Publications by authors named "Lauren Sorce"

21 Publications

  • Page 1 of 1

Are Mothers Certain About Their Perceptions of Recalled Infant Feeding History?

J Pediatr Health Care 2021 Mar-Apr;35(2):156-162. Epub 2020 Oct 2.

Introduction: Maternal recall of infant feeding, a potential measurement bias, is used to identify the relationship between mothers' own milk (MOM) feeding and subsequent health outcomes. This study describes maternal recall certainty of MOM feedings at four time periods.

Method: In this secondary analysis, mothers of children ages 4-36 months describe infants' MOM feeding and rate certainty of their recall.

Results: MOM was the first feeding for 78.5% of infants and received by 83% the first week, 85% the first month, and 62% the fourth month. Ratings of recall certainty were > 95% for each time period. Recall certainty was significantly different for four time periods (χ = 9.67, p = 0.02), with no two periods significantly different in post hoc analyses.

Discussion: Maternal recall certainty of infant feeding was high regardless of elapsed time. Measuring maternal recall certainty may be useful in clinical practice and studies linking MOM exposure to subsequent health outcomes.
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http://dx.doi.org/10.1016/j.pedhc.2020.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7965233PMC
October 2020

Pediatric Sepsis Definition-A Systematic Review Protocol by the Pediatric Sepsis Definition Taskforce.

Crit Care Explor 2020 Jun 11;2(6):e0123. Epub 2020 Jun 11.

Ann & Robert H. Lurie Children's Hospital, Chicago, IL.

Objectives: Sepsis is responsible for a substantial proportion of global childhood morbidity and mortality. However, evidence demonstrates major inaccuracies in the use of the term "sepsis" in clinical practice, coding, and research. Current and previous definitions of sepsis have been developed using expert consensus but the specific criteria used to identify children with sepsis have not been rigorously evaluated. Therefore, as part of the Society of Critical Care Medicine's Pediatric Sepsis Definition Taskforce, we will conduct a systematic review to synthesize evidence on individual factors, clinical criteria, or illness severity scores that may be used to identify children with infection who have or are at high risk of developing sepsis-associated organ dysfunction and separately those factors, criteria, and scores that may be used to identify children with sepsis who are at high risk of progressing to multiple organ dysfunction or death.

Data Sources: We will identify eligible studies by searching the following databases: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials.

Study Selection: We will include all randomized trials and cohort studies published between January 1, 2004, and March 16, 2020.

Data Extraction: Data extraction will include information related to study characteristics, population characteristics, clinical criteria, and outcomes.

Data Synthesis: We will calculate sensitivity and specificity of each criterion for predicting sepsis and conduct a meta-analysis if the data allow. We will also provide pooled estimates of overall hospital mortality.

Conclusions: The potential risk factors, clinical criteria, and illness severity scores from this review which identify patients with infection who are at high risk of developing sepsis-associated organ dysfunction and/or progressing to multiple organ dysfunction or death will be used to inform the next steps of the Pediatric Sepsis Definition Taskforce.
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http://dx.doi.org/10.1097/CCE.0000000000000123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314341PMC
June 2020

A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention.

Pediatr Crit Care Med 2020 09;21(9):e617-e627

Program in Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Objectives: Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure.

Design: Patient-level, randomized trial.

Setting: Two university-based, tertiary-care children's hospital PICUs.

Participants: Parents of patients requiring more than 24 hours in the PICU.

Interventions: PICU Supports included adding a trained navigator to the patient's healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers.

Measurements And Main Results: The primary outcome was percentage of "excellent" responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3-5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3-5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; SE, 4.53; 95% CI, -5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as "extremely" or "somewhat" helpful.

Conclusions: Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.
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http://dx.doi.org/10.1097/PCC.0000000000002378DOI Listing
September 2020

Navigator-Based Intervention to Support Communication in the Pediatric Intensive Care Unit: A Pilot Study.

Am J Crit Care 2020 07;29(4):271-282

Douglas White is director, Program in Ethics and Decision Making in Critical Illness, and vice chair, professor, and Endowed Chair for Ethics, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Background: Communication in the pediatric intensive care unit (PICU) between families and the health care team affects the family experience, caregiver psychological morbidity, and patient outcomes.

