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Long society scientific session
Session Type
Long society scientific session
Room
Hall F
Date
19.10.2020, Monday
Session Time
09:00 - 10:40
Session Description
Pre recorded and live Q&A

Early mobilization in PICU: what is the evidence on strategies and outcomes

Session Type
Long society scientific session
Date
19.10.2020, Monday
Session Time
09:00 - 10:40
Room
Hall F
Lecture Time
09:00 - 09:20

Nursing interventions and caring evidence based instead of traditions and rituals

Session Type
Long society scientific session
Date
19.10.2020, Monday
Session Time
09:00 - 10:40
Room
Hall F
Lecture Time
09:20 - 09:40

PREVENTING EXTUBATION FAILURE IN PRETERM INFANTS WITH NON-INVASIVE RESPIRATORY SUPPORT

Session Type
Long society scientific session
Date
19.10.2020, Monday
Session Time
09:00 - 10:40
Room
Hall F
Lecture Time
09:40 - 09:50

Abstract

Abstract Body

Background: Extremely preterm infants born <28 weeks’ gestation often require invasive mechanical ventilation. To avoid bronchopulmonary dysplasia and other morbidities, clinicians aim to extubate to non-invasive respiratory support as soon as possible. However, extubation failure occurs in up to 60% of extremely preterm infants. Our aim was to compare non-invasive respiratory support modes used post-extubation in extremely preterm infants.

Methods: A systematic review performed according to PRISMA guidelines using Cochrane Neonatal Review Group methods. Data were pooled and analysed using Review Manager v5.

Results: Five respiratory support modes were identified: nasal continuous positive airway pressure (nCPAP), nasal intermittent positive pressure ventilation (NIPPV), nasal high-flow (nHF), nasal high frequency oscillatory ventilation (nHFOV), and non-invasive neurally-adjusted ventilatory assistance (NI-NAVA). Twenty-three eligible studies were included in the quantitative synthesis. NIPPV delivered using any mode reduced risk of reintubation (RR 0.86 [95% CI 0.79, 0.94]). The effect was more pronounced in a subgroup of trials in which NIPPV was synchronized and delivered by a ventilator (RR 0.22 [95% CI 0.14, 0.37]). Nasal CPAP was superior to nHF in preventing reintubation (RR, -0.04 [95% CI, -0.08,-0.01]). Two small trials compared nCPAP using standard pressures with nHFOV and higher pressure nCPAP; both were underpowered, and no definitive recommendations could be made. No RCT’s evaluated NI-NAVA.

Conclusions: NIPPV when synchronised and ventilator derived may be superior than nCPAP when extubating extremely preterm infants. Promising new modes of respiratory support (nHFOV and NI-NAVA) require further evaluation before widespread use.

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EDUCATION FOR PARENT AND TEENAGERS REGARDING RESTRICTED MEDICAL INTERVENTIONS AT HOME: A DUTCH NATIONWIDE INITIATIVE.

Session Type
Long society scientific session
Date
19.10.2020, Monday
Session Time
09:00 - 10:40
Room
Hall F
Lecture Time
09:50 - 10:00

Abstract

Abstract Body

Background and aims

Providing care at home to children with medical complexity is challenging for parents. Parental education has proven to be beneficial, but is often ambiguous. Therefore, we initiated a nationwide programme to develop uniform and family centered education material for parents and teenagers.

Methods

Focus groups and interviews revealed the needs and perspectives of parents concerning the execution and continuity of care at home. Based on these results, we developed education materials in an iterative process with parents, teenagers, paediatric nurses, paediatricians and pedagogical professionals. The starting-point of all the developed education material were evidence based protocols of the medical intervention at hand.

Results

The programme consists of 20 webbased elearnings of medical interventions with written instructions, photos, videos, and self-assessment questions. Apart from the technical aspects of care, special attention is given to safety issues, the relation between parents and child, and the integration in daily life. After the parents have completed the online education, bed-side teaching is provided by a paediatric nurse trained for this task. A certificate is issued after finishing the elearning and the bedside teaching. This certificate is valid for three years after which a refresher course is needed. For teenagers the education is presented in drawings. The programme is supported and will be sustained by the Dutch University Medical Centers, child homecare organisations and parents interest groups.

