclusions: PRISM III score can be effectively used as a reflector of severity of illness. 

Code Blue Events in the Neonatal and Pediatric Intensive Care Units at a Tertiary Care Children's Hospital

2020 ◽  
Author(s):  
Catherine M. Groden ◽  
Erwin T. Cabacungan ◽  
Ruby Gupta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Support ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Neonatal Resuscitation ◽  
Advanced Life Support ◽  
Pediatric Intensive Care ◽  
Code Blue ◽  
Neonatal Resuscitation Program

Objective The authors aim to compare all code blue events, regardless of the need for chest compressions, in the neonatal intensive care unit (NICU) versus the pediatric intensive care unit (PICU). We hypothesize that code events in the two units differ, reflecting different disease processes. Study Design This is a retrospective analysis of 107 code events using the code narrator, which is an electronic medical record of real-time code documentation, from April 2018 to March 2019. Events were divided into two groups, NICU and PICU. Neonatal resuscitation program algorithm was used for NICU events and a pediatric advanced life-support algorithm was used for PICU events. Events and outcomes were compared using univariate analysis. The Mann–Whitney test and linear regressions were done to compare the total code duration, time from the start of code to airway insertion, and time from airway insertion to end of code event. Results In the PICU, there were almost four times more code blue events per month and more likely to involve patients with seizures and no chronic condition. NICU events more often involved ventilated patients and those under 2 months of age. The median code duration for NICU events was 2.5 times shorter than for PICU events (11.5 vs. 29 minutes), even when adjusted for patient characteristics. Survival to discharge was not different in the two groups. Conclusion Our study suggests that NICU code events as compared with PICU code events are more likely to be driven by airway problems, involve patients <2 months of age, and resolve quickly once airway is taken care of. This supports the use of a ventilation-focused neonatal resuscitation program for patients in the NICU. Key Points

Resuscitation and Withdrawal of Therapy in Pediatric Intensive Care

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 961-963
Author(s):  
RICHARD B. MINK ◽  
MURRAY M. POLLACK
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Pediatric Intensive Care ◽  
New Haven ◽  
Hammersmith Hospital ◽  
Hospital Deaths ◽  
Withdrawal Of Therapy ◽  
Haven Hospital

Although issues concerning withdrawal and limitation of life support are commonly discussed,1-6 actual practices in pediatrics are largely unknown and are limited to neonatal intensive care unit (ICU) studies. In the neonatal ICUs at Yale-New Haven Hospital and at Hammersmith Hospital, 14% and 30%, respectively, of all deaths followed withdrawal of care.7,8 In adult ICUs, limitation and/or withdrawal of therapy is common,9 and in one investigation, resuscitation was not attempted immediately before ICU death in nearly two-thirds of cases.10 Nonetheless, many physicians believe that most hospital deaths occur only after all resuscitative attempts have failed,6,11,12 and others believe that resuscitative efforts neither are indicated nor desirable in many cases.1,13

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