Objective: To test the feasibility of studying and implementing a PICU communication intervention called PICU Supports, and to assess families' and health care teams' perceptions of the intervention.

Methods: This study involved patients requiring more than 24 hours of PICU care. An interventionist trained in PICU-focused health care navigation, a "navigator," met with parents and the health care team to discuss communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and checked in with parents after PICU discharge. The feasibility of implementing the intervention was assessed by tracking navigator activities. Health care team and family perceptions were assessed using surveys, interviews, and focus groups.

Results: Of 53 families approached about the study, 35 (66%) agreed to participate. The navigator met with parents on 71% and the health care team on 85% of possible weekdays, and completed 86% of the postdischarge check-ins. Family meetings were offered to 95% of eligible patients. The intervention was rated as helpful by 97% of parents, and comments during interviews were positive.

Conclusions: The PICU Supports intervention is feasible to implement and study and is viewed favorably by parents.
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http://dx.doi.org/10.4037/ajcc2020478DOI Listing
July 2020

Joint Society of Critical Care Medicine-Extracorporeal Life Support Organization Task Force Position Paper on the Role of the Intensivist in the Initiation and Management of Extracorporeal Membrane Oxygenation.

Crit Care Med 2020 Jun;48(6):838-846

Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, New York, NY.

Objectives: To define the role of the intensivist in the initiation and management of patients on extracorporeal membrane oxygenation.

Design: Retrospective review of the literature and expert consensus.

Setting: Series of in-person meetings, conference calls, and emails from January 2018 to March 2019.

Subjects: A multidisciplinary, expert Task Force was appointed and assembled by the Society of Critical Care Medicine and the Extracorporeal Life Support Organization. Experts were identified by their respective societies based on reputation, experience, and contribution to the field.

Interventions: A MEDLINE search was performed and all members of the Task Force reviewed relevant references, summarizing high-quality evidence when available. Consensus was obtained using a modified Delphi process, with agreement determined by voting using the RAND/UCLA scale, with score ranging from 1 to 9.

Measurements And Main Results: The Task Force developed 18 strong and five weak recommendations in five topic areas of extracorporeal membrane oxygenation initiation and management. These recommendations were organized into five areas related to the care of patients on extracorporeal membrane oxygenation: patient selection, management, mitigation of complications, coordination of multidisciplinary care, and communication with surrogate decision-makers. A common theme of the recommendations is extracorporeal membrane oxygenation is best performed by a multidisciplinary team, which intensivists are positioned to engage and lead.

Conclusions: The role of the intensivist in the care of patients on extracorporeal membrane oxygenation continues to evolve and grow, especially when knowledge and familiarity of the issues surrounding extracorporeal membrane oxygenation selection, cannulation, and management are applied.
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http://dx.doi.org/10.1097/CCM.0000000000004330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422732PMC
June 2020

Evolution of Advanced Practice Provider Education.

Pediatr Crit Care Med 2019 12;20(12):1192-1193

Ann & Robert H Lurie Children's Hospital of Chicago; and Department of Pediatrics, Northwestern University, Chicago, IL.

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http://dx.doi.org/10.1097/PCC.0000000000002092DOI Listing
December 2019

Outcomes Associated With Multiple Organ Dysfunction Syndrome in Critically Ill Children With Hyperglycemia.

Pediatr Crit Care Med 2019 12;20(12):1147-1156

Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.

Objectives: Patterns and outcomes of multiple organ dysfunction syndrome are unknown in critically ill children with hyperglycemia. We aimed to determine whether tight glycemic control to a lower vs. higher range influenced timing, duration, or resolution of multiple organ dysfunction syndrome as well as characterize the clinical outcomes of subgroups of multiple organ dysfunction syndrome in children enrolled in the Heart And Lung Failure-Pediatric INsulin Titration trial.

Design: Planned secondary analysis of the multicenter Heart And Lung Failure-Pediatric INsulin Titration trial.

Setting: Thirty-five PICUs.

Patients: Critically ill children with hyperglycemia who received the Heart And Lung Failure-Pediatric INsulin Titration protocol from 2012 to 2016.

Interventions: Randomization to a lower versus higher glucose target group.

