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  1. Article ; Online: Enhancing family experience in the paediatric intensive care unit through the adoption of the family care journal: A single-center study.

    Tcharmtchi, Jennifer / Coss-Bu, Jorge A / Tcharmtchi, M Hossein

    Nursing in critical care

    2024  

    Abstract: Background: Multidisciplinary patient care rounds are increasingly seen as a vital complement to patient care management. Family engagement in these rounds, especially in the paediatric population, is important to treatment and outcomes, but there is ... ...

    Abstract Background: Multidisciplinary patient care rounds are increasingly seen as a vital complement to patient care management. Family engagement in these rounds, especially in the paediatric population, is important to treatment and outcomes, but there is little information about family experience in the Paediatric Intensive Care Unit (PICU).
    Aims: To develop a process using family care journals (FCJ) to systematically evaluate family experience in the PICU and identify needed supportive resources that will enhance their critical care stay.
    Methods: This is a single-centre quasi-experimental design conducted at a large urban quaternary level freestanding children's hospital. A family care journal (FCJ) was distributed to families upon admission to PICU to serve as a resource tool during their stay. An electronic point of care (POC) questionnaire was used to assess families' experiences in the PICU.
    Results: Three hundred sixty-six questionnaires were completed (100% response rate) and analysed. Overall, there was an improvement in all phases post FCJ implementation compared with the baseline. Seventy five percent of families found it a useful tool for communication with the PICU team. Open-ended comments revealed improvement opportunities related to communication, environment, and delay in care. Almost all commented on excellent nursing care.
    Conclusions: Introducing FCJ in a paediatric ICU is a practical approach, providing a cost-effective method to assess family experiences and gain insights for ongoing quality improvement efforts. Collaboration among all care team members, including nursing, medical, and administrative leaders, is crucial for empathetically addressing parental needs during hospitalization.
    Relevance to clinical practice: Combining the use of journals and questionnaires provides the clinical team with an efficient means of collecting valuable feedback from parents regarding their experience in the PICU and the factors that foster ongoing commitment from families. Nurses play a crucial role in encouraging the adoption of these journals, as they promote greater parent involvement in their children's care.
    Language English
    Publishing date 2024-01-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 2011956-2
    ISSN 1478-5153 ; 1362-1017
    ISSN (online) 1478-5153
    ISSN 1362-1017
    DOI 10.1111/nicc.13029
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  2. Article ; Online: Macronutrient and Micronutrient Intake in Children with Lung Disease.

    Knebusch, Nicole / Mansour, Marwa / Vazquez, Stephanie / Coss-Bu, Jorge A

    Nutrients

    2023  Volume 15, Issue 19

    Abstract: This review article aims to summarize the literature findings regarding the role of micronutrients in children with lung disease. The nutritional and respiratory statuses of critically ill children are interrelated, and malnutrition is commonly ... ...

    Abstract This review article aims to summarize the literature findings regarding the role of micronutrients in children with lung disease. The nutritional and respiratory statuses of critically ill children are interrelated, and malnutrition is commonly associated with respiratory failure. The most recent nutrition support guidelines for critically ill children have recommended an adequate macronutrient intake in the first week of admission due to its association with good outcomes. In children with lung disease, it is important not to exceed the proportion of carbohydrates in the diet to avoid increased carbon dioxide production and increased work of breathing, which potentially could delay the weaning of the ventilator. Indirect calorimetry can guide the process of estimating adequate caloric intake and adjusting the proportion of carbohydrates in the diet based on the results of the respiratory quotient. Micronutrients, including vitamins, trace elements, and others, have been shown to play a role in the structure and function of the immune system, antioxidant properties, and the production of antimicrobial proteins supporting the defense mechanisms against infections. Sufficient levels of micronutrients and adequate supplementation have been associated with better outcomes in children with lung diseases, including pneumonia, cystic fibrosis, asthma, bronchiolitis, and acute respiratory failure.
    MeSH term(s) Humans ; Child ; Critical Illness ; Vitamins ; Micronutrients ; Energy Intake ; Eating ; Lung Diseases ; Carbohydrates
    Chemical Substances Vitamins ; Micronutrients ; Carbohydrates
    Language English
    Publishing date 2023-09-25
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2518386-2
    ISSN 2072-6643 ; 2072-6643
    ISSN (online) 2072-6643
    ISSN 2072-6643
    DOI 10.3390/nu15194142
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  3. Article: A methodological and clinical approach to measured energy expenditure in the critically ill pediatric patient.

