Ellen Heimberg

Nurse-driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients.

While several analgesia and sedation guidelines and protocols have been developed and implemented for adults, there is still little evidence of clinical use of analgesia and sedation protocols and the impact on withdrawal symptoms in critically ill children.

State of Cerebrovascular Autoregulation Correlates with Outcome in Severe Infant/Pediatric Traumatic Brain Injury

OBJECTIVE It could be shown in adults with severe traumatic brain injury (TBI) that the functional status of cerebrovascular autoregulation (AR), determined by the pressure reactivity index (PRx), correlates with and even predicts outcome. We investigated PRx and its correlation with outcome in infant and pediatric TBI. Methods Ten patients (median age 2.8 years, range 1 day to 14 years) with severe TBI (Glasgow Coma Scale score <9 at presentation) underwent long-term computerized intracranial pressure (ICP) and mean arterial pressure (MAP) monitoring using dedicated software for continuous determination of cerebral perfusion pressure (CPP) and PRx. Outcome was determined at discharge and at follow-up at 6 months using the Glasgow Outcome Scale (GOS) score. RESULTS Median monitoring time was 182 h (range 22-355 h). Seven patients underwent decompressive craniectomy to control ICP during treatment in the intensive care unit. Favorable outcome (GOS 4 and 5) was reached in 4 patients, an unfavorable outcome (GOS 1-3) in 6 patients. When dichotomized to outcome, no correlation was found with ICP and CPP, but median PRx correlated well with outcome (r = -0.79, p = 0.006) and tended to be lower for GOS 4 and 5 (-0.04) than for GOS 1-3 (0.32; p = 0.067). CONCLUSION The integrity of AR seems to play the same fundamental role after TBI in the pediatric population as in adults and should be determined routinely. It carries an important prognostic value. PRx seems to be an ideal candidate parameter to guide treatment in the sense of optimizing CPP, aiming at improvement of cerebrovascular autoregulation (CPPopt concept).

Structured Performance Assessment in Three Pediatric Emergency Scenarios: A Validation Study

OBJECTIVE To develop and validate 3 performance evaluation checklists (PECs) for systematic performance assessment in 3 clinical scenarios: cardiopulmonary arrest, dyspnea with oxygen desaturation after intubation, and respiratory syncytial virus (RSV). STUDY DESIGN The 3 PECs were developed using an integrative approach and used to rate 50 training sessions in a simulator environment by different raters. Construct validity was tested by correlating the checklist scores with external constructs (ie, global rating, team experience level, and time to action). Further interrater reliability was tested for all 3 PECs. RESULTS The PECs for the desaturation and cardiopulmonary arrest scenarios were valid and reliable, whereas the PEC for RSV had limited validity and reliability. CONCLUSION For 2 pediatric emergencies, the PEC is a valid and reliable tool for systematic performance assessment. The unsatisfactory results for the PEC for RSV may be related to limitations of the simulation setting and require further investigation. Structured assessment of clinical performance can augment feedback on technical performance aspects and is essential for training purposes as well as for research. Only reliable and valid performance measures will allow medical educators to accurately evaluate the behavioral effects of training interventions and further enhance the quality of patient care.

Investigating predictive power of agency and communion for interprofessional learner outcomes: A before–after study

ABSTRACT As interprofessional education (IPE) continues to be instituted, much attention has been paid to training-intervention effectiveness. Less attention has been paid to the selection side of the IPE model; however, efficient delivery is necessary to sustain the development of IPE. This short report investigates the “two big social cognitions” (agency and communion) as individual-difference predictors of attitude change and knowledge acquisition. A 3-week before–after observational design with survey methodology was conducted in a pre-licensure IPE setting (n = 82). Results indicated significant interactions of agency and communion in predicting learner outcomes. Our findings should stimulate future IPE researchers to identify additional, selection-relevant design factors (e.g., individual differences) that may enhance comparative-effectiveness of IPE.

Severe Upper Airway Obstruction After Intraoperative Transesophageal Echocardiography in Pediatric Cardiac Surgery: A Retrospective Analysis*

Objectives: The aim of this study was to evaluate if there is a correlation between the use of intraoperative transesophageal echocardiography and an increased rate of extubation failure and to find other risk factors for severe upper airway obstructions after pediatric cardiac surgery. Design: Retrospective analysis. Setting: Cardiac PICU. Patients: Patients 24 months old or younger who underwent surgery for congenital heart disease with cardiopulmonary bypass were retrospectively enrolled and divided into two groups depending on whether they received an intraoperative transesophageal echocardiography or not. We analyzed all cases of early reintubations within 12 hours after extubation due to a documented upper airway obstruction. Intervention: None. Measurements and Main Results: From a total of 424 patients, 12 patients (2.8%) met our criteria of early reintubation due to upper airway obstruction. Ten of 207 children in the transesophageal echocardiography group had to be reintubated, whereas only two of the 217 children in the control group had to be reintubated (4.8% vs 0.9%; p = 0.018). Logistic regression analysis showed a significant correlation between use of intraoperative transesophageal echocardiography and extubation failure (odds ratio, 5.64; 95% CI, 1.18–27.05; p = 0.030). There was no significant relationship among sex (odds ratio, 4.53; 95% CI, 0.93–22.05; p = 0.061), weight (odds ratio, 1.07; 95% CI, 0.82–1.40; p = 0.601), duration of surgery (odds ratio, 1.04; 95% CI, 0.74–1.44; p = 0.834), duration of mechanical ventilation (odds ratio, 1.00; 95% CI, 0.99–1.00; p = 0.998), and occurrence of trisomy 21 (odds ratio, 3.47; 95% CI, 0.83–14.56; p = 0.089). Conclusions: Although the benefits of intraoperative transesophageal echocardiography during pediatric cardiac surgery are undisputed, it may be one factor which could increase the rate of severe upper airway obstruction after extubation with the need for reintubation. We suggest to take precautions before extubating high-risk patients, especially in young male children with genetic abnormalities after cardiac surgery with cardiopulmonary bypass.

