Caregivers' mental health plays an important role in the quality of care delivery and outcome. Use of appropriate coping styles can reduce the impact of these symptoms.

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Children's National INTRODUCTION/HYPOTHESIS: Discussion of prognosis is a vital component of communication during pediatric intensive care unit (PICU) family conferences when medical decision-making is anticipated. Prior studies demonstrate that sharing clear, meaningful prognostic information positively impacts parental hope, satisfaction, and medical decision-making. For effective communication, the prognosis statement must contain a message, defined as a forecasting of the probable course of a disease, and a meaning, which delineates the impact of the disease on the patient and/ or family. The current practice of how the healthcare team communicates prognosis to parents of critically ill children in the PICU is unknown. We evaluated the frequency and characteristics of prognostic statements made by the healthcare team during PICU decision-making family conferences. METHODS:We conducted a retrospective, qualitative study analyzing transcripts of audio-recorded PICU family conferences where critical decision-making was anticipated. Descriptive, thematic content analysis was applied to the transcripts to identify 1) the presence of prognostic statements and 2) the message and meaning of the prognostic statements. RESULTS:Seventy-two transcripts were analyzed, of which 53 (74%) included at least one prognostic statement. Clinicians made a total of 112 prognostic statements, of which 66 (59%) included both a message and a meaning, such as "your child's lungs are worsening (message) and extubation will be unsuccessful (meaning). " Conversely, 46/112 (41%) statements included a message only, such as "your child's lungs are worsening. " Messages fell into 4 themes: Time (fast vs. slow recovery), Disability (need for medical technology), Cure (reversibility of disease), and Additional disease (brain injury will lead to respiratory problems). CONCLUSIONS:Prognosis was discussed in the majority of family conferences of critical decision-making in the PICU, yet clinicians didn't discuss prognosis 26% of the time. When prognosis was discussed, 41% of the time clinicians struggled to provide meaning to families regarding how this life-altering news may impact the patient and family. Providing context to the prognosis is essential for families to understand the prognosis and plan for the future.

Introduction Hemolysis during pediatric extracorporeal membrane oxygenation (ECMO) is associated with increased risk for renal failure and mortality. Objectives We aim to describe risk factors for hemolysis in pediatric ECMO supported by centrifugal pumps. Methods We conducted an analysis of retrospective data collected at an academic children’s hospital from January 2017 to December 2019. Measurements and results Plasma-free hemoglobin (PFH) levels were measured daily, and hemolysis was defined as PFH>50 mg/dL. Of 46 ECMO runs over 528 ECMO days, hemolysis occurred in 23 (58%) patients over a total of 40 (8%) ECMO days. In multivariable logistic regression models, VA-ECMO (aOR=4.69, 95% CI: 1.01–21.83) and higher hemoglobin (aOR = 1.38, 95% CI: 1.06–1.81) were independently associated with hemolysis. There were also non-significant trends toward increased risk for hemolysis with higher rotational pump speed (aOR=2.39, 95% CI: 0.75–7.65), higher packed red blood cell transfusions (aOR=1.15, 95% CI: 0.99–1.34), and higher cryoprecipitate transfusions (aOR=2.01, 95% CI: 0.83–4.86). Isolated pump exchanges that were performed in 12 patients with hemolysis led to significant decreases in PFH levels within 24 h (89 vs 11 mg/dL, p<0.01). Conclusions Hemolysis is common in pediatric ECMO using centrifugal pumps. Avoidance of high pump speeds and conservative administration of blood products may help to mitigate the risk for hemolysis. Furthermore, pump exchange may be an effective first-line treatment for hemolysis.

OBJECTIVES:Multidisciplinary PICU teams must effectively share information while caring for critically ill children. Clinical documentation helps clinicians develop a shared understanding of the patient's diagnosis, which informs decision-making. However, diagnosis-related documentation in the PICU is understudied, thus limiting insights into how pediatric intensivists convey their diagnostic reasoning. Our objective was to describe how pediatric critical care clinicians document patients' diagnoses at PICU admission. DESIGN:Retrospective mixed methods study describing diagnosis documentation in electronic health records.