    Silva-Gburek, Jaime / Zhu, Paola Hong / Mansour, Marwa / Walding, David / Coss-Bu, Jorge A

    Frontiers in pediatrics

    2022  Volume 10, Page(s) 1027358

    Abstract: The metabolic response to injury and stress is characterized initially by a decreased energy expenditure (Ebb phase) followed by an increased metabolic expenditure (Flow phase). Indirect calorimetry is a methodology utilized to measure energy expenditure ...

    Abstract The metabolic response to injury and stress is characterized initially by a decreased energy expenditure (Ebb phase) followed by an increased metabolic expenditure (Flow phase). Indirect calorimetry is a methodology utilized to measure energy expenditure and substrate utilization by measuring gas exchange in exhaled air and urinary nitrogen. The use of indirect calorimetry in critically ill patients requires precise equipment to obtain accurate measurements. The most recent guidelines suggested that measured energy expenditure by indirect calorimetry be used to determine energy requirements. This article reviews the methodological and clinical use of indirect calorimetry in critically ill pediatric patients.
    Language English
    Publishing date 2022-10-24
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2022.1027358
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  4. Article: Effects of COVID-19 Pandemic on Nutritional Status, Feeding Practices, and Access to Food Among Infants and Children in Lower and Middle-Income Countries: a Narrative Review.

    Zhu, Paola Hong / Mhango, Susan Nita / Vinnakota, Anirudh / Mansour, Marwa / Coss-Bu, Jorge A

    Current tropical medicine reports

    2022  , Page(s) 1–10

    Abstract: Purpose of review: The COVID-19 pandemic has affected children across the planet and the consequences on their health, nutritional status, and social structure have been more pronounced in low- and middle-income countries (LMICs). This review will focus ...

    Abstract Purpose of review: The COVID-19 pandemic has affected children across the planet and the consequences on their health, nutritional status, and social structure have been more pronounced in low- and middle-income countries (LMICs). This review will focus on the effects of the COVID-19 pandemic on infant growth and feeding practices and access to food and obesity prevalence among children in LMICs. An electronic search was performed on MEDLINE and Embase to identify relevant articles in the English language.
    Recent findings: A higher prevalence of infections by the SARS-CoV-2 virus and a lower mortality rate were found in children in LMICs compared to western countries. In 2020, 22% and 52% of the wasting and deaths in children under 5 years of age in LMICS came from the sub-Saharan Africa region, respectively. Despite the decrease in stunting from 40% in 1990 to 24.2% in 2019, the prevalence remains above 30% in LMICs. Regarding breastfeeding practices in LMICs, many organizations recommend breastfeeding for infants and children born to infected mothers with SARS-CoV-2. This pandemic has resulted in higher food insecurity and disruption to access to health care and nutrition-related programs from schools; this situation has been more detrimental for younger children from LMICs.
    Summary: Given the devastating effects of the COVID-19 pandemic on the nutritional status, higher food insecurity, and lack of access to health care for infants and children in LMICs, efforts from government, world organizations, and non-for-profit institutions should be implemented to ameliorate the effects of this pandemic.
    Language English
    Publishing date 2022-10-10
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 2196-3045
    ISSN 2196-3045
    DOI 10.1007/s40475-022-00271-8
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  5. Article ; Online: Perioperative Nutritional Status and Organ Dysfunction Following Surgery for Congenital Heart Disease.

