Aims & Objectives

Daily goals checklists have been shown to improve patient care and team communication in the critical care setting. Institutional surveys showed that staff found previous checklists ineffective. The objective of this study was to evaluate a novel daily goals checklist using the glass door of the patient rooms, as an easily visible communication tool, to set patient goals and track progress in a Pediatric Intensive Care Unit (PICU).

Methods

We used the Pronovost’s 4 E’s model (Engage, Educate, Execute, and Evaluate) to implement the Glass Goals. The Glass Goals are a template on patient doors, for goal setting in specific domains of sedation, breathing, circulation, diet, early mobilization, fluids, and family goals. Content was created in collaboration with PICU staff, leadership, and families, and rolled out over 1 month. Goal setting and team communication were assessed using pre- and post-implementation rounding audits and surveys, and a post-implementation uptake assessment.

Results

Pre-implementation rounding audits on 49 patients found the frequency of goal setting was 40.2% across all domains excluding family goals. Median rounding time was 11:46 (IQR = 8:25). Post-implementation, Glass Goals completion was 94.6% (N = 74). Post-implementation surveys and rounding audits are ongoing.

Conclusions

Preliminary analyses indicate that implementation of the Glass Goals leads to improved uptake of patient goal setting and team communication. Future analyses will assess post-implementation goal setting during rounds, rounding time, and perceptions of the Glass Goals by parents and HCPs using surveys.

Acknowledgements: Hannah Zimmerman, Grace Lamond, Data Collection Assistants; McMaster Family Advisory Council; Dr. Samara Zavalkoff

Aims & Objectives

To demonstrate feasibility of a music trial in pediatric intensive care and to obtain the necessary information to plan a larger trial.

Methods

Pilot, double blind, parallel randomized controlled trial (RCT) conducted at the Stollery Children’s Hospital pediatric intensive care units (PICUs) between March 2018 and April 2019. We included children 1 month to 16 years of age on mechanical ventilation and receiving sedation/analgesia drugs. Sixty patients were randomized in a 1:1:1 ratio to music, noise cancellation or control. Music group received classical music three times/day for 30 minutes using noise cancellation headphones. Noise cancellation group received the same intervention but without music. Control group received usual care. Children remained in the study until extubation or a maximum of 7 days. Primary outcomes were feasibility (protocol adherence > 80%) and sedation/analgesia requirements measured by daily Sedation Intensity score (higher score = more sedation administered) and Sedation Frequency (doses/day).

Results

The average enrollment rate was 4.8 patients/month, with a consent rate of 69%. Protocol adherence was achieved with patients receiving 83% of the interventions. Mean (SD) daily Sedation Intensity scores were: control 47.6 (26.0) vs. music group 53.7 (36.9) vs. noise cancellation group 55.6 (26.1), p-value = 0.561. Mean (SD) Sedation frequency (doses/day) were: control 8.58 (6.11), vs. music group 9.75 (7.1) vs. noise cancellation group 10.9 (8.14), p-value = 0.511.

Conclusions

This RCT demonstrates the feasibility of a music trial in PICU and provides the information to plan a trial to evaluate the efficacy of music to reduce sedation/analgesia requirements.

Aims & Objectives

In an ongoing study, we are aiming to characterize the peripheral immune reaction of patients suspected to have neuroimmune disorders (NID). A subset of these patients were later diagnosed to have acute psychosis (AP). This case series examined the AP and NID overlap immune-signature and its genetic basis.

Methods

Patients aged from 9-25 years old with suspicion of a NID were eligible to participate. Peripheral blood was drawn upon clinical presentation for flow cytometric immunophenotyping of T effector (Teff) and T regulatory (Treg) cells. In a subset of patients from each group we performed a DNA microarray analysis utilizing Nannostring technology directed to 770 neuroimmune genes. Subjects were placed in 2 separate groups: acute psychosis with no NID and confirmed NID. Additionally, a third group (age-matched control) was constructed from our internal repository.

Results

We found that in the NID and the cases of AP the CD4+ lineage that is associated with autoimmune conditions,Th1 and Th17 , was higher with a lower number of controlling memory Tregulatory cell that express CD25 mfi. When we applied an algorithm that adjust for polyclonal expansion of the CD4+ (Th1 + Th17 - Th2) over the regulatory control of the subpopulation of CD25 mfi Treg cells we found: a) a similar pattern in AP and NID and b) a clear distinction between NID/AP with the cohort group.

Conclusions

Some case of AP and NID share a common autoimmune dysregulation. This could be tantamount to a common pathobiological mechanism.