Examination of Early Endotracheal Aspirate Cultures in Children with Acute Respiratory Failure Due to Presumed Acute Respiratory Tract Infection.

OBJECTIVE: To determine the yield of early endotracheal aspirate cultures in mechanically ventilated pediatric patients with acute respiratory failure due to acute respiratory tract infection and endeavor to guide antibiotic choice in acute respiratory failure with concern for infectious etiology. RESULTS: One-hundred ten admissions were included. Of those samples, 61 percent (67 out of 110) had bacterial growth in tracheal aspirate samples. Ninety percent (99 out of 110) patients have received antibiotics and in 47 percent (53 out of 110) antibiotics were optimized or discontinued according to the culture results. There were no difference in duration of mechanical ventilation or PICU stay in patients with positive versus negative cultures (p: 0.613, P: 0.337). CONCLUSIONS: Our study shows a high yield of positive tracheal aspirate cultures in infants, children and adolescents with acute respiratory failure. The cultures identify common organisms, helps to guide initial antibiotics choice, as well as later optimization or antibiotic discontinuation.

Learner Preference of Schedule Type Improves Engagement of Pediatric Residents: Results of a Mixed-Methods Analysis.

OBJECTIVE: Determine whether a call or shift schedule is better for acquiring optimal knowledge and professionalism, while limiting fatigue for pediatric residents during the pediatric intensive care unit (PICU) rotation in a small residency program. METHODS: This was a prospective, randomized, crossover, mixed-methods study in which pediatric residents were randomized to either a call or shift schedule during their PICU rotation. Attentiveness, bedside care, perceived knowledge, and professionalism were assessed by the resident participants, attending physicians, and nursing staff. Epworth Sleepiness Scale determined the level of resident fatigue. Statistical analysis utilized a t test of unequal variances. Two focus groups were conducted of resident non-participants and participants. Graduated resident participants and non-participants were surveyed via anonymous e-mail responses. RESULTS: Thirty residents participated in the study and twenty residents were surveyed and participated in a focus group. No major differences were detected between each participating group, whether assigned to a call or shift schedule in regard to perceived knowledge, professionalism, or fatigue. Overall themes from qualitative analysis identified advantages and disadvantages for both work schedules. Participants recognized a learner preference for schedule type depending on level of training, suggesting a shift schedule for junior residents and a call schedule for senior residents. CONCLUSIONS: There is no difference between the call or shift schedule in regard to residents' perceived knowledge, professionalism, and fatigue. Participants expressed learner preferences for one schedule over the other, recommending the shift schedule during the PGY-2 year and the call schedule during the PGY-3 year.