背部测温法在儿科重症监护病房体温监测中的应用

目的比较儿科重症监护病房(PICU)患儿腋下体温与背部体温的差异性,探讨背温测量的可行性及意义。方法采用随机抽样法对2009年1月至2009年8月入住PICU的不同年龄的患儿110例进行体温测量试验。每例患儿分别测量10min腋下体温与背部体温。记录并进行比较。结果腋下体温与背部体温差异无统计学意义(P>0.05)。结论背温监测具有较腋温测量准确性高、护理工作量小的优点,可作为PICU体温测量的常规方法之一,测量时间应为10min。     

Vitamin D supplementation and improvement of pneumonic children at a tertiary pediatric hospital in Egypt: A randomized controlled trial

Background:Despite the well-recognized effect of vitamin D in metabolism and homeostasis, there is now growing interest in its probable association with pneumonia. This study aims to supply vitamin D3 (Cholecalciferol) (100,000 IU) to pneumonic children to minimize the duration of illness and improve their outcome.Methods:A double-blinded, randomized, placebo-controlled trial was conducted in a Pediatric Cairo University affiliated hospital. An intervention arm (93 children) and a control arm (98 children), who had pneumonia with an insufficient or deficient level of vitamin D and whose parental permission was obtained, were enrolled in the trial. All children were treated with antibiotics according to WHO guidelines. Children were given a single injection of 1 mL of 100,000 IU of vitamin D3 or placebo. Clinical data were recorded every eight hours for all children. Outcomes were assessed 7 days after vitamin D injection.The primary outcome variable was the change in serum level of 25(OH)D, while the secondary outcomes were the medical state of the assigned cases (improvement or death) and duration between enrollment and hospital discharge for improved cases.Results:In the supplementation group, the percentage of patients who suffered either deficient (38.7%) or insufficient levels (61.3%) of 25 (OH)D at day one had significantly decreased in the seventh day to (11.8%) and (52.7%), respectively. Kaplan--Meier plots highlighted that the median time to recover of the placebo group was significantly longer than that of the supplementation group (Log Rank P value < .001).Conclusion:VDD was detected in pediatric critical care children. In pneumonic children with high VDD, it is illustrated that Vitamin D supplementation is accompanied by lowered mortality risk and pSOFA scores, reduced time to recover, and improved PaO₂/FiO₂.Trial registration:Trial Identifier number: {"type":"clinical-trial","attrs":{"text":"NCT04244474","term_id":"NCT04244474"}}NCT04244474. Registered on 27 January 2020- Retrospectively registered at ClinicalTrials.gov https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009JXO&selectaction=Edit&uid=U0004UO8&ts=152&cx=9cceq6     

儿童心脏外科重症监护病房医院感染临床研究

目的:探讨先天性心脏病患儿术后PICU医院感染的发生情况.方法:回顾性分析行心脏手术的2 258例先天性心脏病患儿的临床资料,观察术后PICU医院感染发生率、发生部位、病原茵分布及耐药性,并进行统计分析.结果:198例惠儿术后发生PICU医院感染,发生率8.77%,其中呼吸机相关性肺炎181例(8.02%)、脓毒血症10例(0.44%)、血管相关性感染7例(0.31%).198例惠儿标本中共检出病原茵242株,包括革兰阴性杆菌174株(71.9%),革兰阳性球茵30株(12.4%),真茵38株(15.7%).复杂先天性心脏病与简单先天性心脏病患儿术后医院感染发生率比较差异有统计学意义(P＜0.01).不同住院时间患儿医院感染发生率比较差异有统计学意义(P＜0.01).随体外循环时间延长,医院感染发生率增高,差异有统计学意义(P＜0.01).常见的革兰阴性杆茵是肺炎克雷伯茵、铜绿假单胞茵、鲍曼不动杆茵、大肠埃希茵和嗜麦芽窄食单胞茵等;常见革兰阳性球菌是凝固酶阴性葡萄球菌、粪肠球菌、屎肠球菌和金黄色葡萄球茵等;真茵以白色假丝酵母茵为主.结论:先天性心脏病术后PICU医院感染发生率较高,不同感染部位病原茵分布有其自身特点.体外循环时间延长、住院时间延长可能会增加术后医院感染发生率.     

影响PICU心电监护准确性的因素分析及处理

了解PICU心电监护的内容,并分析影响PICU监护仪所显示各项参数及图像的因素.包括:电极接触不良及干扰、仪器感知功能不良是影响心率及心律显示准确性的主要因素;测量部位、袖带松紧度及患儿体位是影响血压显示准确性的因素;血氧饱和度传感器是否脱落,所夹部位皮肤及血液循环是否良好,是影响血氧饱和度准确性的因素.认为PICU护士应加强培训,认真阅读使用说明书,正确识别各种偏差异常值的影响因素,从而有效减少人为失误,提高监护质量.     