Conclusion

This nationwide initiative resulted in a free accessible website, that provides education for parents and teenagers to provide care at home, safely and effectively.

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NURSE-LED TELEPHONE FOLLOW-UP AND HOSPITAL REUTILIZATION: A SYSTEMATIC REVIEW.

Session Type
Long society scientific session
Date
19.10.2020, Monday
Session Time
09:00 - 10:40
Room
Hall F
Lecture Time
10:00 - 10:10

Abstract

Abstract Body

Background and aims

It is assumed that post-discharge telephone follow-up (TFU) has a positive effect on hospital reutilization. However, studies and reviews among adult populations found no strong evidence to support this hypothesis. Still TFU is standard policy in many paediatric hospitals. Up to date, the effectiveness of TFU in the prevention of hospital reutilization in paediatrics stays unclear, as no overview of the evidence is available. Therefore, we performed a systematic review to evaluate the impact of TFU on hospital reutilization in paediatric populations.

Methods

We searched CINAHL, Cochrane database, Embase, PsycInfo and Pubmed for relevant literature until February 2020. Two reviewers independently selected studies, extracted data and assessed study quality. A meta-analysis was considered depending on the heterogeneity of the studies.

Results

Out of 581 titles, we finally included seven studies: three RCTs, two case-control studies, one before-after study and one prospective cohort. The overall quality of the studies was moderate to high. The type of TFU, frequencies and timing varied considerably between the studies, hampering a meta-analysis. Sample sizes varied between 15 and 1285 children. Six studies report the effect of TFU on hospital readmissions. Although these results suggest an effect in favour of TFU, none of the results were statistically significant. Two studies report statistically significant effects of TFU on the number of Emergency Department visits: a decrease from 26% to 12% (p=0.02) and from 1.7% to 0.47% (p=0.03).

Conclusion

This current systematic review shows there is limited evidence that TFU reduces hospital reutilization.

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USE OF HONEY VERSUS STANDARD CARE FOR HOSPITAL ACQUIRED PRESSURE INJURY IN CRITICALLY ILL CHILDREN- A MULTICENTRE RANDOMIZED CONTROLLED TRIAL

Session Type
Long society scientific session
Date
19.10.2020, Monday
Session Time
09:00 - 10:40
Room
Hall F
Lecture Time
10:10 - 10:20

Abstract

Abstract Body

Aims & Objectives
To examine if use of ‘honey’ (medicated) for dressing is superior to ‘standard care’ in terms of time to complete wound healing in stages 1 to 3 pressure injuries in children admitted to the Pediatric Intensive Care Unit (PICU).
Methods
In this multi-centre (3 sites),open label, parallel-group randomized trial conducted from 2017 to 2019, we enrolled 99 critically ill children aged 2 months to 17 years of age who developed pressure injury (stages 1-3 inclusive) in the hospital. Children were randomized to receive either medicated ‘Honey’ dressing (Manuka or active Leptospermum honey) for their pressure injury in the ‘study group’ or ‘Standard care’ in the ‘control group’.The primary outcome was ‘time to complete wound healing’ (clinicaltrials.gov: NCT03391310).
Results
Baseline characteristics including nutritional status were comparable (Table 1). The most common sites of injury were bony prominences and, at contact points of face mask. The median time to complete healing – was 7 (95% CI 6 to 7) vs. 9 days (7 to 10) in the ‘Honey’ and ‘Standard
care’ groups, respectively (log rank test p=0.002). At any random time, children in the ‘Honey’ group were around 1.9-fold more likely to have completely healed their pressure injury than those in the ‘Standard care’ group (HR 1.86; 95% CI 1.21 to 2.87). There were no allergic
reactions or secondary wound infection in the ‘Honey group’.

Conclusions
Use of medicated honey dressings decreased the time to wound healing in critically ill children with pressure injuries.

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