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  1. Article: Furosemide in pediatric intensive care: a retrospective cohort analysis.

    Gaetani, Melany / Parshuram, Christopher S / Redelmeier, Donald A

    Frontiers in pediatrics

    2024  Volume 11, Page(s) 1306498

    Abstract: Introduction: Furosemide is the most commonly used medication in pediatric intensive care. Growing data indicates improved hemodynamic stability and efficacy of furosemide infusions compared to intermittent injections, thereby suggesting furosemide ... ...

    Abstract Introduction: Furosemide is the most commonly used medication in pediatric intensive care. Growing data indicates improved hemodynamic stability and efficacy of furosemide infusions compared to intermittent injections, thereby suggesting furosemide infusions might be considered as first line therapy in critically ill, paediatric patients. The objective of this study is to examine furosemide treatment as either continuous infusions or intermittent injections and subsequent patient outcomes.
    Methods: This is a retrospective cohort analysis of patients treated in a pediatric intensive care unit (ICU) over a nine year period (July 31st 2006 and July 31, 2015). Eligible patients were admitted to either the general pediatric or cardiac specific ICU for a duration of at least 6 hours and who received intravenous furosemide treatment.
    Results: A total of 7,478 patients were identified who received a total of 118,438 furosemide administrations for a total of 113,951 (96%) intermittent doses and 4,487 (4%) infusions running for a total of 1,588,750 hours. A total of 5,996 (80%) patients received exclusively furosemide injections and 1,482 (20%) patients received at least one furosemide infusion. A total of 193 patients died during ICU admission, amounting to 87 (6%) of the 1,482 patients who received an infusion and 106 (2%) of the 5,996 who received intermittent injections. Multivariable regression analysis showed no statistically significant decrease in adjusted mortality for patients who received furosemide injections compared to furosemide infusions (aOR 1.20, CI 0.76-1.89).
    Discussion: This retrospective study observed similar mortality for patients who received furosemide infusions compared to furosemide injections. More research on furosemide in the ICU could provide insights on fluid management, drug effectiveness, and pharmacologic stewardship for critically ill children.
    Language English
    Publishing date 2024-01-16
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2023.1306498
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  2. Article ; Online: Being Present After Pediatric Critical Illness-Home and Hospital, School and Work.

    Parshuram, Christopher S / Cunningham, Todd

    JAMA network open

    2021  Volume 4, Issue 12, Page(s) e2140902

    MeSH term(s) Child ; Critical Illness ; Hospitals ; Humans ; Intensive Care Units, Pediatric ; Schools
    Language English
    Publishing date 2021-12-01
    Publishing country United States
    Document type Journal Article ; Comment
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2021.40902
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  3. Article ; Online: Implementing a complex hospital innovation: conceptual underpinnings, program design and implementation of a complex innovation in an international multi-site hospital trial.

    Dryden-Palmer, Karen / Berta, Whitney B / Parshuram, Christopher S

    BMC health services research

    2022  Volume 22, Issue 1, Page(s) 1342

    Abstract: Background: Designing implementation programs that effectively integrate complex healthcare innovations into complex settings is a fundamental aspect of knowledge translation. We describe the development of a conceptually grounded implementation program ...

    Abstract Background: Designing implementation programs that effectively integrate complex healthcare innovations into complex settings is a fundamental aspect of knowledge translation. We describe the development of a conceptually grounded implementation program for a complex healthcare innovation and its subsequent application in pediatric hospital settings.
    Methods: We conducted multiple case observations of the application of the Phased Reciprocal Implementation Synergy Model (PRISM) framework in the design and operationalization of an implementation program for a complex hospital wide innovation in pediatric hospital settings.
    Results: PRISM informed the design and delivery of 10 international hospital wide implementations of the complex innovation, BedsidePEWS. Implementation and innovation specific goals, overarching implementation program design principles, and a phased-based, customizable, and context responsive implementation program including innovation specific tools and evaluation plans emerged from the experience.
    Conclusion: Theoretically grounded implementation approaches customized for organizational contexts are feasible for the adoption and integration of this complex hospital-wide innovation. Attention to the fitting of the innovation to local practices, setting, organizational culture and end-user preferences can be achieved while maintaining the integrity of the innovation.
    MeSH term(s) Child ; Humans ; Delivery of Health Care ; Organizational Culture ; Research Design ; Hospitals ; Organizational Innovation
    Language English
    Publishing date 2022-11-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-022-08768-8
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  4. Article ; Online: Intensive Care Unit Physician Discretion in Pediatric Critical Care. Polarized, Evaluated, and Reframed.

    Parshuram, Christopher S

    American journal of respiratory and critical care medicine

    2016  Volume 194, Issue 12, Page(s) 1443–1444

    Language English
    Publishing date 2016-12-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.201606-1309ED
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  5. Article: Discussing Death as a Possible Outcome of PICU Care.

