Potential Acceptability of a Pediatric Ventilator Management Computer Protocol.

OBJECTIVES: To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome. DESIGN: Survey/questionnaire. SETTING: The eight PICUs in the Collaborative Pediatric Critical Care Research Network. PARTICIPANTS: One hundred twenty-two physicians (attendings and fellows). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for FIO2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables. CONCLUSIONS: Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.

The function of parents and their children with cerebral palsy.

OBJECTIVE: To determine associations between the function of parents and that of their children with cerebral palsy (CP) and the influence of the levels of the child's impairment, parenting stress, parent self-efficacy, and family functioning. DESIGN: Descriptive correlational cross-sectional survey. SETTING: Academic tertiary care children's hospital and pediatric specialty orthopedic hospital in the intermountain West. PARTICIPANTS: A total of 51 parents or guardians who provide the majority of daily care in their homes for their children with CP between the ages of 5 and 18 years. METHODS: Survey of a convenience sample of parents of children with CP. MAIN OUTCOME MEASUREMENTS: (1) Short-form 36 Health Survey v2.0 to measure parent mental and physical health; (2) Pediatric Quality of Life Inventory v4.0 to measure the physical, social, school, emotional and psychosocial function, and total quality of life of their children with CP; (3) Gross Motor Function Classification System to assess severity of the child's CP; (4) Parenting Stress Index; (5) Family Environment Scale, relationship dimension; and (6) Self-Efficacy for Parenting Tasks Index. RESULTS: Positive correlations were found between parent physical health and the physical function of their children with CP (r = 0.32) and between parent mental health and the emotional function (r = 0.46), psychosocial function (r = 0.40), and total health-related quality of life (r = 0.38) of their children. When adjusting for severity of CP, we found that parenting stress and parenting self-efficacy attenuated these relationships to varying degrees. CONCLUSIONS: A clear positive correlation was found between the function of parents and the function of their children with CP. Although a cross-sectional study does not demonstrate the direction of the relationship, it seems reasonable to conclude that clinicians who are attempting to directly maximize child function should also consider the potential value of interventions that support and improve parent function, particularly mental health.