In Situ Simulation

In situ simulation describes training that occurs in real patient care environments, rather than in a simulation center or off-site training area. Mobile simulation, taking simulation to hospitals or clinics in the community, can make in situ simulation methodologies accessible across institutions and international boundaries.

Nurse-driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first-stage palliation surgery: A pilot study

Few data are available regarding requirements of sedation and analgesia in children during extracorporeal life support.

Erweiterte Maßnahmen der kardiopulmonalen Reanimation bei Kindern und Jugendlichen. Kommentierte Zusammenfassung der aktuellen Empfehlungen des European Resuscitation Council

ZusammenfassungDie erweiterten Reanimationsmaßnahmen beinhalten die Gabe von Medikamenten, Herzrhythmusanalyse und Defibrillation. Reanimationssituationen sind in der Pädiatrie insgesamt selten und stellen für alle Beteiligten eine hohe kognitive Herausforderung und eine große emotionale Belastung dar. Daher sind ständige Schulungsmaßnahmen zum Erlernen und zur Auffrischung der Basic-Life-Support(BLS)- und Advanced-Life-Support(ALS)-Maßnahmen erforderlich. Hierfür werden spezielle Kinderreanimationskurse des European Resuscitation Council (European Paediatric Life Support, EPLS; http://www.erc.edu) angeboten. Sogenannte nichttechnische Fertigkeiten, wie Kommunikation, Teamführung und Aufgabenverteilung im Team, gewinnen zunehmend an Bedeutung und sollten in Trainingskonzepte integriert werden. Hier finden teamorientierte Ausbildungskonzepte an hochmodernen Patientensimulatoren wachsende Verbreitung. Allerdings gibt es in den Leitlinien kein eindeutiges Statement über die verpflichtende Durchführung von Trainings und die Häufigkeit von Wiederholungen. Es gibt zunehmende Hinweise darauf, dass erlerntes Wissen und auch Fähigkeiten schon nach wenigen Monaten wieder verloren gehen. Daher wird postuliert, dass jährliche Trainings möglicherweise nicht ausreichend sind. Die Autoren hoffen, dass die vorliegende Zusammenfassung zu einer hohen Akzeptanz und zur weiteren Verbreitung der aktuellen internationalen Leitlinien für die lebensrettenden Maßnahmen bei Kindern beiträgt.AbstractThe extended resuscitation measures include the administration of medications, heart rhythm analysis and defibrillation. Resuscitation situations in pediatrics are rare events and represent a high cognitive challenge and a significant emotional burden for all concerned; therefore, continuous training measures for learning and refreshing pediatric basic life support (BLS) and advanced life support (ALS) techniques is essential. For this purpose the European Resuscitation Council provides special child resuscitation courses (European pediatric life support, EPLS, http://www.erc.edu). So-called non-technical skills, such as communication, team leadership and task distribution within the team are becoming increasingly more important and should be integrated into training concepts. Team-oriented training concepts using state of the art patient simulators are becoming more widespread; however, in the guidelines there is no clear statement about an obligatory participation in training or the frequency of refresher courses. There is an increasing amount of evidence that acquired knowledge and also skills become lost even after only a few months; therefore, it is postulated that annual training refreshers are possibly not sufficient. The authors hope that the summary provided here will contribute to a greater acceptance and wider distribution of the current guidelines for life-saving measures in children.

Erweiterte Maßnahmen der kardiopulmonalen Reanimation bei Kindern und Jugendlichen@@@Extended measures for cardiopulmonary resuscitation in children and adolescents: Kommentierte Zusammenfassung der aktuellen Empfehlungen des European Resuscitation Council@@@Summary of the current recommendations of the European Resuscitation Council with comments