Measurements And Main Results: Of 698 patients analyzed, 48 (7%) never developed multiple organ dysfunction syndrome, 549 (79%) had multiple organ dysfunction syndrome without progression, 32 (5%) developed new multiple organ dysfunction syndrome, and 69 (10%) developed progressive multiple organ dysfunction syndrome. Of those whose multiple organ dysfunction syndrome resolved, 192 (34%) experienced recurrent multiple organ dysfunction syndrome. There were no significant differences in the proportion of multiple organ dysfunction syndrome subgroups between Heart And Lung Failure-Pediatric INsulin Titration glucose target groups. However, patients with new or progressive multiple organ dys function syndrome had fewer ICU-free days through day 28 than those without new or progressive multiple organ dysfunction syndrome, and progressive multiple organ dysfunction syndrome patients had fewer ICU-free days than those with new multiple organ dysfunction syndrome: median 25.1 days for never multiple organ dysfunction syndrome, 20.2 days for multiple organ dysfunction syndrome without progression, 18.6 days for new multiple organ dysfunction syndrome, and 0 days for progressive multiple organ dysfunction syndrome (all comparisons p < 0.001). Patients with recurrent multiple organ dysfunction syndrome experienced fewer ICU-free days than those without recurrence (median, 11.2 vs 22.8 d; p < 0.001).

Conclusions: Tight glycemic control target range was not associated with differences in the proportion of new, progressive, or recurrent multiple organ dysfunction syndrome. New or progressive multiple organ dysfunction syndrome was associated with poor clinical outcomes, and progressive multiple organ dysfunction syndrome was associated with worse outcomes than new multiple organ dysfunction syndrome. In future studies, new multiple organ dysfunction syndrome and progressive multiple organ dysfunction syndrome may need to be considered separately, as they represent distinct subgroups with different, potentially modifiable risk factors. Patients with recurrent multiple organ dysfunction syndrome represent a newly characterized, high-risk group which warrants attention in future research.
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http://dx.doi.org/10.1097/PCC.0000000000002151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895434PMC
December 2019

Mother's Own Milk Feeding and Severity of Respiratory Illness in Acutely Ill Children: An Integrative Review.

J Pediatr Nurs 2020 Jan - Feb;50:5-13. Epub 2019 Oct 26.

Neonatal Intensive Care, Pediatrics, Women, Children and Family Nursing, Rush University Medical Chicago, IL USA. Electronic address:

Problem: Breastfed infants experience less severe infections while actively breastfeeding. However, little is known about whether a history of prior breastfeeding affects severity of illness. Therefore, the purpose of this integrative review was to examine the relationship between previous exposure to mother's own milk (MOM) feeding and severity of respiratory infectious illness in infants and children.

Eligibility Criteria: Studies meeting the following criteria were included: human subjects, term birth, ages 0-35 months at time of study, diagnosis of pneumonia, bronchiolitis or croup, MOM feeding, and statistical analyses reporting separate respiratory infectious illness outcomes when combined with other infections.

Sample: Twelve articles met eligibility criteria.

Results: Major findings were inconsistent definitions of both dose and exposure period of breastfeeding and the severity of illness. In particular, the severity of illness measure was limited by the use of proxy variables such as emergency room visits or hospitalizations that lacked reliability and validity. However, given this limitation, the data suggested that exclusive breastfeeding for four to six months was associated with reduced severity of illness as measured by frequency of visits to the primary care provider office, emergency department or hospitalization.

Conclusions: Future research in this area should incorporate reliable and valid measures of MOM dose and exposure period and severity of illness outcomes in the critically ill child.

Implications: Among many positive outcomes associated with breastfeeding, an additional talking point for encouragement of exclusive breastfeeding for four to six months may be protective against severe respiratory infectious illness after cessation of breastfeeding.
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http://dx.doi.org/10.1016/j.pedn.2019.09.020DOI Listing
December 2020

Biobanking in the Pediatric Critical Care Setting: Adolescent/Young Adult Perspectives.

J Empir Res Hum Res Ethics 2018 10 14;13(4):391-401. Epub 2018 Jun 14.

