Staffing and workforce issues in the pediatric intensive care unit

Wheeler, Derek S.; Dewan, Maya; Maxwell, Andrea; Riley, Carley; Stalets, Erika

doi:10.21037/tp.2018.09.05

Cited by 22 publications

(18 citation statements)

References 107 publications

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“…Despite great improvements in mechanical ventilation in recent years, the mortality rate of ARDS is still high (40%) (2). Low tidal volume ventilation (LTVV), optimum positive end-expiratory Original Article pressure, permissive hypercapnia, lung recruitment, and the prone position are common treatments for ARDS (3)(4)(5)(6). The prognosis of ARDS is closely related to mechanical ventilation airway pressure (7).…”

Section: Introductionmentioning

confidence: 99%

Airway pressure release ventilation versus low tidal volume ventilation for patients with acute respiratory distress syndrome/acute lung injury: a meta-analysis of randomized clinical trials

Zhong

Yang

et al. 2020

Ann Transl Med

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Background: It is uncertain whether airway pressure release ventilation (APRV) is better than low tidal volume ventilation (LTVV) for patients with acute respiratory distress syndrome (ARDS). The purpose of this meta-analysis was to compare APRV and LTVV on patients with ARDS. Methods: Randomized controlled trials (RCTs) comparing outcomes in ARDS ventilator therapy with APRV or LTVV were identified using Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, the Cochrane Library, and The Chinese Biomedicine Literature Database (SinoMed) from inception to March 2019. Results: A total of 7 RCTs with a 405 patients were eligible for our meta-analysis. The results revealed that APRV was associated with lower hospital mortality [405 patients; odds ratio (OR), 0.57; 95% confidence interval (CI), 0.37-0.88; P=0.01], a shorter time of ventilator therapy [373 patients; mean difference (MD), 5.36; 95% CI, 1.99-8.73; P=0.002], and intensive care unit (ICU) stay (315 patients; MD, −4.50; 95% CI, −6.56 to −2.44; P<0.0001), better respiratory system compliance on day 3 (202 patients; MD, 8.19; 95% CI, 0.84-15.54; P=0.03), arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) on day 3 (294 patients; MD, 44.40; 95% CI, 16.05-72.76; P=0.002), and higher mean arterial pressure (MAP) on day 3 (285 patients; MD, 4.18; 95% CI, 3.10-5.25; P<0.00001). There was no statistical difference in the incidence of pneumothorax (170 patients; OR, 0.40; 95% CI, 0.12-1.34; P=0.14). Conclusions:The meta-analysis showed that APRV could reduce hospital mortality, duration of ventilation and ICU stay, improve lung compliance, oxygenation index, and MAP compared with LTVV for patients with ARDS. We found APRV to be a safe and effective ventilation mode for patients with ARDS.

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Section: Introductionmentioning

confidence: 99%

Airway pressure release ventilation versus low tidal volume ventilation for patients with acute respiratory distress syndrome/acute lung injury: a meta-analysis of randomized clinical trials

Zhong

Yang

et al. 2020

Ann Transl Med

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“…have to remain alert all the time and are responsible for every patient under their care and in critical condition. 4 Out of these the pediatric intensive care unit (PICU) is much more stressful, as children are unable to take care of themselves, have no familiar face around and are difficult to soothe. The PICU gets even more stressful for a nurse because the nurse has to deal with the child and the medical treatment at the same time.…”

Section: Original Researchmentioning

confidence: 99%

Exploring experiences and coping strategies of nurses working in intensive care unit: A qualitative study