    Gilleland, Jonathan C / Parshuram, Christopher S

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

    2018  Volume 19, Issue 8S Suppl 2, Page(s) S4–S9

    Abstract: ... impact(s) of alternate treatments, describe possible modes of death, and acknowledge the extent ...

    Abstract Objectives: To describe practical considerations related to discussions about death or possible death of a critically ill child.
    Data sources: Personal experience and reflection. Published English language literature.
    Study selection: Selected illustrative studies.
    Data extraction: Not available.
    Data synthesis: Narrative and experiential review were used to describe the following areas benefits and potential adverse consequences of conversations about risk of death and the timing of, preparation for, and conduct of conversations about risk of death.
    Conclusions: Timely conversations about death as a possible outcome of PICU care are an important part of high-quality ICU care. Not all patients "require" these conversations; however, identifying patients for whom conversations are indicated should be an active process. Informed conversations require preparation to provide the best available objective information. Information should include distillation of local experience, incorporate the patients' clinical trajectory, the potential impact(s) of alternate treatments, describe possible modes of death, and acknowledge the extent of uncertainty. We suggest the more factual understanding of risk of death should be initially separated from the more inherent value-laden treatment recommendations and decisions. Gathering and sharing of collective knowledge, conduct of additional investigations, and time can increase the factual content of risk of death discussions. Timely and sensitive delivery of this best available knowledge then provides foundation for high-quality treatment recommendations and decision-making.
    MeSH term(s) Attitude to Death ; Child ; Communication ; Critical Illness/psychology ; Death ; Decision Making ; Family/psychology ; Female ; Humans ; Intensive Care Units, Pediatric/standards ; Male ; Physician-Patient Relations ; Physicians ; Risk Assessment ; Terminal Care/psychology ; Uncertainty
    Language English
    Publishing date 2018-08-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2052349-X
    ISSN 1947-3893 ; 1529-7535
    ISSN (online) 1947-3893
    ISSN 1529-7535
    DOI 10.1097/PCC.0000000000001557
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  6. Article ; Online: Implementing a complex hospital innovation

    Karen Dryden-Palmer / Whitney B. Berta / Christopher S. Parshuram

    BMC Health Services Research, Vol 22, Iss 1, Pp 1-

    conceptual underpinnings, program design and implementation of a complex innovation in an international multi-site hospital trial

    2022  Volume 16

    Abstract: Abstract Background Designing implementation programs that effectively integrate complex healthcare innovations into complex settings is a fundamental aspect of knowledge translation. We describe the development of a conceptually grounded implementation ... ...

    Abstract Abstract Background Designing implementation programs that effectively integrate complex healthcare innovations into complex settings is a fundamental aspect of knowledge translation. We describe the development of a conceptually grounded implementation program for a complex healthcare innovation and its subsequent application in pediatric hospital settings. Methods We conducted multiple case observations of the application of the Phased Reciprocal Implementation Synergy Model (PRISM) framework in the design and operationalization of an implementation program for a complex hospital wide innovation in pediatric hospital settings. Results PRISM informed the design and delivery of 10 international hospital wide implementations of the complex innovation, BedsidePEWS. Implementation and innovation specific goals, overarching implementation program design principles, and a phased-based, customizable, and context responsive implementation program including innovation specific tools and evaluation plans emerged from the experience. Conclusion Theoretically grounded implementation approaches customized for organizational contexts are feasible for the adoption and integration of this complex hospital-wide innovation. Attention to the fitting of the innovation to local practices, setting, organizational culture and end-user preferences can be achieved while maintaining the integrity of the innovation.
    Keywords Implementation program ; Implementation design ; Knowledge translation ; Health care innovation ; Public aspects of medicine ; RA1-1270
    Subject code 005
    Language English
    Publishing date 2022-11-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
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  7. Article ; Online: Evaluating the Validity of the Responses to Illness Severity Quantification Score to Discriminate Illness Severity and Level of Care Transitions in Hospitalized Children with Severe Acute Malnutrition.

    Dale, Nancy M / Ashir, Garba Mohammed / Maryah, Lawan Bukar / Shepherd, Susan / Tomlinson, George / Briend, André / Zlotkin, Stanley / Parshuram, Christopher S

    The Journal of pediatrics

    2023  Volume 262, Page(s) 113609

    Abstract: Objective: To evaluate the validity of the Responses to Illness Severity Quantification (RISQ) score to discriminate illness severity and transitions between levels of care during hospitalization.: Study design: A prospective observational study ... ...