1 Northwestern University, Chicago, IL, USA.

Biorepository research in children raises numerous ethical questions that are heightened in the pediatric intensive care unit (PICU) setting. We conducted a cross-sectional, interview-based study of 20 adolescent/young adult (A/YA) PICU patients and 75 parents of PICU patients to elucidate perspectives on biorepository research. A/YAs had a positive attitude toward biobanking. In young adults, comprehension was higher for knowledge of a choice to withdraw and participate in the research and lower for purpose, procedures, risks, and benefits of participation. All but one A/YA wanted to have a say in whether their samples would be used. Parent views on child assent were mixed; 55% of parents favored child involvement in decisions. Efforts should be made to improve comprehension by A/YAs and involvement of A/YAs in decisions.
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http://dx.doi.org/10.1177/1556264618782231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146019PMC
October 2018

Long-Term Outcomes after Protocolized Sedation versus Usual Care in Ventilated Pediatric Patients.

Am J Respir Crit Care Med 2018 06;197(11):1457-1467

12 Critical Care and Cardiovascular Program, Boston Children's Hospital, Boston, Massachusetts.

Rationale: Whether a nurse-implemented goal-directed sedation protocol resulting in more awake yet calm intubated children affects postdischarge functional status, health-related quality of life, or risk for post-traumatic stress disorder is unknown.

Objectives: To compare postdischarge outcomes in children with acute respiratory failure cluster-randomized to a sedation protocol or usual care.

Methods: A stratified random sample of 1,360 patients from 31 centers in the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) trial was assessed by mail, electronically, and/or telephone 6 months after ICU discharge. In treatment group comparisons, we controlled for age, baseline functional status, and severity of illness.

Measurements And Main Results: We used the Pediatric Overall Performance Category and the Pediatric Cerebral Performance Category to characterize functional status, the Infant and Toddler Quality of Life Questionnaire (97-item full-length version) (<2 yr old) or Pediatric Quality of Life Inventory (≥2 yr old), and the Child Post-traumatic Stress Disorder Symptom Scale (≥8 yr old and developmentally able). Functional status worsened from baseline to follow-up in 20%. Decline in functional status did not differ by treatment arm and was more common among those with baseline impairment than those with baseline normal function (27 vs. 18%; P < 0.001). There were no significant differences in health-related quality of life total scores by treatment arm. Scores indicating risk of post-traumatic stress disorder occurred in 30%, with no difference between treatment arms.

Conclusions: A sedation strategy that allows patients to be more awake and exposes them to fewer sedative and analgesic medications produces no long-term harm. However, postdischarge morbidity after acute respiratory failure is common. Clinical trial registered with www.clinicaltrials.gov (NCT00814099).
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http://dx.doi.org/10.1164/rccm.201708-1768OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005554PMC
June 2018

The Process and Impact of Stakeholder Engagement in Developing a Pediatric Intensive Care Unit Communication and Decision-Making Intervention.

J Patient Exp 2016 Dec 1;3(4):108-118. Epub 2016 Dec 1.

Program in Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Stakeholder-developed interventions are needed to support pediatric intensive care unit (PICU) communication and decision-making. Few publications delineate methods and outcomes of stakeholder engagement in research. We describe the process and impact of stakeholder engagement on developing a PICU communication and decision-making support intervention. We also describe the resultant intervention. Stakeholders included parents of PICU patients, healthcare team members (HTMs), and research experts. Through a year-long iterative process, we involved 96 stakeholders in 25 meetings and 26 focus groups or interviews. Stakeholders adapted an adult navigator model by identifying core intervention elements and then determining how to operationalize those core elements in pediatrics. The stakeholder input led to PICU-specific refinements, such as supporting transitions after PICU discharge and including ancillary tools. The resultant intervention includes navigator involvement with parents and HTMs and navigator-guided use of ancillary tools. Subsequent research will test the feasibility and efficacy of our intervention.
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http://dx.doi.org/10.1177/2374373516685950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513658PMC
December 2016

Pain and Sedation Management in Mechanically Ventilated Children.

J Pediatr Intensive Care 2015 Jun;4(2):64-72

Women and Children's Service, University of Maryland Medical Center, University of Maryland School of Nursing Pediatric Acute Care, Baltimore, Maryland, United States.

