- Email: [email protected]
Occurrence, management and outcome of fever in critically ill children
Papers and Poster Abstracts / Australian Critical Care 29 (2016) 110–123
patient care however monitoring does not occur in any PICU routinely in Australia and New Zealand. Between May 2014 and Jan 2015 a questionnaire was distributed to medical and nursing staff in seven tertiary level PICUs in Australia and New Zealand and the results collected anonymously. A convenience sample of healthcare professionals including 190 (84.8%) nurses 34 (15.1%) doctors completed the questionnaire. While 93% of health professional surveyed use a tool to assess sedation only 20.85% of individuals have used a delirium tool and delirium is rarely or never (61%) discussed on ward round. Responders had difficulty separating withdrawal and delirium symptoms and assessments. The perceived delirium rate (23%) was also substantially lower than that found in published literature. Similar conflicting attitudes to sedation and delirium were shared with staff understanding the need for assessment and light sedation despite the desire for deeper sedation. Responders where able to identify hyperdelirium but struggled with hypodelirium symptoms and only 30% where aware of the different types of delirium. The barriers identified by this population seemed to stem from a lack of education with only 15% receiving any delirium training and 45% of responders not comfortable to perform a delirium assessment. This lack of knowledge was highlighted in two case study where up to 60% of responders where unsure when and how to appropriately assess for delirium. This survey points to a disconnect between the significance of delirium and perceived rate, current practice of assessment and education that is occurring in PICU. http://dx.doi.org/10.1016/j.aucc.2015.12.034
Occurrence, management and outcome of fever in critically ill children Debbie Long 1,∗ , Christopher Flatley 2 , Tara Williams 1 , Jane Harnischfeger 1 , Julie McEniery 1 , Leanne Aitken 3 1
Lady Cilento Children’s Hospital, Brisbane, Australia Mater Medical Research, Brisbane, Australia 3 Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia 2
Despite fever being a common problem and antipyretics being the most widely used medication, little research has looked at the epidemiology and management of fever in paediatric critical illness. The aim of this project was to investigate the occurrence, management and outcomes associated with fever in critically ill children. We conducted a retrospective audit of 8755 children with 321,441 temperature measurements, and admitted to two tertiary PICUs between 2009 and 2014. We examined children with a length of stay between 8 hours and 2 weeks, and assessed outcomes against fever thresholds at 38, 38.3, 38.5, and 39 ◦ C using Pearson’s Chi Square and Mann–Whitney U tests. Fever (temp ≥38.3 ◦ C) was present in 19% of admissions, with 33.9% of children with fever having an infection. 96.6% of children with a fever received
123
paracetamol; 86.3% of children with fever receiving antibiotics. Fever had a statistically significant association with PICU length of stay (p < 0.001) and PIM2 (p < 0.001). Bivariate logistic regression indicated that children with a fever at 39 ◦ C had a statistically significant association with PICU (p < 0.001) and hospital mortality rates (p < 0.001). Despite a lower incidence in critically ill children compared to adults, fever remains associated with poor outcome. Paracetamol administration is high, despite some literature suggesting that mounting a febrile response may be protective in particular instances. Further multivariate analyses are required to determine risk factors for children with and without fever during critical illness. Staff attitudes around fever management also need exploration. http://dx.doi.org/10.1016/j.aucc.2015.12.035
Paediatric Critical Care Posters The role of hypothermia in the management of severe traumatic brain injury in children Stephen Honeybul Sir Charles Gairdner Hospital, Perth, Australia Introduction: Over the past two decades there has been a considerable amount of interest in the use of controlled hypothermia in the context of severe traumatic brain injury however clinical efficacy has yet to be established. Study objectives: The aim of this narrative review was to assess the evidence for clinical efficacy and determine the role and direction of future research. Methods: All randomised controlled trials conducted in the past decade were reviewed. Whilst the emphasis was placed on clinical evidence in the paediatric population a number of significant studies in the adult population were included. Each study was examined specifically to review evidence for clinical efficacy and also to determine complications and recommendations for further research avenues. Results: Overall twenty seven articles were reviewed. Amongst the paediatric studies there was no convincing evidence that outcome was improved. In some studies there was a tendency to worse outcomes in the hypothermia arm of the trial. In the adult studies the results were mixed with some studies showing lower mortality in the surgical arm of the trial whereas other studies have shown the opposite effect. Most studies have confirmed a reduction in the intracranial pressure but this is not necessarily converted into an improvement in outcome. Conclusion: The role of hypothermia on the management of children with severe traumatic brain injury remains uncertain. No studied have shown that it provides a convincing clinical benefit and in some cases it may have caused harm. This raises interesting issues both clinically and ethically when considering the direction of future research. http://dx.doi.org/10.1016/j.aucc.2015.12.036
