Recorded sessions on demand will be available 24 hours after the session ends

Abstract Body

The aim of critical care transport services is the provision of care similar to that offered in tertiary care intensive care units, prior to and during transportation. Transport units must be well prepared and organized in order to prevent adverse events that might occur during interfacility transport. Anticipation and communication are key aspects to be aware of when initiating transfer of a deteriorating child or newborn. Initial triage and handover to the receiving unit are fully part of the transport and should not be overlooked.

Effective triage begins at the first telephone contact between the referring hospital and the retrieval service, and can only be achieved with standardized assessment procedures. Transport settings, such as dispatch time, destination, team composition, and mode of transportation can be discussed with the use of standardized tools and scores to estimate mortality and transport risk.

Neonatal and pediatric transport often present clinically stressful circumstances where concise and accurate information is required to be shared clearly between multidisciplinary health care providers. Transport units should communicate with the receiving team before arrival for optimal preparation and anticipation. Standardization of the handover with communication tools such as SBAR (situation, background, assessment and recommendation) is strongly encouraged. Effective communication, active listening, limiting distractions, determining optimal location and caregivers’ presence are all key aspects that should be considered and anticipated on an institutional or unit-based level, and in a practical and sustainable way that accommodates everyone’s needs.

Interprofessional simulation may provide an opportunity to standardize communication during the handover procedure.

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Background:

Cardiopulmonary arrests are a major contributor to mortality and morbidity in paediatric intensive care units (PICU). Understanding the epidemiology and risk factors for CPR may inform national quality improvement initiatives.

Methods:

A retrospective cohort analysis using prospectively collected data from the Paediatric Intensive Care Audit Network (PICANET) database. PICANET contains data on all PICU admissions in the UK. We identified children who received CPR in 23 PICUs in England (2013-2017). Incidence rates of CPR and associated factors were analysed. Logistic regression was used to estimate the size and precision of associations.

Results:

Cumulative incidence of CPR was 2.3% for 68,114 admissions over five years with an incidence rate of 4.9 episodes/1000 bed days. CPR was associated with a cardiovascular diagnosis (OR: 2.30, [95%CI:2.02-2.61]), age less than 1 year (OR: 1.84, [95%CI:1.65-2.04]), the Paediatric Index of Mortality (PIM2) score on admission (OR: 1.21, [95%CI:1.19-1.22]), longer length of stay (OR: 1.013, [95%CI:1.012-1.014]) and in PICU mortality (OR: 23.25, [95%CI:20.68-26.15]). We also found a higher risk of CPR associated with history of pre-admission cardiac arrest (OR: 20.69, [95%CI: 18.16-23.58]), and for children with a cardiac condition admitted to non-cardiac PICU (OR: 2.75, [95%CI: 1.91-3.98]). Children from black (OR: 1.68, [95%CI: 1.36-2.07]) and Asian (OR: 1.49, [95%CI: 1.28-1.74]) ethnic backgrounds were at higher risk of receiving CPR in PICU.

Conclusion:

Data from this first multi-centre study from England provides foundation for further research and evidence for bench marking and quality improvement for prevention of cardiac arrests in PICU.

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Background and Aim: End-of-Life (EOL) decision-making in paediatric critical care is complex and frequently heterogeneous depending by cultural, legal, and resources. The aim of this study was to compare similarities and differences in the experiences and attitudes of paediatric intensive care doctors, nurses and allied health professionals regarding EOL decision-making and care across Europe.

Methods: A survey method was adopted. The survey was distributed to ESPNIC members and through social media. The survey included the sections: 16-item attitudes of EOL care, 14-item EOL decision, and 18-item EOL care in practice. A 5-point Likert scale was used. Descriptive statistical analysis was used.

Results: A total of 198 questionnaires were completed by physicians (62%), nurses (34%) and allied health professionals (4%). Nurses had less active involvement in decision-making processes compared to doctors (64% versus 95%; p<0.001). Expected quality-of-life view by the child and family is recognised as one of the most important issue in EOL decisions. Sub-analysis of Northern, Central and Southern European regions revealed differences across regions about the right timing of EOL decisions. Majority of respondents (n=179; 90%) agreed to discuss organ donation with parents during EOL. Differences were observed in deep sedation and nutritional support during EOL care practices.

Conclusions: Nurses felt less involved in EOL decision-making processes. However, the attitudes and experiences in EOL care were similar across all PICU professionals. Differences in EOL decisions remain throughout Europe. Further research is needed to identify cultural, religious, and legal differences impacting EOL decision-making and practice.

