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Objective:To search and summarize the evidence for the non-pharmacological management of delirium of critically ill patients in PICU, and to provide evidence-based guidance for clinical practice.Methods:According to the "6S" evidence pyramid model, we searched computerized decision support system, websites of guidelines, and databases, and obtained the guidelines, clinical decisions, systematic reviews, and evidence summaries.After screening the articles, two researchers independently appraise articles using validated tools, and finally formed the evidence summary of delirium non-pharmacological management of critically ill patients in PICU.Results:Totally six articles were included for the evidence synthesis, including three guidelines, two systematic reviews, and one expert advice.Twenty pieces of evidence including four aspects were summarized, namely delirium screening, risk prediction, non-pharmacological prevention and management strategies, health care provider education and departmental standardization.Conclusion:The evidence summarized in this study can provide a reference to health care professionals.When we apply this evidence in the clinical setting, we should adapt it accordingly to the specific clinical setting to improve the effectiveness of the evidence.
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Targeted temperature management mainly affects the progression of sepsis by inhibiting inflammatory response, protecting mitochondrial function and reducing metabolism, which can improve survival, the prognosis and outcome of sepsis to some extent.Targeted temperature management has a positive impact on the occurrence and development of sepsis, which may be an adjuvant treatment method of sepsis.This review summarized the mechanism studies on the impact of targeted temperature management on sepsis in recent years, and summarized the existing problems, so as to provide reference for carrying out practical research on targeted temperature management for patients with sepsis.
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Sedation therapy is an important part of the safety and comfort management of critically ill children.The accurate selection of a sedation assessment tool can help nurses effectively assess the level of sedation and guide clinical care.This review summarized the existing six commonly used sedation assessment scales in pediatric intensive care unit, such as the Ramsay Sedation Scale, Richmond Agitation-Sedation Scale and Comfort Scale and related sedation concepts.Our study aims to provide a reference for choosing a sedation assessment scale suitable for critically ill children and standardizing sedation nursing practice.
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Delirium is an acute, fluctuating state of brain dysfunction characterized by a change in consciousness and a reduced ability to concentrate, maintain, or transfer, which can lead to cognitive or perceptual disorders, hallucinations and sleep-arousal disorders.It cannot be better explained by pre-existing, occurring or developing diseases.At present, its pathogenesis is not clear, and is related to a variety of factors.Early and effective identification and evaluation is the premise, and the clinical practice strategy of prevention and treatment of pediatric delirium needs to be further studied.
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Delirium is an acute, fluctuating state of brain dysfunction characterized by a change in consciousness and a reduced ability to concentrate, maintain, or transfer, which can lead to cognitive or perceptual disorders, hallucinations and sleep-arousal disorders.It cannot be better explained by pre-existing, occurring or developing diseases.At present, its pathogenesis is not clear, and is related to a variety of factors.Early and effective identification and evaluation is the premise, and the clinical practice strategy of prevention and treatment of pediatric delirium needs to be further studied.
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Objective@#To evaluate the clinical application of Chinese version of Cornell assessment of pediatric delirium (CAPD) scale in children by a pilot study.@*Methods@#A prospective observational study. From June 2017 to December 2017, the original CAPD screen was translated into Chinese and debugged cross-culturally according to the guidelines, which was further applied in the Department of Critical Care Medicine, Children′s Hospital of Chongqing Medical University. The clinical data of 250 patients who were evaluated with the Chinese version of CAPD scale and Richmond agitation-sedation scale were extracted and analyzed with chi-square test or Mann-Whitney U test. Cronbach′s α coefficient,Split-half coefficient and intra-group correlation coefficient were used to evaluate the reliability, while exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The result was compared with the gold standard diagnostic results to evaluate the diagnostic efficacy of the CAPD.@*Results@#Sixty-one (24.4%) patients had delirium during pediatric intensive care unit hospitalization,and significant differences existed between them and 189 patients without delirium in age (χ2=11.220, P=0.011), rates of mechanical ventilation (χ2=6.691, P=0.010) and length of PICU hospitalization (Z=10.656, P=0.001). The Chinese version of the CAPD scale had high discrimination among the 8 items in the main table without skewed distribution and discrete items. The internal and external reliability of the scale were preferable as the Cronbach′s α coefficient was 0.819 and ICC value was 0.835. The KMO value of EFA was 0.834 and Bartlett spherical test showed statistical significance (χ2=661.440, P<0.01). CFA constructed a two-factor structural equation model with favorable fit index:Chi-square/degree of freedom (DF) ratio was 1.786 (χ2=33.930, P=0.019), goodness of fit index (GFI) was 0.967,adjusted GFI was 0.938,root mean square of the approximate error (RMSEA) was 0.056. A good diagnostic efficacy of this scale was demonstrated by receiver operating characteristic curve analysis as when the cut-off was 10, the area under curve was 0.99 (95%CI: 0.97-0.99), sensitivity was 96.7% (95%CI: 88.7-99.6), specificity was 93.1% (95%CI: 88.5-96.3), positive likelihood ratio was 14.0 (95%CI: 13.2-14.9), and the negative likelihood ratio was 0.035 (95%CI: 0.008-0.200).@*Conclusion@#The Chinese version of the CAPD Scale has favorable reliability,validity,diagnostic efficacy, as well as feasibility, which should be applied in evaluation of pediatric delirium in clinical observation and research in the future.
