Background

This talk will discuss why multiprofessional research is the way forward in intensive care

Objectives

To present the history of uniprofessional research and the evidence around current practice

Methods

An interactive workshop talk

Results

Both the historical and current practices around uni and multiprofessional research will be discussed and reviewed, with evidence for the conclusion that multiprofessional research is the only way forward for the speciality

Conclusion

Multiprofessional research is the way forward for successful pediatric and neonatal intensive care research.

Background

The ‘Barriers to feeding’ survey instrument is validated for adult ICU as a quality improvement tool.

Objectives

We aimed to undertake initial validation of the tool for the PICU setting.

Methods

The adult survey was reviewed and minor wording changes were made to make it understandable to a UK context. The electronic survey was sent to staff in a single large UK mixed cardiac and general PICU for testing with a free text question about any perceived pediatric barriers that were missing.

Results

64 questionnaires were returned (response rate 64/150 42%) by a mixture of nurses (81.8%) , medical staff (15%) and dieticians (3.2%) with 58/64 complete. Few respondents (10%) skipped any questions, and no one particular question was skipped. Mean scores for each survey item ranged from 2.08 to 5.08. There were 15 responses for missing items, these were categorised into four new items: Delays to preparing or obtaining non-standard enteral feeds; 2) Severe fluid restriction (especially post-operative cardiac surgery); 3) Lack of staff knowledge and support around breastfeeding mothers and 4) Conservative PICU feeding protocol.

Conclusion

Initial validation work has been successful, further qualitative work was done around layout and question wording, and translations into multiple languages are underway before being extended to examine barriers to enteral feeding internationally. This process will provide a valid quality improvement survey tool that PICUs can use to target improvement locally.

Background

The infusion of packed of red blood cells (RBC) in paediatric patients requires the use of a syringe infusion pumps (SIP) for accuracy. However, there is uncertainties regarding the effect of SIPs cause red cell damage and haemolysis of the RBC.

Objectives

To evaluate biochemical and haemolytic markers of RBC transfused in three different brands of SIP with two different infusion rates (10 and 100 ml/h), simulating clinical practice in paediatric and neonatal patients.

Methods

A lab-based experimental study with aliquots of 16 RBC bags. Haemolysis markers (total haemoglobin(g/dl), haematocrit(%), free haemoglobin(g/dl), potassium(mmol/L), lactate dehydrogenase(U/L), osmolality(mOms/kg), pH, degree of haemolysis(%)) were measured before and after RBC infusion. Three different SIP brands (A, B and C) were compared with two different infusion rates (10 and 100 ml/h).

Results

The total haemoglobin fell significantly in all RBC units during manipulation (p=0.026). The degree of haemolysis significantly increased (p=0.005) after manipulation of the RBC. One pump (SIP A) caused a threefold increase in potassium levels when compared to SIP B and C. (A: 3.78±6.10; B: -0.14±1.46; C: 1.63±1.98). SIP A also produced the worst changes, with an increase in free haemoglobin (0.05±0.05; p=0.038) and more haemolysis (0.08±0.07; p=0.033). No significant differences were found between the infusion rates.

Conclusion

SIPs cause significant RBC damage after infusion, and exposure of RBC in the infusion system with significant increases in free haemoglobin, potassium and the degree of haemolysis. One SIP caused significantly more damage compared to other pumps. Acknowledgment: CAPES (308281/2015-2); CNPq (474906/2013-2).

Background

Achieving adequate nutrition in preterm or very sick infants is vital but equally challenging for different reasons.

Objectives

Objective

To describe practices around gastric residual volume (GRV) measurement in UK neonatal units (NNUs) as part of a feasibility study.

Methods

Methods

Cross-sectional electronic survey of all UK neonatal units, in October 2018. A doctor, nurse and dietician triad were asked to complete the survey collaboratively.

Results

Results

95/183 (52%) NNUs completed the survey, a mixture of neonatal intensive care units (71%), local neonatal units (47%) and special care baby units (33%). 85% (81/95) NNUs had written guidance around enteral feeding. Most (94.7% 90/95) units fed by bolus feed with only 5% feeding continuously. 42% NNUs provided guidance around GRV measurement. 29% (5/17) NNUs that admitted both medical and surgical babies reported having different guidance for these different babies. NNUs reported variable frequency of GRV measurement from before every feed (22%) to only when clinically indicated 30% with a range of ‘other’ responses. Decision-making around GRV aspirate was made predominantly by the bedside nurse (62.2%) or nurse in charge (28.9%).