儿科重症监护室先天性心脏病合并呼吸道感染患儿的病毒性病原学研究

目的：总结儿科重症监护室中先天性心脏病合并呼吸道感染患儿的病毒性病原谱。方法收集2010年6月至2012年6月因呼吸道感染入住本院儿科重症监护室的患儿咽拭子标本622份,其中先天性心脏病合并呼吸道感染患儿咽拭子34份。应用多重聚合酶链反应(PCR)技术对呼吸道病毒进行检测,并对照分析合并先天性心脏病患儿的病毒性病原学特点。结果①34份先天性心脏病组咽拭子标本中,呼吸道病毒检测阳性20份(58.8%),588份非先天性心脏病组咽拭子标本中,呼吸道病毒检测阳性368份(62.6%)。②先天性心脏病组中,最常见的病毒分别为人鼻病毒(human rhinovirus,HRV)8份,呼吸道合胞病毒(respiratory syncytial virus, RSV)6份,人博卡病毒(human bocavirus,HBoV)4份,腺病毒(adenovirus,ADV)2份;非先天性心脏病组中,最常见的病毒分别为 HRV 160份,RSV 104份,ADV 72份,HBoV50份;其他病毒阳性率较低。③先天性心脏病组中,混合病毒感染有2份(2/20,10.0%),非先天性心脏病组中,混合病毒感染有110份(110/368,29.9%)。结论本地区儿科重症监护室中先天性心脏病合并呼吸道感染患儿的病原体中病毒性病原体检出率高,以鼻病毒、呼吸道合胞病毒、人博卡病毒和腺病毒最常见,病毒谱和非先天性心脏病组相似。     

SWOT分析法对PICU护理风险管理质量、护理不良事件及患儿预后的影响

目的 探究SWOT分析法对PICU护理风险管理质量、护理不良事件及患儿预后的影响.方法 选取2018年6月-2020年6月我院PICU收治的1000例患儿为研究对象,按照两组基础资料具有匹配性原则将其分为对照组和研究组,各500例.对照组采用常规护理,研究组在对照组的基础上实施SWOT分析法干预,比较两组护理管理质量、...     

Parents' experiences and the effect on the family two years after their child was admitted to a PICU—An interview study

BackgroundFor parents, having a child admitted to a paediatric intensive care unit (PICU) is a very stressful experience filled with anxiety. Parents are often scared and traumatised. This stress can lead to PTSD.AimThe aim was to describe parents’ experiences and the effect on the family two years after their child was admitted to a paediatric intensive care unit.Material and methodsTen parents were interviewed according to a semi-structured interview guide. An inductive approach was applied for the study and qualitative content analysis was used to analyse the data.FindingsThe parents carried vivid memories and they were still strongly affected by the experience of having their child admitted to a paediatric intensive care unit. They could clearly recall the environment, feelings that affected them and how they felt powerless. The relationship between the parents had been strengthened.ConclusionParents, siblings and the ill child could all show symptoms of anxiety, stress and sleeping disorders. The parents valued life differently.     

Mortality prediction in pediatric trauma

BackgroundIn trauma research, accurate estimates of mortality that can be rapidly calculated prior to enrollment are essential to ensure appropriate patient selection and adequate sample size. This study compares the accuracy of the BIG (Base Deficit, International normalized ratio and Glasgow Coma scale) score in predicting mortality in pediatric trauma patients to Pediatric Risk of Mortality III (PRISM III) score, Pediatric Index of Mortality 2 (PIM2) score and Pediatric Logistic Organ Dysfunction (PELOD) score.MethodsData were collected from Virtual Pediatric Systems (VPS, LLC) database for children between 2004 and 2015 from 149 PICUs. Logistic regression models were developed to evaluate mortality prediction. The Area under the Curve (AUC) of Receiver Operator Characteristic (ROC) curves were derived from these models and compared between scores.ResultsA total of 45,377 trauma patients were analyzed. The BIG score could only be calculated for 152 patients (0.33%). PRISM III, PIM2, and PELOD scores were calculated for 44,360, 45,377 and 14,768 patients respectively. The AUC of the BIG score was 0.94 compared to 0.96, 0.97 and 0.93 for the PRISM III, PIM2, and PELOD respectively.ConclusionsThe BIG score is accurate in predicting mortality in pediatric trauma patients.Level of evidenceLevel I prognosis.