ZusammenfassungDie erweiterten Reanimationsmaßnahmen beinhalten die Gabe von Medikamenten, Herzrhythmusanalyse und Defibrillation. Reanimationssituationen sind in der Pädiatrie insgesamt selten und stellen für alle Beteiligten eine hohe kognitive Herausforderung und eine große emotionale Belastung dar. Daher sind ständige Schulungsmaßnahmen zum Erlernen und zur Auffrischung der Basic-Life-Support(BLS)- und Advanced-Life-Support(ALS)-Maßnahmen erforderlich. Hierfür werden spezielle Kinderreanimationskurse des European Resuscitation Council (European Paediatric Life Support, EPLS; http://www.erc.edu) angeboten. Sogenannte nichttechnische Fertigkeiten, wie Kommunikation, Teamführung und Aufgabenverteilung im Team, gewinnen zunehmend an Bedeutung und sollten in Trainingskonzepte integriert werden. Hier finden teamorientierte Ausbildungskonzepte an hochmodernen Patientensimulatoren wachsende Verbreitung. Allerdings gibt es in den Leitlinien kein eindeutiges Statement über die verpflichtende Durchführung von Trainings und die Häufigkeit von Wiederholungen. Es gibt zunehmende Hinweise darauf, dass erlerntes Wissen und auch Fähigkeiten schon nach wenigen Monaten wieder verloren gehen. Daher wird postuliert, dass jährliche Trainings möglicherweise nicht ausreichend sind. Die Autoren hoffen, dass die vorliegende Zusammenfassung zu einer hohen Akzeptanz und zur weiteren Verbreitung der aktuellen internationalen Leitlinien für die lebensrettenden Maßnahmen bei Kindern beiträgt.AbstractThe extended resuscitation measures include the administration of medications, heart rhythm analysis and defibrillation. Resuscitation situations in pediatrics are rare events and represent a high cognitive challenge and a significant emotional burden for all concerned; therefore, continuous training measures for learning and refreshing pediatric basic life support (BLS) and advanced life support (ALS) techniques is essential. For this purpose the European Resuscitation Council provides special child resuscitation courses (European pediatric life support, EPLS, http://www.erc.edu). So-called non-technical skills, such as communication, team leadership and task distribution within the team are becoming increasingly more important and should be integrated into training concepts. Team-oriented training concepts using state of the art patient simulators are becoming more widespread; however, in the guidelines there is no clear statement about an obligatory participation in training or the frequency of refresher courses. There is an increasing amount of evidence that acquired knowledge and also skills become lost even after only a few months; therefore, it is postulated that annual training refreshers are possibly not sufficient. The authors hope that the summary provided here will contribute to a greater acceptance and wider distribution of the current guidelines for life-saving measures in children.

Erweiterte Maßnahmen der kardiopulmonalen Reanimation bei Kindern und Jugendlichen

ZusammenfassungDie erweiterten Reanimationsmaßnahmen beinhalten die Gabe von Medikamenten, Herzrhythmusanalyse und Defibrillation. Reanimationssituationen sind in der Pädiatrie insgesamt selten und stellen für alle Beteiligten eine hohe kognitive Herausforderung und eine große emotionale Belastung dar. Daher sind ständige Schulungsmaßnahmen zum Erlernen und zur Auffrischung der Basic-Life-Support(BLS)- und Advanced-Life-Support(ALS)-Maßnahmen erforderlich. Hierfür werden spezielle Kinderreanimationskurse des European Resuscitation Council (European Paediatric Life Support, EPLS; http://www.erc.edu) angeboten. Sogenannte nichttechnische Fertigkeiten, wie Kommunikation, Teamführung und Aufgabenverteilung im Team, gewinnen zunehmend an Bedeutung und sollten in Trainingskonzepte integriert werden. Hier finden teamorientierte Ausbildungskonzepte an hochmodernen Patientensimulatoren wachsende Verbreitung. Allerdings gibt es in den Leitlinien kein eindeutiges Statement über die verpflichtende Durchführung von Trainings und die Häufigkeit von Wiederholungen. Es gibt zunehmende Hinweise darauf, dass erlerntes Wissen und auch Fähigkeiten schon nach wenigen Monaten wieder verloren gehen. Daher wird postuliert, dass jährliche Trainings möglicherweise nicht ausreichend sind. Die Autoren hoffen, dass die vorliegende Zusammenfassung zu einer hohen Akzeptanz und zur weiteren Verbreitung der aktuellen internationalen Leitlinien für die lebensrettenden Maßnahmen bei Kindern beiträgt.AbstractThe extended resuscitation measures include the administration of medications, heart rhythm analysis and defibrillation. Resuscitation situations in pediatrics are rare events and represent a high cognitive challenge and a significant emotional burden for all concerned; therefore, continuous training measures for learning and refreshing pediatric basic life support (BLS) and advanced life support (ALS) techniques is essential. For this purpose the European Resuscitation Council provides special child resuscitation courses (European pediatric life support, EPLS, http://www.erc.edu). So-called non-technical skills, such as communication, team leadership and task distribution within the team are becoming increasingly more important and should be integrated into training concepts. Team-oriented training concepts using state of the art patient simulators are becoming more widespread; however, in the guidelines there is no clear statement about an obligatory participation in training or the frequency of refresher courses. There is an increasing amount of evidence that acquired knowledge and also skills become lost even after only a few months; therefore, it is postulated that annual training refreshers are possibly not sufficient. The authors hope that the summary provided here will contribute to a greater acceptance and wider distribution of the current guidelines for life-saving measures in children.