Zulfiqar

Rafiq

2020

APIC

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Background: The nursing profession is in its developing stages in the country yet when it comes to the work itself, the environment can be very competitive. Though nurses, in general, go through a tough time, it is the intensive care unit (ICU) nurses who have to be on their toes all the time. Those working in the pediatric department, deal with young patients requiring constant supervision and care compared to other ICUs. The aim of the current project was to explore the experiences and coping strategies of nurses working in pediatric ICUs in a public sector hospital of Lahore, Pakistan. Methodology: Semi structured in-depth interviews were conducted with 5 nurses who were working in pediatric ICU (PICU) in a public sector hospital. All the nurses were female. Results: The data was managed and analyzed using NVivo 12 version. The four superordinate themes, e.g. vocational problems, psychological problems, biosocial problems and coping had 11 master themes and 70 sub themes. Conclusion: Nurses in PICU face a lot of problems in their everyday work life, yet they have found their own ways to cope with their stress. Regardless the shortage of staff and constant complaints against them, nurses of PICU find solace in religious coping and socialization (as much as they can get). These results will help authorities to look into the problems and provide suitable solutions. Citation: Zulfiqar L, Rafiq M. Exploring experiences and coping strategies of nurses working in intensive care unit: A qualitative study. Anaesth Pain Intensive Care 2020;24(1):__ DOI: https://doi.org/10.35975/apic.v2i1. Received – 03 February 2020; Reviewed – 7 March 2020; Revised – 11 March 2020; Accepted – 12 March 2020;

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“…Related studies have pointed out that ARDS is one of the key causes of disability and death in children, and the incidence and mortality rates of ARDS have been increasing in recent years (2). Mechanical ventilation is the main treatment method for ARDS, but it is likely to cause lung injury.…”

Section: Introductionmentioning

confidence: 99%

Effect of lung recruitment on blood gas index, hemodynamics, lung compliance, and rehabilitation index in children with acute respiratory distress syndrome

Li²,

Huang³

et al. 2020

Transl Pediatr

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Background: Acute respiratory distress syndrome (ARDS) is a common pediatric disease, with an increasing mortality rate in recent years. This study aims to explore the effects of lung recruitment on blood gas indexes, hemodynamics, lung compliance, and rehabilitation index in children with ARDS.Methods: Seventy children with ARDS admitted to our hospital from December 2017 to December 2018 were selected as the study subjects, and were divided into a study group (35 cases, treated with lung recruitment strategy) and a control group (35 cases, treated with routine therapy). The changes of blood gas indexes, such as partial pressure of oxygen (PO 2 ), partial pressure of carbon dioxide (PCO 2 ), and partial pressure of oxygen/fraction of inspired oxygen (PO 2 /FiO 2 ) levels, as well as hemodynamic indexes, including cardiac output (CO), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), were compared before and after treatment in the two groups.Results: Results showed that the difference in blood gas indexes between the two groups was statistically significant after treatment (P<0.05), and that the levels of PaO 2 , PaCO 2 , pondus Hydrogenii (pH), and PO 2 / FiO 2 in the study group were all higher compared to the control group (P<0.05). The hemodynamic indexes showed that CO was significantly different between the two groups (P<0.05), but HR, MAP, and CVP were not (P>0.05). The lung compliance values of the two groups continued to increase at different time points after treatment (P<0.05), and the lung compliance of the study group was higher than that of the control group immediately after recruitment, as well as at 10 and 60 min of lung recruitment (P<0.05). In addition, the ventilator use, ICU stay, and hospital stay times of the study group were shorter than those in the control group (P<0.05), and the mortality rate of the study group was lower than that of the control group (P>0.05). Conclusions:The lung recruitment strategy has a significant therapeutic effect on children with ARDS.It can effectively improve blood and gas function and lung compliance, and has a positive effect on the hemodynamic stability of children with ARDS.

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Staffing and workforce issues in the pediatric intensive care unit

Abstract: The best possible care of critically ill patients can be rendered when physicians of various specialties, nurses, and allied health professionals join forces and treat problems together." --Ake Grenvik

Cited by 22 publications

References 107 publications

Airway pressure release ventilation versus low tidal volume ventilation for patients with acute respiratory distress syndrome/acute lung injury: a meta-analysis of randomized clinical trials

Airway pressure release ventilation versus low tidal volume ventilation for patients with acute respiratory distress syndrome/acute lung injury: a meta-analysis of randomized clinical trials

Exploring experiences and coping strategies of nurses working in intensive care unit: A qualitative study

Effect of lung recruitment on blood gas index, hemodynamics, lung compliance, and rehabilitation index in children with acute respiratory distress syndrome

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