Conclusion

Conclusions

The routine measurement of GRV remains a common practice in UK NNUs, further work will explore in more detail clinicians and parental views around this practice.

Funding acknowledgement
This study was funded by the NIHR HTA ref 16/94/02

Department of Health and Social Care disclaimer
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Background

A collaborative approach to Quality Improvement (QI) is key to enhance ownership and engagement.

Objectives

To identify and prioritise QI areas for our mixed cardiac and general UK PICU.

Methods

A modified three-round e-Delphi study was undertaken in December – January 2019 involving all clinical professionals working in PICU.

Results

Sixty topics were submitted by 36 respondents in round 1.These were categorised into 10 broad domains of 60 topics: 1) Staff wellbeing, 2) Professional development and education, 3) Communication with families, 4) Communication within health care team, 5) Service delivery, 6) Clinical care, 7) Cost effectiveness, 8) Information Technology and Computer Integrated System, 9) Quality and safety, and 10) Medication and drug safety. Sixty three participants completed the ranking in round 2. Topics with a mean score <4 were removed leaving 37 topics for final ranking in round 3. This generated a final list of 5 top ranked topics for prioritisation under the 8 domains. The 5 highest scoring topics were: 1) Strategies to improve staff health, safety, support and wellbeing, 2) Strategies to improve parental communication, 3) Interventions to reduce noise in PICU and improve patient sleep and comfort, 4) Reducing the parallel duplication process in computer systems, and 5) Developing and implementing a structured ward round to improve patient care, communication and education.

Conclusion

The delphi method is a useful tool to identify QI priorities for PIC staff. The results of this survey will allow us to prioritise QI projects in the highest ranked topics.

Background

There are many myths and misconceptions around enteral nutrition in the critically ill child.

Objectives

This talk will review common myths and misconceptions and prevent evidence to disprove these

Methods

Interactive evidence based session

Results

Common misconcpetions and myths will be presented and discussed with the audience amnd then the evidence for these presented with a final conclusion

Conclusion

Common myths and misconceptions are enteral feeding after contribute to underfeeding or inadquate nutrition in the critically ill neoante and child

Background

Despite little evidence, the practice of routine measurement of gastric residual volume to guide both the initiation and delivery of enteral feeding in pediatric intensive care units is widespread internationally. In light of increased scrutiny of the evidence surrounding this practice, and as part of a trial feasibility study,

Objectives

To determine enteral feeding and Gastric Residual Volume (GRV) measurement practices in United Kingdom (UK) Pediatric Intensive Care Units (PICUs).

Methods

On-line cross-sectional survey to all UK PICUs in our network.

Results: 24/27 (89%) units approached completed the survey. Twenty-three units (95.8% 23/24) had written feeding guidelines and 19 units (19/23 83%) sent their guidelines for review. More units fed continuously (15/24 62%) than intermittently (9/24 37%) via the gastric route as their primary feeding method. All but one PICU routinely measured GRV, regardless of the method of feeding. Eighteen units had an agreed definition of feed tolerance, and all these included GRV. GRV thresholds for feed tolerance were either volume based (ml/kg body weight) (11/21 52%) or a percentage of the volume of feed administered (6/21 29%). Yet only a third of units provided guidance about the technique of GRV measurement.

Conclusion

Routine GRV measurement is part of standard practice in UK PICUs, with little guidance provided about the technique, which can influence the accuracy of GRV. All PICUs that defined feed tolerance included GRV in the definition.

Background

This talk will discuss why multiprofessional research is the way forward in intensive care

Objectives

To present the history of uniprofessional research and the evidence around current practice

Methods

An interactive workshop talk

Results

Both the historical and current practices around uni and multiprofessional research will be discussed and reviewed, with evidence for the conclusion that multiprofessional research is the only way forward for the speciality

Conclusion

Multiprofessional research is the way forward for successful pediatric and neonatal intensive care research.

Background

The ‘Barriers to feeding’ survey instrument is validated for adult ICU as a quality improvement tool.

Objectives

We aimed to undertake initial validation of the tool for the PICU setting.

Methods

The adult survey was reviewed and minor wording changes were made to make it understandable to a UK context. The electronic survey was sent to staff in a single large UK mixed cardiac and general PICU for testing with a free text question about any perceived pediatric barriers that were missing.

