RESUMO
PURPOSE: This paper describes the methodology of a clinical trial of prone positioning in pediatric patients with acute lung injury (ALI). Nonrandomized studies suggest that prone positioning improves oxygenation in patients with ALI/acute respiratory distress syndrome without the risk of serious iatrogenic injury. It is not known if these improvements in oxygenation result in improvements in clinical outcomes. A clinical trial was needed to answer this question. MATERIALS AND METHODS: The pediatric prone study is a multicenter, randomized, noncrossover, controlled clinical trial. The trial is designed to test the hypothesis that at the end of 28 days, children with ALI treated with prone positioning will have more ventilator-free days than children treated with supine positioning. Secondary end points include the time to recovery of lung injury, organ failure-free days, functional outcome, adverse events, and mortality from all causes. Pediatric patients, 42 weeks postconceptual age to 18 years of age, are enrolled within 48 hours of meeting ALI criteria. Patients randomized to the prone group are positioned prone within 4 hours of randomization and remain prone for 20 hours each day during the acute phase of their illness for a maximum of 7 days. Both groups are managed according to ventilator protocol, extubation readiness testing, and sedation protocols and hemodynamic, nutrition, and skin care guidelines. CONCLUSIONS: This paper describes the process, multidisciplinary input, and procedures used to support the design of the clinical trial, as well as the challenges faced by the clinical scientists during the conduct of the clinical trial.
Assuntos
Avaliação de Resultados em Cuidados de Saúde , Decúbito Ventral , Projetos de Pesquisa , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Síndrome do Desconforto Respiratório/terapia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Respiração Artificial , Decúbito DorsalRESUMO
Over the last 50 years, healthcare has undergone countless changes. Some of the important changes in recent years have been budget cuts, decreased resident work hours, and increased patient acuity. The need for additional clinical expertise at the bedside has resulted in nurse practitioners becoming an integral part of the healthcare delivery team. To date, little has been published regarding the role of the nurse practitioners in intensive care units. This article outlines how one pediatric hospital has successfully utilized nurse practitioners in the intensive care unit.
Assuntos
Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva Pediátrica/organização & administração , Profissionais de Enfermagem , Papel do Profissional de Enfermagem , Enfermagem Pediátrica , Certificação , Educação Continuada em Enfermagem/organização & administração , Educação de Pós-Graduação em Enfermagem/organização & administração , Hospitais Pediátricos , Hospitais Universitários , Hospitais Urbanos , Humanos , Profissionais de Enfermagem/educação , Profissionais de Enfermagem/organização & administração , Avaliação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde , Planejamento de Assistência ao Paciente , Enfermagem Pediátrica/educação , Enfermagem Pediátrica/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , TexasRESUMO
The need for advanced practice nurses (APN) has expanded over the past several decades as a result of the changing healthcare environment. Increased patient acuity and decreased resident work hours have lead to a need for additional clinical expertise at the bedside. APNs are becoming an integral part of the acute care delivery team in many trauma programs and intensive care units. To date little has been published regarding the role of the APN in Trauma Centers. This article outlines the wide variety of responsibilities and services provided by a select group of nurse practitioners who work in trauma centers throughout the United States.
