THE IDEAL TIME INTERVAL FOR CRITICAL CARE SEVERITY-OF-ILLNESS ASSESSMENT
Pollack MM, Dean JM, Butler J, Holubkov R, Doctor A, Meert KL, Newth, CJL, Berg, RA, Moler F, Dalton H, Wessel DL, Berger J, Harrison RE, Carcillo JA, Shanley TP, Nicholson CE. Pediatr Crit Care Med. 2013;14(5):448-453.
The aim of this research project was to determine the shortest time period for collection of laboratory variable that would be sensitive across multiple sites without site-specific bias for baseline severity of illness in pediatric critical care. A total of 376 patients from 8 pediatric critical care units (PICUs) were included in this study.
The researchers used selected physiologic variables that were components of the Pediatric Risk of Mortality III score, which included the following: pH, pCO2, total CO2, PaO2, glucose, potassium, blood urea nitrogen, creatinine, total white blood cell count, platelet count, and prothrombin time/partial thromboplastin time. The measurements were recorded 2 hours before PICU admission through 12 hours of PICU care except for data from the operating room.
The researchers concluded that prognostically important laboratory physiologic date collected within the interval of 2 hours before PICU admission through 4 hours after admission accounted for most of all dysfunction that contribute to the Pediatric Risk of Mortality III compared with the standard 0 to 12 hours.
THE IMPACT OF A QUALITY IMPROVEMENT INTERVENTION TO REDUCE NOSOCOMIAL INFECTIONS IN THE PICU
Esteban E, Ferrer R, Urrea M, Suarez D, Rozas L, Balaguer M, Palomeque A, Jordan I. Pediatr Crit Care Med. 2013;14(5):525-532.
The researchers in this prospective interventional cohort study sought to evaluate whether a quality improvement intervention could reduce nosocomial infection (NI) rates in a pediatric critical care unit setting and improve patient outcomes. The study included 3 periods: preintervention (n = 851), intervention (n = 822), and long-term follow-up (n = 940). The intervention consisted of the establishment of an infection control team, a program targeting hand hygiene, and quality practices focused on prevention of NIs.
The authors compared preintervention periods and intervention periods and found decreased rates of central line infections, from 8.1 to 6/1000 central venous catheter days; ventilator-associated pneumonia rates, from 28.3 to 10.6/1000 ventilation days; and catheter-associated urinary tract infections rates, from 23.3 to 5.8/1000 urinary catheter days. Hospital length of stay decreased from 18.56 to 14.57 days, and mortality decreased from 5.1% to 3.3%. Long-term follow-up period demonstrated that central line infections decreased to 4.6/1000 central venous catheter days, ventilator-associated pneumonia decreased to 9.1/1000 ventilation days, and catheter-associated urinary tract infections decreased to 5.21/1000 urinary catheter days. Hospital length decreased to 14.45 days and mortality decreased to 3.2%.
The researchers concluded the multifaceted quality improvement program reduced NI rates, hospital length of stay, and mortality rates.