Objective We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine if echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation. Study Design A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was >15 µg/kg/min. Echocardiograms and cortisol measurements were obtained between 6 and 14 hours after the ligation (prior to the presence of catecholamine-resistant hypotension). Results 45 infants were enrolled: 10 received catecholamines (6 were catecholamine-responsive, 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration. Conclusion We speculate that low cortisol levels and impaired vascular tone may play a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.

To assess current practice and provide a basis for a provincial template, clinicians at a Canadian pediatric hospice reviewed the literature surrounding pediatric advance care planning (pACP) documentation, process, and implementation for children/youth. The scoping review protocol was developed in accordance with the Joanna Briggs Institute methodology for scoping reviews, and was prospectively registered on the Open Science Framework. MEDLINE, Embase, CINAHL, the Web of Science Core Collection, and Google Scholar, as well as sources of unpublished studies and grey literature, were reviewed. Sixty-four articles met the criteria. Fifteen pACP documentation forms/tools were also identified. Overall, the included articles highlighted that pACP should be a structured, collaborative and iterative process between the family and a trusted or relevant healthcare provider, encompassing medical and non-medical issues. Few articles provided insights into specific elements recommended for advance directive forms. Identified strategies for implementation included a structured, step-by-step pACP interventional tool along with ongoing training, mentorship, and defined organizational structures for the clinician. No single specific ACP tool was acknowledged as the gold standard. Use of a pACP tool, along with ongoing provider education and communication skill development, standardized/accessible documentation, and system-wide quality improvement support, were noted as integral components of pACP.

Objective: To explore the literature surrounding pediatric ACP process, documenting and implementing the documentation processes in hopes to inform and support content experts in the creation of a pediatric provincial document for ACP.Introduction: The number of children with serious illness/medical complexity in this province who require ACP and documentation of medical intervention is estimated to be >500 or possibly more. An ongoing data analysis suggests that the number may exceed 1,000 children, greater than the number of children and families consulted to the CPCH program. Currently there is no provincial document for pediatric patients such as the BC Medical Orders for Scope of Treatment form (MOST) as there is in adult care.Inclusion criteria: The review will include studies that focus on documentation, process or implementation in pediatric advance care planning. Child refers to prenatal, neonate, child and youth population (0-19 years), but may also extend into young adulthood in some contexts. These children are defined as at-risk for sudden death and/or expected death prior to reaching adulthood.Methods: We will search MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection and Google Scholar, as well as sources of unpublished studies and grey literature. Identified studies will be screened against the eligibility criteria. This review will only consider studies published in English and no date limits will be placed on the search. Relevant data will be extracted from eligible studies and the extracted data will presented in narrative and tabular/charted formats.

Objectives To explore experiences of pediatric clinicians participating in a serious illness communication program (SICP) for advance care planning (ACP), examining how the SICP supports clinicians to improve their communication and the challenges of implementing new communication tools into clinical practice. Methods A qualitative description study using individual interviews with a diverse group of pediatric clinicians who participated in 2.5-hour SICP training workshops at pediatric tertiary hospitals. Discussions were transcribed, coded, and arranged into overarching themes. Thematic analysis was conducted using interpretive description methodology. Results Fourteen clinicians from 2 Canadian pediatric tertiary hospital settings were interviewed, including nurses (36%), physicians (36%), and social workers (29%), from the fields of neonatology (36%), palliative care (29%), oncology (21%), and other pediatric specialties (14%). Key themes included specific benefits of SICP, with subthemes of connecting with families, increased confidence in ACP discussions, providing tools to improve communication, and enhanced self-awareness and self-reflection. A second theme of perceived challenges emerged, which included subthemes of not having the conversation guide readily accessible, divergent team communication practices, and particular features of the clinical environment which limited the possibility of engaging in ACP discussions with parents. Significance of results A structured program to enhance serious illness communication supports clinicians to develop skills and tools to increase their confidence and comfort in conducting conversations about end-of-life issues. Addressing challenges of adopting the newly learned communication practices, by providing access to digital SICP tools and conducting SICP training for clinical teams may further support clinicians to engage in ACP.