Results

64 questionnaires were returned (response rate 64/150 42%) by a mixture of nurses (81.8%) , medical staff (15%) and dieticians (3.2%) with 58/64 complete. Few respondents (10%) skipped any questions, and no one particular question was skipped. Mean scores for each survey item ranged from 2.08 to 5.08. There were 15 responses for missing items, these were categorised into four new items: Delays to preparing or obtaining non-standard enteral feeds; 2) Severe fluid restriction (especially post-operative cardiac surgery); 3) Lack of staff knowledge and support around breastfeeding mothers and 4) Conservative PICU feeding protocol.

Conclusion

Initial validation work has been successful, further qualitative work was done around layout and question wording, and translations into multiple languages are underway before being extended to examine barriers to enteral feeding internationally. This process will provide a valid quality improvement survey tool that PICUs can use to target improvement locally.

Background

The infusion of packed of red blood cells (RBC) in paediatric patients requires the use of a syringe infusion pumps (SIP) for accuracy. However, there is uncertainties regarding the effect of SIPs cause red cell damage and haemolysis of the RBC.

Objectives

To evaluate biochemical and haemolytic markers of RBC transfused in three different brands of SIP with two different infusion rates (10 and 100 ml/h), simulating clinical practice in paediatric and neonatal patients.

Methods

A lab-based experimental study with aliquots of 16 RBC bags. Haemolysis markers (total haemoglobin(g/dl), haematocrit(%), free haemoglobin(g/dl), potassium(mmol/L), lactate dehydrogenase(U/L), osmolality(mOms/kg), pH, degree of haemolysis(%)) were measured before and after RBC infusion. Three different SIP brands (A, B and C) were compared with two different infusion rates (10 and 100 ml/h).

Results

The total haemoglobin fell significantly in all RBC units during manipulation (p=0.026). The degree of haemolysis significantly increased (p=0.005) after manipulation of the RBC. One pump (SIP A) caused a threefold increase in potassium levels when compared to SIP B and C. (A: 3.78±6.10; B: -0.14±1.46; C: 1.63±1.98). SIP A also produced the worst changes, with an increase in free haemoglobin (0.05±0.05; p=0.038) and more haemolysis (0.08±0.07; p=0.033). No significant differences were found between the infusion rates.

Conclusion

SIPs cause significant RBC damage after infusion, and exposure of RBC in the infusion system with significant increases in free haemoglobin, potassium and the degree of haemolysis. One SIP caused significantly more damage compared to other pumps. Acknowledgment: CAPES (308281/2015-2); CNPq (474906/2013-2).

Background

There are many myths and misconceptions around enteral nutrition in the critically ill child.

Objectives

This talk will review common myths and misconceptions and prevent evidence to disprove these

Methods

Interactive evidence based session

Results

Common misconcpetions and myths will be presented and discussed with the audience amnd then the evidence for these presented with a final conclusion

Conclusion

Common myths and misconceptions are enteral feeding after contribute to underfeeding or inadquate nutrition in the critically ill neoante and child

Background

Despite little evidence, the practice of routine measurement of gastric residual volume to guide both the initiation and delivery of enteral feeding in pediatric intensive care units is widespread internationally. In light of increased scrutiny of the evidence surrounding this practice, and as part of a trial feasibility study,

Objectives

To determine enteral feeding and Gastric Residual Volume (GRV) measurement practices in United Kingdom (UK) Pediatric Intensive Care Units (PICUs).

Methods

On-line cross-sectional survey to all UK PICUs in our network.

Results: 24/27 (89%) units approached completed the survey. Twenty-three units (95.8% 23/24) had written feeding guidelines and 19 units (19/23 83%) sent their guidelines for review. More units fed continuously (15/24 62%) than intermittently (9/24 37%) via the gastric route as their primary feeding method. All but one PICU routinely measured GRV, regardless of the method of feeding. Eighteen units had an agreed definition of feed tolerance, and all these included GRV. GRV thresholds for feed tolerance were either volume based (ml/kg body weight) (11/21 52%) or a percentage of the volume of feed administered (6/21 29%). Yet only a third of units provided guidance about the technique of GRV measurement.

Conclusion

Routine GRV measurement is part of standard practice in UK PICUs, with little guidance provided about the technique, which can influence the accuracy of GRV. All PICUs that defined feed tolerance included GRV in the definition.