    Silva-Gburek, Jaime / Marroquín, Andrea / Flores, Saul / Roddy, Jeramy / Ghanayem, Nancy S / Shekerdemian, Lara S / Coss-Bu, Jorge A

    Pediatric cardiology

    2023  Volume 44, Issue 6, Page(s) 1350–1357

    Abstract: Children with congenital heart disease (CHD) are at risk of malnutrition; however, there is limited information regarding the impact of nutritional status on organ dysfunction and outcomes after surgery for CHD. The study aim was to assess the ... ...

    Abstract Children with congenital heart disease (CHD) are at risk of malnutrition; however, there is limited information regarding the impact of nutritional status on organ dysfunction and outcomes after surgery for CHD. The study aim was to assess the association between malnutrition, organ dysfunction, and outcomes after surgery for CHD. Retrospective cohort study of patients aged 30 days to 18 years admitted to the cardiac intensive care unit (CICU) following cardiac surgery. Nutritional status (malnutrition defined as weight for age z-score < - 2) and validated organ dysfunction scores (pSOFA and PELOD-2) on CICU days 1 and 3 were collected. The cohort included 967 patients with a median age of 2.8 years (IQR 0.46, 7.12) and hospital survival of 98.86%. The prevalence of malnutrition was 18.5% (n = 179). By multivariable logistic regression analysis including age, malnutrition, cardiopulmonary bypass time, and duration of mechanical ventilation; High STAT category (OR 7.51 [1.03-54], p = 0.0462) and PSOFA score > 5 day 1 (OR 1.84 [1.25-2.72], p = 0.0021) were associated with mortality; in a similar model including the same variables; High STAT category (OR 9.12 [1.33-62], p = 0.0243) and PELOD-2 score > 5 day 1 (OR 1.75 [1.10-2.77], p = 0.0175) were associated with mortality. Malnutrition was associated with persistent or worsening organ dysfunction by pSOFA (p < 0.05) and PELOD-2 (p < 0.01) on day 3. Malnutrition was present in infants and children undergoing surgery for congenital heart disease. Organ dysfunction and high surgical risk were associated with mortality. Malnutrition was not associated with mortality but was associated with postoperative organ dysfunction.
    MeSH term(s) Infant ; Child ; Humans ; Nutritional Status ; Retrospective Studies ; Multiple Organ Failure/complications ; Risk Factors ; Heart Defects, Congenital/complications ; Malnutrition/epidemiology ; Malnutrition/complications
    Language English
    Publishing date 2023-02-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 800857-7
    ISSN 1432-1971 ; 0172-0643
    ISSN (online) 1432-1971
    ISSN 0172-0643
    DOI 10.1007/s00246-023-03111-2
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  6. Article: Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study.

    Campos-Miño, Santiago / Figueiredo-Delgado, Artur / Zárate, Patricia / Zamberlan, Patricia / Muñoz-Benavides, Eliana / Coss-Bu, Jorge A

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

    2023  Volume 24, Issue 12, Page(s) 1033–1042

    Abstract: Objectives: To characterize the nutritional status of children admitted to Latin American (LA) PICUs and to describe the adequacy of nutrition support in reference to contemporary international recommendations.: Design: The Nutrition in PICU ( ... ...