Assessing and managing pain and agitation in critically ill children can be challenging. Multiple factors contribute to the challenges of management, including prior medication exposure, surgical and procedural interventions, pharmacokinetics, and age-related pharmacodynamics making the population heterogeneous. Therefore, individualizing treatment approaches embedded with frequent assessments is likely to improve the management of pain and agitation in critically ill children. Novel approaches to manage pain and agitation continue to evolve and will require ongoing evaluation prior to widespread adoption.
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http://dx.doi.org/10.1055/s-0035-1556748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513151PMC
June 2015

Nursing in the Pediatric Intensive Care Unit.

J Pediatr Intensive Care 2015 Jun;4(2):55

Division of Pediatric Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States.

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http://dx.doi.org/10.1055/s-0035-1556746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513173PMC
June 2015

Pediatric Critical Care Nursing Research Priorities-Initiating International Dialogue.

Pediatr Crit Care Med 2015 Jul;16(6):e174-82

1PICU and Children's Nursing Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom. 2School of Health, University of Central Lancashire, Preston, United Kingdom. 3Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. 4PICU, Critical Care Program, Hospital for Sick Children, Toronto, Ontario, Canada. 5Department of Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada. 6Department of Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, MA. 7Harvard Medical School, Boston, MA. 8Department of Nursing Research, The Royal Children's Hospital, Melbourne, Australia. 9School of Health Sciences and the Department of Paediatrics, The University of Melbourne, Melbourne, Australia. 10School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, United Kingdom. 11School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, WA, Australia. 12Department of Pediatric Nursing, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil. 13Division of Pediatric Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 14School of Nursing and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Objective: To identify and prioritize research questions of concern to the practice of pediatric critical care nursing practice.

Design: One-day consensus conference. By using a conceptual framework by Benner et al describing domains of practice in critical care nursing, nine international nurse researchers presented state-of-the-art lectures. Each identified knowledge gaps in their assigned practice domain and then poised three research questions to fill that gap. Then, meeting participants prioritized the proposed research questions using an interactive multivoting process.

Setting: Seventh World Congress on Pediatric Intensive and Critical Care in Istanbul, Turkey.

Participants: Pediatric critical care nurses and nurse scientists attending the open consensus meeting.

Interventions: Systematic review, gap analysis, and interactive multivoting.

Measurements And Main Results: The participants prioritized 27 nursing research questions in nine content domains. The top four research questions were 1) identifying nursing interventions that directly impact the child and family's experience during the withdrawal of life support, 2) evaluating the long-term psychosocial impact of a child's critical illness on family outcomes, 3) articulating core nursing competencies that prevent unstable situations from deteriorating into crises, and 4) describing the level of nursing education and experience in pediatric critical care that has a protective effect on the mortality and morbidity of critically ill children.

Conclusions: The consensus meeting was effective in organizing pediatric critical care nursing knowledge, identifying knowledge gaps and in prioritizing nursing research initiatives that could be used to advance nursing science across world regions.
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http://dx.doi.org/10.1097/PCC.0000000000000446DOI Listing
July 2015

Use of a noninvasive electromagnetic device to place transpyloric feeding tubes in critically ill children.

Am J Crit Care 2011 Nov;20(6):453-9; quiz 460

College of Nursing, Rush University in Chicago, Illinois, USA.

Background: The start of transpyloric feedings is often delayed because of challenges in reliably placing tubes blindly at the bedside.

Objective: To determine whether tube placement with the guidance of a noninvasive computerized electromagnetic device shortens the time needed to achieve accurate placement of transpyloric feeding tubes in critically ill children.

Methods: In a prospective, randomized trial in a tertiary-care, university-affiliated pediatric intensive care unit, 49 children requiring transpyloric feeding tube placement were randomized to have their tube placed by using conventional blind technique or with the assistance of a noninvasive electromagnetic device.

Results: Twenty-seven patients were randomized to blind placement, and 22 were randomized to the electromagnetic device group. The time required to place the tubes successfully was significantly longer (P < .03) in the electromagnetic device group (median, 9.5 minutes; 95% confidence interval, 7-13 minutes) compared with the conventional placement group (median, 5 minutes; 95% confidence interval, 4.0-7.0 minutes).

