The pattern of intravenous drug administration during the transfer of critically ill children by a specialist transport team.

BACKGROUND: There are few published data on the patterns of intravenous drug administration by specialist pediatric intensive care unit (PICU) transport teams during the transfer of critically ill children between hospitals. METHODS: A retrospective review of retrieval documentation was undertaken for all patients transported by the Royal Manchester Children's Hospital PICU transport team over a period of 1 year. RESULTS: A total of 257 patients were transported during the study period, 82 patients (32%) were excluded owing to incomplete or absent documentation, leaving a sample of 175 available for analysis. Intravenous drugs were administered to 168 of these patients (96%). In total, 38 different drugs were administered. The four most commonly administered drugs were midazolam (130 patients), morphine (129 patients), atracurium (108 patients), and heparin (53 patients). Ten drugs accounted for 90% of all prescription episodes (total number of infusions and bolus doses administered), whilst 16 drugs were prescribed only once. The mean number of drugs administered per patient was 3.25 with a mean of 1.96 drug infusions and 1.29 bolus drugs administered per patient. CONCLUSIONS: A relatively small number of drugs are used frequently during the retrieval of critically ill children, but the total range of drugs that are used is large. This has implications for the rational carriage of drugs by PICU transport teams, the potential for drug errors and also for the development of advanced nurse practitioners whose prescribing-like activities may depend on the development of Patient Group Directions.

Persistent respiratory symptom can be a manifestation of neurofibromatosis-1.

A 3-year old boy with neurofibromatosis-1 presented with persistent respiratory symptoms and X-ray changes. High resolution computerised tomography (CT), bronchoscopy and spiral CT showed a mediastinal mass encasing and compressing the left main stem bronchus. Surgical removal and histology of the mass revealed a neurofibroma. Repeat scan six months post-surgery showed some persistence of the mass. Symptomatic, mediastinal neurofibroma in the paediatric age group is very rare. We could not find any previous report of a neurofibroma encasing the mediastinal structures. This case also demonstrates that persistent respiratory symptom in a patient with neurofibromatosis-1 warrants a search for intra-thoracic neurofibroma.