    Abstract Objectives: To characterize the nutritional status of children admitted to Latin American (LA) PICUs and to describe the adequacy of nutrition support in reference to contemporary international recommendations.
    Design: The Nutrition in PICU (NutriPIC) study was a combined point-prevalence study of malnutrition carried out on 1 day in 2021 (Monday 8 November) and a retrospective cohort study of adequacy of nutritional support in the week preceding.
    Setting: Four-one PICUs in 13 LA countries.
    Patients: Patients already admitted to the PICU of 1 month to 18 years old on the study day were included in the point-prevalence study. For the retrospective arm, we included patients receiving nutritional support on the study day and with a PICU length of stay (LOS) greater than or equal to 72 hours. Exclusion criteria were being a neonate, conditions that precluded accurate anthropometric measurements, and PICU LOS greater than 14 days.
    Interventions: None.
    Measurements and main results: Of 316 patients screened, 5 did not meet age criteria. There were 191 of 311 patients who were included in the point-prevalence study and underwent anthropometric evaluation. Underweight and length for age less than -2 z scores were present in 42 of 88 children (47.7%) and 41 of 88 children (46.6%) less than 24 months old, and 14 of 103 (13.6%) and (23/103) 22.3% of 103 children greater than or equal to 24 months, respectively. Evidence of obesity (body mass index > 2 z score) was present in 7 of 88 children (5.7%) less than 24 months old and 13 of 103 children (12.6%) greater than or equal to 24 months. In the 115 of 311 patients meeting criteria for the retrospective arm, a total of 98 patients reported complete nutritional data. The 7-day median (interquartile range) adequacy for delivered versus recommended enteral energy and protein requirement was 114% (75, 154) and 99% (60, 133), respectively.
    Conclusions: The NutriPIC study found that in 2021 malnutrition was highly prevalent especially in PICU admissions of less than 24 months old. Retrospectively, the 7-day median nutritional support appears to meet both energy and protein requirements.
    MeSH term(s) Child ; Infant, Newborn ; Humans ; Infant ; Child, Preschool ; Retrospective Studies ; Latin America/epidemiology ; Nutritional Support ; Malnutrition/diagnosis ; Malnutrition/epidemiology ; Length of Stay ; Intensive Care Units, Pediatric ; Critical Illness
    Language English
    Publishing date 2023-08-04
    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.0000000000003337
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    Zs.MO 472: Show issues

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  7. Article ; Online: Application of organ dysfunction assessment scores following pediatric lung transplantation.

    O'Connor, Chinyere / Munoz, Flor M / Gazzaneo, Maria C / Melicoff, Ernestina / Das, Shailendra / Lam, Fong / Coss-Bu, Jorge A

    Clinical transplantation

    2022  Volume 37, Issue 3, Page(s) e14863

    Abstract: Objective: Organ dysfunction (OD) after lung transplantation can reflect preoperative organ failure, intraoperative acute organ damage and post-operative complications. We assessed two OD scoring systems, both the PEdiatric Logistic Organ Dysfunction ( ... ...

    Abstract Objective: Organ dysfunction (OD) after lung transplantation can reflect preoperative organ failure, intraoperative acute organ damage and post-operative complications. We assessed two OD scoring systems, both the PEdiatric Logistic Organ Dysfunction (PELOD) and the pediatric Sequential Organ Failure Assessment (pSOFA) scores, in recognizing risk factors for morbidity as well as recipients with prolonged post-transplant morbidity.
    Design: Medical records of recipients from January 2009 to March 2016 were reviewed. PELOD and pSOFA scores were calculated on post-transplant days 1-3. Risk factors assessed included cystic fibrosis (CF), prolonged surgical time and worst primary graft dysfunction (PGD) score amongst others. Patients were classified into three groups based on their initial scores (group A) and subsequent trends either uptrending (group B) or downtrending (group C). Morbidity outcomes were compared between these groups.
    Results: Total 98 patients were enrolled aged 0-20 years. Risk factors for higher pSOFA scores ≥ 5 on day 1 included non-CF diagnosis and worst PGD scores (p = .0006 and p = .03, respectively). Kruskal Wallis analysis comparing pSOFA group A versus B versus C scores showed significantly prolonged ventilatory days (median 1 vs. 4 vs. 2, p = .0028) and ICU days (median 4 vs. 10 vs. 6, p = .007). Similarly, PELOD group A versus B versus C scores showed significantly prolonged ventilatory days (1 vs. 5 vs. 2, p = < .0001).
    Conclusion: Implementing pSOFA scores bedside is a more effective tool compared to PELOD in identifying risk factors for worsened OD post-lung transplant and can be valuable in providing direction on morbidity outcomes in the ICU.
    MeSH term(s) Child ; Humans ; Organ Dysfunction Scores ; Multiple Organ Failure/diagnosis ; Lung Transplantation ; Cystic Fibrosis ; Risk Factors
    Language English
    Publishing date 2022-12-22
    Publishing country Denmark
    Document type Journal Article
    ZDB-ID 639001-8
    ISSN 1399-0012 ; 0902-0063
    ISSN (online) 1399-0012
    ISSN 0902-0063
    DOI 10.1111/ctr.14863
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    Zs.A 2204: Show issues Location:
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  8. Article ; Online: Post-operative dysnatremia is associated with adverse early outcomes after surgery for congenital heart disease.