Conclusions: Placement of transpyloric feeding tubes with the guidance of a noninvasive electromagnetic device significantly increases the time required for accurate placement. Because placement of transpyloric feeding tubes in critically ill children is common practice in many pediatric intensive care units, technology that delays satisfactory placement may be counterproductive in experienced hands.
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http://dx.doi.org/10.4037/ajcc2011221DOI Listing
November 2011

Educational preparation and postgraduate training curriculum for pediatric critical care nurse practitioners.

Pediatr Crit Care Med 2010 Mar;11(2):205-12

Pediatric Intensive Care Unit, Children's Memorial Hospital, Chicago, IL, USA.

Background: Nurse practitioners (NPs) in pediatric intensive care units have increased dramatically over recent years. Although state regulations are changing pediatric nurse practitioner certification, licensure and credentialing requirements, available acute care, and critical care educational programs are limited. Thus, entry-level practitioners continue to have varied clinical experience and educational preparation.

Objective: To describe the current educational preparation and scope of practice of pediatric NPs and provide guidelines for postgraduate training to successfully integrate NPs into the pediatric intensive care unit (PICU).

Design: A group of NPs practicing in pediatric critical care recognized the imminent need for comprehensive orientation guidelines that are readily accessible to physicians and other nurse practitioners to successfully transition entry-level NPs into the PICU. The NPs held many discussions to identify commonalities and differences in the education foundation in pediatric NP programs, expected clinical experience and knowledge of NP students, and anticipated needs and gaps for the entry-level practitioner. A convenience sample of 20 pediatric critical care nurse practitioners practicing for > or =5 yrs were interviewed to examine current orientation processes for entry-level NPs into the PICU. Sample orientation guidelines, job descriptions, and procedural competency forms were collected and reviewed from various PICUs across the United States. An orientation model was drafted and distributed to a secondary panel of ten experienced practitioners to gather expert opinions. Responses were reviewed and a revised draft of the document was distributed to a group of APNs involved in postgraduate education.

Results: A PICU orientation model for entry-level pediatric critical care nurse practitioners was developed.

Conclusions: The orientation curriculum presented here may serve as a resource for NPs and collaborating physicians who are developing a training program for entry-level practitioners.
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http://dx.doi.org/10.1097/PCC.0b013e3181b80a19DOI Listing
March 2010

Respiratory syncytial virus: from primary care to critical care.

Authors:
Lauren R Sorce

J Pediatr Health Care 2009 Mar-Apr;23(2):101-8. Epub 2008 Mar 4.

Pediatric Critical Care, Children's Memorial Hospital, Chicago, IL, USA.

Respiratory syncytial virus (RSV) is a common disease in pediatrics. Certain subpopulations of children are at greatest risk for serious disease. However, previously healthy children also may become critically ill. In the clinic or the intensive care unit, children with RSV pose the challenge of how to treat a disease when evidence to support therapeutic options is severely limited. Prophylaxis is an option for certain children, although many do not qualify. RSV has been implicated in continued wheezing and the subsequent development of asthma. While evidence for this implication is still being sought, researchers are working on finding new ways to treat and prevent RSV.
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http://dx.doi.org/10.1016/j.pedhc.2007.11.004DOI Listing
May 2009

Preventing corneal abrasions in critically ill children receiving neuromuscular blockade: a randomized, controlled trial.

Pediatr Crit Care Med 2009 Mar;10(2):171-5

Children's Memorial Hospital, Chicago, IL, USA.

Objective: To determine the incidence of corneal abrasions in critically ill children requiring neuromuscular blockade (NMB) and to determine whether a moisture chamber over the eye is more effective in preventing corneal abrasions compared with standard therapy.

Design: Randomized controlled clinical trial.

Setting: Three pediatric intensive care units at two free-standing, university-affiliated children's hospitals.

Patients: Consecutive intubated, mechanically ventilated patients receiving NMB <36 hours, 2 weeks to 18 years of age.

Intervention: After confirming the absence of a corneal abrasion, patients' eyes were randomized to either control (Q6H lubrication and eye closure) or treatment (Q6H lubrication, eyelid closure and moisture chamber). Eyes were examined daily for 3 days then every other day until NMB was discontinued, a corneal abrasion developed, or on study day 9. Data were analyzed on an intention-to-treat basis.