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Objective@#To investigate the epidemiological characteristics of hospitalized pediatric patients with burns and explore the prevention and treatment strategy of pediatric burns.@*Methods@#Medical records of pediatric burn patients hospitalized in multiple departments of Children′s Hospital of Chongqing Medical University from January 2012 to December 2016 were retrospectively analyzed. Data including gender, age, residence, ways of paying, total burn area, burn severity, cause, time, and place of burns, prehospital treatment ways, clinical outcome, length of hospital stay were collected and processed with chi-square test, Kruskal-Wallis H test, and Bonferroni correction. The factors which influence wound healing were processed with multivariate logistic regression analysis.@*Results@#(1) A total of 1 946 pediatric burn patients with complete medical records were hospitalized in Children′s Hospital of Chongqing Medical University during the 5 years, with 1 127 boys (57.91%), which were more than 819 girls (42.09%). Pediatric patients≤3 years old were with the highest incidence of burns of 87.15% (1 696/1 946). There was no significantly statistical difference in gender composition ratio among pediatric patients of different ages (χ2=2.294, P= 0.318). (2) The residence of 1 536 pediatric patients (78.93%) were in town, and most of them used urban resident essential medical insurance for medical cost. Most of the pediatric patients living in rural areas paid the medical cost at their own expense. There was significantly statistical difference in way of paying between pediatric patients living in urban and those in rural areas (χ2=658.324, P<0.05). (3) The pediatric patients with total burn surface area≥5% total body surface area (TBSA) and<15% TBSA were the most (1 200 cases, accounting for 61.66%). The pediatric patients with moderate burns were the most (1 225 cases, accounting for 62.95%), followed by mild burns (494 cases, accounting for 25.39%), severe burns (124 cases, accounting for 6.37%), and extremely severe burns (46 cases, accounting for 2.36%). (4) The pediatric patients with scald caused by hot water were the most (1 801 cases, accounting for 92.55%), followed by flame burns (69 cases, accounting for 3.55%), chemical burns (44 cases, accounting for 2.26%), and electrical burns (32 cases, accounting for 1.64%). There was significantly statistical difference in cause of injury among pediatric patients of different ages (χ2=85.471, P<0.05). (5) The incidence of burns of pediatric patients in Spring was 27.95% (544/1 946), which was slightly higher than those in other seasons. There was significantly statistical difference in the burn season among pediatric patients admitted to the hospital in different years (χ2= 23.172, P< 0.05). As to burn place, most of burns of pediatric patients happened at home (1 776 cases, accounting for 91.26%). (6) There was significantly statistical difference in clinical outcome among pediatric patients with different prehospital treatments (H=16.005, P<0.05). There was significantly statistical difference in clinical outcome between pediatric patients with reasonable prehospital treatments and those with unreasonable prehospital treatments (H=-64.990, P<0.05), and between pediatric patients with reasonable prehospital treatments and those without any treatment (H=-74.775, P<0.05). There was no significantly statistical difference in clinical outcome between pediatric patients with unreasonable prehospital treatments and those without any prehospital treatment (H=-9.785, P>0.05). (7) The median of length of hospital stay of pediatric patients was 8 days. The pediatric patients with length of hospital stay≤7 days were the most (834 cases, accounting for 42.86%), and the pediatric patients with length of hospital stay>30 days were the least (39 cases, accounting for 2.00%). (8) The way of prehospital treatment and cause of injury were independent risk factors influencing wound healing (χ2=7.946, 12.977, P<0.05). With no prehospital treatment as benchmark, reasonable prehospital treatments promoted wound healing (odds ratio=1.662, 95% confidence interval=1.129-2.447, P<0.05). With chemical burns as benchmark, electrical burn wounds were harder to heal (odds ratio=0.144, 95% confidence interval=0.028-0.734, P<0.05).@*Conclusions@#Pediatric burn patients hospitalized in Children′s Hospital of Chongqing Medical University were mainly boys≤3 years old with moderate scald caused by hot water at home in urban areas. Timely and reasonable prehospital treatments are beneficial to wound healing.
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Humidificait on by artificial means must be provided when the upper airway is bypassed during mechanical ventilation.Enough humidification is very important during mechanical ventilation.Heated humidification( HH) and heta and moisture exchanger( HME) are the most commonly used types of artificial humidification in this situation.In this article, their advantages and disadvantages are itn roduced.HH na d HME are compared in humidification performance,effect no ventilator mechanics and association with venti-lation associated pneumonia.Depending on the clinical scenario, humidifier is reasonably selected, and the selection may changeo ver time according the treatment effect.