    Ontaneda, Andrea M / Coss-Bu, Jorge A / Kennedy, Curtis / Akcan-Arikan, Ayse / Fernandez, Ernesto / Lasa, Javier J / Price, Jack F / Shekerdemian, Lara S

    Pediatric research

    2023  Volume 94, Issue 2, Page(s) 611–617

    Abstract: Background: Dysnatremia is a common disorder in critically ill surgical children. The study's aim is to determine the prevalence of dysnatremia and its association with outcomes after surgery for congenital heart disease (CHD).: Methods: This is a ... ...

    Abstract Background: Dysnatremia is a common disorder in critically ill surgical children. The study's aim is to determine the prevalence of dysnatremia and its association with outcomes after surgery for congenital heart disease (CHD).
    Methods: This is a single-center retrospective cohort study of children <18 years of age undergoing surgery for CHD between January 2012 and December 2014. Multivariable logistic regression analysis was used to evaluate the relationship between dysnatremia and outcomes during the perioperative period. A total of 1345 encounters met the inclusion criteria.
    Results: The prevalence of pre- and post-operative dysnatremia were 10.2% and 47.1%, respectively. Hyponatremia occurred in 19.1%, hypernatremia in 25.6%. Hypernatremia at 24, 48, and 72 h post-operative was associated with increased hospital mortality (odds ratios (OR) [95% confidence intervals (CI)] 3.08 [1.16-8.17], p = 0.024; 4.35 [1.58-12], p = 0.0045; 4.14 [1.32-12.97], p = 0.0148, respectively. Hypernatremia was associated with adverse neurological events 3.39 [1.12-10.23], p = 0.0302 at 48 h post-operative. Hyponatremia was not associated with any adverse outcome in our secondary analysis.
    Conclusions: Post-operative dysnatremia is a common finding in this heterogeneous cohort of pediatric cardiac-surgical patients. Hypernatremia was more prevalent than hyponatremia and was associated with adverse early post-operative outcomes.
    Impact: Our study has shown that dysnatremia was highly prevalent in children after congenital heart surgery with hypernatremia associated with adverse outcomes including mortality. It is important to understand fluid and sodium regulation in the post-operative period in children with congenital heart disease to better address fluid overload and associated electrolyte imbalances and acute kidney injury. While clinicians are generally very aware of the importance of hyponatremia in critically ill children, similar attention should be given to hypernatremia in this population.
    MeSH term(s) Humans ; Child ; Hypernatremia/complications ; Hypernatremia/epidemiology ; Retrospective Studies ; Critical Illness ; Sodium ; Hyponatremia/complications ; Hyponatremia/epidemiology ; Heart Defects, Congenital/complications ; Heart Defects, Congenital/surgery ; Water-Electrolyte Imbalance
    Chemical Substances Sodium (9NEZ333N27)
    Language English
    Publishing date 2023-01-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 4411-8
    ISSN 1530-0447 ; 0031-3998
    ISSN (online) 1530-0447
    ISSN 0031-3998
    DOI 10.1038/s41390-023-02495-4
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  9. Article ; Online: Pulmonary specialist involvement in critical asthma in the pediatric intensive care unit: A retrospective review.

    Paskaradevan, Janaki / Zier, Mackenzie / Rissmiller, Brian / Katkin, Julie P / Coss-Bu, Jorge A / Gazzaneo, M Carolina

    Pediatric pulmonology

    2021  Volume 57, Issue 2, Page(s) 395–402

    Abstract: Introduction: Asthma is one of the most common chronic diseases of childhood. There is a scarcity of published literature on critical asthma, considered acute asthma requiring pediatric intensive care unit (PICU) admission. The goal of this study was to ...