Measurements And Main Results: Two hundred thirty-seven patients were enrolled. Thirty patients exited the study before randomization (17 upon confirmation of a corneal abrasion on initial examination [7%; 95% confidence interval 4%-11%]; 12 upon discontinuation of NMB; 1 patient death). The remaining 207 patients were randomized and evaluated twice (median; interquartile range [IQR] 1-4 observations). Twenty-one patients developed a corneal abrasion over the course of the study (10%; 95%confidence interval 6%-15%). Median time from enrollment to abrasion was 2 days (IQR 1-3 days). The incidence of corneal abrasion was not different between the patient's control and treatment eyes; specifically, eight corneal abrasions developed in the control eye, five corneal abrasions in the treatment eye, and eight corneal abrasions in both eyes (McNemar's test; p = 0.58).

Conclusions: The occurrence of corneal abrasions in critically ill children receiving NMB is not trivial. The additional use of a moisture chamber over the eye was no more effective than Q6H lubrication and eye closure alone in preventing corneal abrasions in this at-risk patient group.
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http://dx.doi.org/10.1097/PCC.0b013e3181956ccfDOI Listing
March 2009

Adverse responses: sedation, analgesia and neuromuscular blocking agents in critically ill children.

Authors:
Lauren R Sorce

Crit Care Nurs Clin North Am 2005 Dec;17(4):441-50, xi-xii

Pediatric Critical Care, Children's Memorial Hospital, 2300 Children's Plaza Box 246, Chicago, IL 60614, USA.

Advanced practice nurses (APNs) prescribe sedation, analgesia, and neuromuscular blocking agents in the management of critically ill children. Although most children are unscathed from the use of the medications, some suffer adverse responses. This article elucidates adverse responses to these medications for the APN, including withdrawal syndrome, muscle weakness, decreased gastric motility, corneal abrasions, and costs associated with these morbidities.
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http://dx.doi.org/10.1016/j.ccell.2005.07.002DOI Listing
December 2005

Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial.

JAMA 2005 Jul;294(2):229-37

Children's Hospital Boston, Medical-Surgical Intensive Care Unit, 300 Longwood Ave, Boston, MA 02115, USA.

Context: In uncontrolled clinical studies, prone positioning appeared to be safe and to improve oxygenation in pediatric patients with acute lung injury. However, the effect of prone positioning on clinical outcomes in children is not known.

Objective: To test the hypothesis that at the end of 28 days infants and children with acute lung injury treated with prone positioning would have more ventilator-free days than those treated with supine positioning.

Design, Setting, And Patients: Multicenter, randomized, controlled clinical trial conducted from August 28, 2001, to April 23, 2004, of 102 pediatric patients from 7 US pediatric intensive care units aged 2 weeks to 18 years who were treated with supine vs prone positioning. Randomization was concealed and group assignment was not blinded.

Intervention: Patients were randomized to either supine or prone positioning within 48 hours of meeting acute lung injury criteria, with those patients in the prone group being positioned within 4 hours of randomization and remaining prone for 20 hours each day during the acute phase of their illness for a maximum of 7 days, after which they were positioned supine. Both groups were treated using lung protective ventilator and sedation protocols, extubation readiness testing, and hemodynamic, nutrition, and skin care guidelines.

Main Outcome Measure: Ventilator-free days to day 28.

Results: The trial was stopped at the planned interim analysis on the basis of the prespecified futility stopping rule. There were no differences in the number of ventilator-free days between the 2 groups (mean [SD], 15.8 [8.5] supine vs 15.6 [8.6] prone; mean difference, -0.2 days; 95% CI, -3.6 to 3.2; P = .91). After controlling for age, Pediatric Risk of Mortality III score, direct vs indirect acute lung injury, and mode of mechanical ventilation at enrollment, the adjusted difference in ventilator-free days was 0.3 days (95% CI, -3.0 to 3.5; P = .87). There were no differences in the secondary end points, including proportion alive and ventilator-free on day 28 (P = .45), mortality from all causes (P>.99), the time to recovery of lung injury (P = .78), organ-failure-free days (P = .88), and cognitive impairment (P = .16) or overall functional health (P = .12) at hospital discharge or on day 28.

Conclusion: Prone positioning does not significantly reduce ventilator-free days or improve other clinical outcomes in pediatric patients with acute lung injury.
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http://dx.doi.org/10.1001/jama.294.2.229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1237036PMC
July 2005