    Abstract Objective: To evaluate the validity of the Responses to Illness Severity Quantification (RISQ) score to discriminate illness severity and transitions between levels of care during hospitalization.
    Study design: A prospective observational study conducted in Maiduguri, Nigeria, enrolled inpatients aged 1-59 months with severe acute malnutrition. The primary outcome was the RISQ score associated with the patient state. Heart and respiratory rate, oxygen saturation, respiratory effort, oxygen use, temperature, and level of consciousness are summed to calculate the RISQ score. Five states were defined by levels of care and hospital discharge outcome. The states were classified hierarchically, reflecting illness severity: hospital mortality was the most severe state, then intensive care unit (ICU), care in the stabilization phase (SP), care in the rehabilitation phase (RP), and lowest severity, survival at hospital discharge. A multistate statistical model examined performance of the RISQ score in predicting clinical states and transitions.
    Results: Of 903 children enrolled (mean age, 14.6 months), 63 (7%) died. Mean RISQ scores during care in each phase were 3.5 (n = 2265) in the ICU, 1.7 (n = 6301) in the SP, and 1.5 (n = 2377) in the RP. Mean scores and HRs for a 3-point change in score at transitions: ICU to death, 6.9 (HR, 1.80); SP to ICU, 2.8 (HR, 2.00); ICU to SP, 2.0 (HR, 0.5); and RP to discharge, 1.4 (HR, 0.91).
    Conclusions: The RISQ score can discriminate between points of escalation or de-escalation of care and reflects illness severity in hospitalized children with severe acute malnutrition. Evaluation of clinical implementation and demonstration of benefit will be important before widespread adoption.
    MeSH term(s) Child ; Humans ; Infant ; Child, Hospitalized ; Patient Transfer ; Nigeria ; Intensive Care Units ; Severity of Illness Index ; Patient Acuity ; Severe Acute Malnutrition/diagnosis ; Severe Acute Malnutrition/therapy
    Language English
    Publishing date 2023-07-05
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 3102-1
    ISSN 1097-6833 ; 0022-3476
    ISSN (online) 1097-6833
    ISSN 0022-3476
    DOI 10.1016/j.jpeds.2023.113609
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  8. Article: Risk factors for unplanned paediatric intensive care unit admission after anaesthesia-an international multicentre study.

    Taylor, Katherine L / Frndova, Helena / Szadkowski, Leah / Joffe, Ari R / Parshuram, Christopher S

    Paediatrics & child health

    2022  Volume 27, Issue 6, Page(s) 333–339

    Abstract: Objectives: Unplanned intensive care unit (ICU) admissions are associated with near-miss events, morbidity, and mortality. We describe the rate, resource utilization, and outcomes of paediatric patients urgently admitted directly to ICU post-anaesthesia ...

    Abstract Objectives: Unplanned intensive care unit (ICU) admissions are associated with near-miss events, morbidity, and mortality. We describe the rate, resource utilization, and outcomes of paediatric patients urgently admitted directly to ICU post-anaesthesia compared to other sources of unplanned ICU admissions.
    Methods: We performed a secondary analysis of data from specialist paediatric hospitals in 7 countries. Patients urgently admitted to the ICU post-anaesthesia were combined and matched with 1 to 3 unique controls from unplanned ICU admissions from other locations by age and hospital. Demographic, clinical, and outcome variables were compared using the Wilcoxon rank-sum test for continuous variables and chi-square or Fisher's exact test for categorical variables. The effect of admission sources on binary outcomes was estimated using univariable conditional logistic regression models with stratification by matched set of anaesthesia and non-anaesthesia admission sources.
    Results: Most admissions were <1 year of age and for respiratory reasons. Admissions post-anaesthesia were shorter, occurred later in the day, and were more likely to be mechanically ventilated. Admissions post-anaesthesia were less likely to have had a previous ICU admission (4.8% compared to 11%, P=0.032) or PIM 'high-risk diagnosis' (9.5% versus 17.2%, P=0.035) but there was no difference in the number of subsequent ICU admissions. There was no difference in the PIM severity of illness score and no mortality difference between the groups.
    Conclusions: Young children and respiratory indications dominated unplanned ICU admissions post-anaesthesia, which was more likely later in the day and with mechanical ventilation.
    Language English
    Publishing date 2022-07-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2106767-3
    ISSN 1918-1485 ; 1205-7088
    ISSN (online) 1918-1485
    ISSN 1205-7088
    DOI 10.1093/pch/pxac041
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  9. Article: Science and Acute Kidney Injury: Exploring the Rhetoric of Standardization.

    Slater, Morgan B / Parshuram, Christopher S

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

    2017  Volume 18, Issue 7, Page(s) 730

    MeSH term(s) Acute Kidney Injury ; Child ; Critical Illness ; Humans ; Risk Factors
    Language English
    Publishing date 2017-07-24
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2052349-X
    ISSN 1947-3893 ; 1529-7535
    ISSN (online) 1947-3893
    ISSN 1529-7535
    DOI 10.1097/PCC.0000000000001190
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  10. Article: The authors reply.

    Parshuram, Christopher S / Dryden-Palmer, Karen

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

    2019  Volume 20, Issue 1, Page(s) 93–94

    MeSH term(s) Child ; Critical Care ; Death ; Humans
    Language English
    Publishing date 2019-01-07
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2052349-X
    ISSN 1947-3893 ; 1529-7535
    ISSN (online) 1947-3893
    ISSN 1529-7535
    DOI 10.1097/PCC.0000000000001773
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