    Abstract Introduction: Asthma is one of the most common chronic diseases of childhood. There is a scarcity of published literature on critical asthma, considered acute asthma requiring pediatric intensive care unit (PICU) admission. The goal of this study was to describe the clinical care of children with critical asthma admitted to a single center PICU and to determine whether pulmonary medicine consultation during admission impacted outcomes.
    Methods: Retrospective chart review of known asthma patients aged 4-18 years admitted to a quaternary PICU between 01/2013 and 07/2019 for management of critical asthma.
    Results: A total of 179 patients were enrolled with median age of 8 years. Median hospital length of stay (LOS) was 3.2 days and PICU LOS was 1.5 days. A total of 80 (44.7%) patients had a pulmonary medicine consultation. In the pulmonary medicine consultation group versus the no-pulmonary medicine consultation group, there was a significant difference in hospital LOS (4.16 vs. 2.86 days, p value <.0001) and PICU LOS (2.00 vs. 1.00, p value <.0001), escalation of controller medication (66% vs. 21%, p value <.0001), scheduled outpatient pulmonology follow-up (87.5% vs. 45.4%, p value <.0001), and receiving ≥3 courses of systemic steroids in the 12 months after discharge (32.2% vs. 14.7%). There was no difference in attendance of scheduled follow up appointments or in having ≥3 emergency room visits or admissions in the 12 months after discharge.
    Conclusion: Pulmonary medicine consultation during hospital admission may impact management of critical asthma by increasing escalation of controller medication and scheduled outpatient follow up.
    MeSH term(s) Adolescent ; Asthma/drug therapy ; Child ; Child, Preschool ; Humans ; Infant ; Intensive Care Units, Pediatric ; Length of Stay ; Retrospective Studies ; Status Asthmaticus
    Language English
    Publishing date 2021-12-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632784-9
    ISSN 1099-0496 ; 8755-6863
    ISSN (online) 1099-0496
    ISSN 8755-6863
    DOI 10.1002/ppul.25780
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  10. Article ; Online: Characteristics and Outcomes of Pediatric Rapid Response With a Respiratory Trigger.

    Meulmester, Kristen M / Coss-Bu, Jorge A / Meskill, Sarah D / Wakefield, Bryan M / Moore, Robert H / Vachani, Joyee G / Bavare, Aarti C

    Hospital pediatrics

    2021  Volume 11, Issue 8, Page(s) 806–807

    Abstract: Background and objectives: Authors of adult rapid response (RRT) studies have established that RRT triggers play an important role in outcomes, but this association is not studied in pediatrics. In this study, we explore the characteristics and outcomes ...

    Abstract Background and objectives: Authors of adult rapid response (RRT) studies have established that RRT triggers play an important role in outcomes, but this association is not studied in pediatrics. In this study, we explore the characteristics and outcomes of pediatric rapid response with a respiratory trigger (Resp-RRT). We hypothesize that outcomes differ on the basis of patients' primary diagnoses at the time of Resp-RRT.
    Methods: We conducted a 2-year retrospective observational study at an academic tertiary care pediatric hospital.
    Results: Among the 1287 Resp-RRTs in 1060 patients, those with a respiratory diagnosis (
    Conclusions: Among pediatric respiratory-triggered RRT events, patients with a respiratory diagnosis were more likely to receive acute respiratory support in ICU but have better long-term outcomes. Presence of complex chronic conditions increases risk of acute respiratory support and mortality. The interplay of primary diagnosis with RRT trigger can potentially inform resource needs and outcomes for pediatric Resp-RRTs.
    MeSH term(s) Adult ; Child ; Hospital Rapid Response Team ; Humans ; Pediatrics ; Retrospective Studies
    Language English
    Publishing date 2021-07-09
    Publishing country United States
    Document type Journal Article ; Observational Study
    ISSN 2154-1671
    ISSN (online) 2154-1671
    DOI 10.1542/hpeds.2020-004630
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