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Background and aims: Off-label drug prescriptions are common in pediatrics, but doses are often based on expert consensus and/or extrapolated from adults, which is suboptimal at best. To increase the evidence-base of off-label prescribing we aimed to study the feasibility using published pediatric pharmacokinetic data to simulate pediatric dosing guidelines, using piperacillin and amikacin as examples.

Methods: Piperacillin and amikacin pharmacokinetic models in critically ill children were extracted from literature. Concentration-time profiles were simulated for various dosing regimens, including the summary of product characteristics (SmpC) dose and doses proposed in the studied publications. Simulations were performed in R for a critically ill pediatric patient cohort. Lastly, probability of target attainment (PTA) was compared between the different dosing regimens.

Results: Three studies for piperacillin (critically ill children) and one for amikacin (pediatric burn patients) were included. Demographic and clinical data of 307 patients, median age 4.9 years, were used. Simulated concentration-time profiles matched those in the original publications. PTA for piperacillin unbound trough concentrations >16 mg/l was >90% for continuous infusion regimens of 400 mg/kg/day, 36.7% for 100 mg/kg/6h (3h infusion) and 9.7% for the SmpC dose (80 mg/kg/6h, 30 minute infusion). Amikacin PTA was >90% with 20 mg/kg/day, higher than PTA using the SmpC dose of 15 mg/kg/day (63.5%).

Conclusions: We studied a standardized approach using existing pharmacokinetic data as a proof-of-concept to support dosing regimens. These simulations could complement literature and consensus-based dosing guidelines for off-label drugs in the absence of stronger evidence to support pediatricians in daily practice.

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Background:

The use of bundles for the management of pediatric sepsis is controversial. The aim of this study is to describe the use of early management bundles in critically ill children with sepsis and assess its association with morbidity and mortality.

Methods

Restrospective analysis of critically ill children with sepsis included in the national multi-center registry ENVIN-HELICS between 2013-2017. Variables regarding demographic data, severity score (PRIMS III) and the use of bundles were recorded. The primary outcome was in-hospital mortality and the secondary outcomes were length of hospital and PICU stay.

Results

346 patients with a median of age of 11 months (ICR 0-250 months) and PRIMS III score of 7 (ICR 0-40) were included. Early management bundles were used in 51 patients (19 with severe sepsis and 32 with septic shock). In-hospital mortality rate was 13.3%. Severity of inflammatory response (OR 2.4 95% CI 1.6-3.6) and the number of antibiotics administered prior to the onset of sepsis (OR 1.1, 95% CI 1-1.2) were associated with increased mortality. However, there was no association with age, PRIMS III, or the origin of sepsis. Care bundles were used in 72% of patients and its use increased during the period of study. Administration of 3 or more bundles was not associated with reduced mortality or length of stay. No difference was found between hospital and community acquired sepsis.

Conclusions

Use of care bundles was not associated with improved outcomes of pediatric sepsis patients. The management strategy for these patients should be individualized.

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BACKGROUND AND AIMS
The Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach is a universally applied approach for the assessment and treatment of critically ill patients. However, adherence in practice appears to be suboptimal. As knowledge is a prerequisite for adherence, we assessed healthcare professionals’ knowledge of the ABCDE approach.

METHODS
A digital multiple-choice assessment tool regarding the ABCDE approach was developed with assistance of an expert panel through a mini-Delphi method. The expert panel consisted of representatives from six departments from the Radboudumc in Nijmegen, the Netherlands, two educational experts, an expert on test development and an external expert. The assessment tool was sent to all healthcare professionals of the participating departments: Anaesthesiology, Paediatrics, Emergency Department and the Neonatal- (NICU), Paediatric- (PICU) and Adult Intensive Care Units (ICU).

RESULTS
Of the 954 eligible participants, 240 filled out the assessment tool. The mean (SD) test score (% of correct answers) was 80.1 ±12.2%. Nurses had significantly lower mean scores (74.9 ±10.9%) than residents (92.2 ±7.5%) and medical specialists (88.0 ±8.6%). Additionally, the NICU (75.9 ±12.6%) and ICU (77.4 ±11.2%) had significantly lower scores than the PICU (85.6 ±10.6%), Emergency department (85.5 ±10.4%) and Anaesthesiology (85.3 ±10.6%). Participants of a younger age scored higher on the test than older participants.

CONCLUSIONS
Based on the test scores, theoretical knowledge of the contents of the ABCDE approach seem to vary among healthcare professionals working with critically ill patients. Type of department, profession category and age had a significant influence on the test score.