patient care however monitoring does not occur in any PICU routinely in Australia and New Zealand. Between May 2014 and Jan 2015 a questionnaire was distributed to medical and nursing staff in seven tertiary level PICUs in Australia and New Zealand and the results collected anonymously. A convenience sample of healthcare professionals including 190 (84.8%) nurses 34 (15.1%) doctors completed the questionnaire. While 93% of health professional surveyed use a tool to assess sedation only 20.85% of individuals have used a delirium tool and delirium is rarely or never (61%) discussed on ward round. Responders had difficulty separating withdrawal and delirium symptoms and assessments. The perceived delirium rate (23%) was also substantially lower than that found in published literature. Similar conflicting attitudes to sedation and delirium were shared with staff understanding the need for assessment and light sedation despite the desire for deeper sedation. Responders where able to identify hyperdelirium but struggled with hypodelirium symptoms and only 30% where aware of the different types of delirium. The barriers identified by this population seemed to stem from a lack of education with only 15% receiving any delirium training and 45% of responders not comfortable to perform a delirium assessment. This lack of knowledge was highlighted in two case study where up to 60% of responders where unsure when and how to appropriately assess for delirium. This survey points to a disconnect between the significance of delirium and perceived rate, current practice of assessment and education that is occurring in PICU. http://dx.doi.org/10.1016/j.aucc.2015.12.034
Occurrence, management and outcome of fever in critically ill children Debbie Long 1,∗ , Christopher Flatley 2 , Tara Williams 1 , Jane Harnischfeger 1 , Julie McEniery 1 , Leanne Aitken 3 1
Lady Cilento Children’s Hospital, Brisbane, Australia Mater Medical Research, Brisbane, Australia 3 Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia 2
Despite fever being a common problem and antipyretics being the most widely used medication, little research has looked at the epidemiology and management of fever in paediatric critical illness. The aim of this project was to investigate the occurrence, management and outcomes associated with fever in critically ill children. We conducted a retrospective audit of 8755 children with 321,441 temperature measurements, and admitted to two tertiary PICUs between 2009 and 2014. We examined children with a length of stay between 8 hours and 2 weeks, and assessed outcomes against fever thresholds at 38, 38.3, 38.5, and 39 ◦ C using Pearson’s Chi Square and Mann–Whitney U tests. Fever (temp ≥38.3 ◦ C) was present in 19% of admissions, with 33.9% of children with fever having an infection. 96.6% of children with a fever received
123
paracetamol; 86.3% of children with fever receiving antibiotics. Fever had a statistically significant association with PICU length of stay (p < 0.001) and PIM2 (p < 0.001). Bivariate logistic regression indicated that children with a fever at 39 ◦ C had a statistically significant association with PICU (p < 0.001) and hospital mortality rates (p < 0.001). Despite a lower incidence in critically ill children compared to adults, fever remains associated with poor outcome. Paracetamol administration is high, despite some literature suggesting that mounting a febrile response may be protective in particular instances. Further multivariate analyses are required to determine risk factors for children with and without fever during critical illness. Staff attitudes around fever management also need exploration. http://dx.doi.org/10.1016/j.aucc.2015.12.035
Paediatric Critical Care Posters The role of hypothermia in the management of severe traumatic brain injury in children Stephen Honeybul Sir Charles Gairdner Hospital, Perth, Australia Introduction: Over the past two decades there has been a considerable amount of interest in the use of controlled hypothermia in the context of severe traumatic brain injury however clinical efficacy has yet to be established. Study objectives: The aim of this narrative review was to assess the evidence for clinical efficacy and determine the role and direction of future research. Methods: All randomised controlled trials conducted in the past decade were reviewed. Whilst the emphasis was placed on clinical evidence in the paediatric population a number of significant studies in the adult population were included. Each study was examined specifically to review evidence for clinical efficacy and also to determine complications and recommendations for further research avenues. Results: Overall twenty seven articles were reviewed. Amongst the paediatric studies there was no convincing evidence that outcome was improved. In some studies there was a tendency to worse outcomes in the hypothermia arm of the trial. In the adult studies the results were mixed with some studies showing lower mortality in the surgical arm of the trial whereas other studies have shown the opposite effect. Most studies have confirmed a reduction in the intracranial pressure but this is not necessarily converted into an improvement in outcome. Conclusion: The role of hypothermia on the management of children with severe traumatic brain injury remains uncertain. No studied have shown that it provides a convincing clinical benefit and in some cases it may have caused harm. This raises interesting issues both clinically and ethically when considering the direction of future research. http://dx.doi.org/10.1016/j.aucc.2015.12.036