My Long Covid Advocacy’s Post

High Pediatric Hospital Mortality in LMICs: Urgent Call for Resource Allocation and Research The increasing rate of pediatric hospital deaths in low- and middle-income countries

Incidence of Pediatric to Adult Transition Among Tracheotomy Patients Our newest study, published in The Laryngoscope, investigates the incidence and predictors of pediatric tracheostomy patients transitioning into adulthood with a tracheostomy in place. Conducted at a single pediatric hospital, the research analyzed 663 pediatric patients who received a tracheostomy between 2009 and 2022. Key Findings: 15.5% of patients (103 children) survived to adulthood, with 25% (26 patients) still having a tracheostomy in place at age 18. Older age at tracheostomy placement (mean age of 14.3 years) and severe neurocognitive disabilities were significant predictors of maintaining a tracheostomy into adulthood. Patients requiring mechanical ventilation at discharge and those of Hispanic ethnicity were also more likely to retain their tracheostomies. Predictive Factors: Older age at tracheostomy placement increased the likelihood of transitioning with a tracheostomy (odds ratio [OR] = 1.35). Children with severe neurocognitive disabilities were six times more likely to transition into adulthood with their tracheostomy (OR = 6.20). Implications: The study highlights the need for specialized adult care transition programs for pediatric tracheostomy patients, especially those with complex needs, such as severe disabilities. Structured programs are critical to ensure continuity of care and address the medical and social challenges faced by this population. Conclusion: Older children and those with severe neurocognitive impairments are more likely to transition to adult care with tracheostomies, underscoring the importance of targeted healthcare strategies for these patients. This study provides valuable insight into the characteristics of this patient group, paving the way for future research and better-designed care programs. https://lnkd.in/gRvFQSz7

🚨 Revolutionary Sepsis Protocol Saves Lives in Pediatric Oncology! 🚨 A groundbreaking sepsis management strategy in a pediatric hematology-oncology unit has achieved a remarkable milestone—zero sepsis-related deaths! This significant advancement highlights the critical importance of innovative healthcare solutions for vulnerable children battling severe illnesses. 🔍 Key Highlights: - Sepsis Algorithm Implementation: A comprehensive protocol that integrates continuous education for nurses, quality improvement techniques, and proactive prevention measures. - 📈 Impressive Results: - 10.7% increase in compliance with the algorithm. - 24.7% rise in timely antibiotic administration within the crucial one-hour window. This initiative underscores how structured education and timely interventions can drastically improve patient outcomes and safety. 🌟 The success of this protocol not only showcases the vital role of well-trained nursing staff but also serves as a scalable model that other pediatric units can adopt to combat sepsis effectively. Let's continue to prioritize child healthcare and explore innovative solutions! 👉 Click to learn more about this transformative achievement! #ClinicalResearches #HealthcareInnovation #NursingExcellence #PediatricHealth #SepsisAwareness #MarketAccess #MarketAccessToday

This is great to see! Sepsis is a leading cause of death in children globally, with an estimated 2 to 3 million pediatric deaths annually attributed to sepsis worldwide. In low- and middle-income countries, sepsis accounts for a significant portion of these deaths, often due to delayed diagnosis and lack of access to proper medical care. In the United States, around 7000 children die from sepsis annually, with over 75,000 children affected by the condition each year, making it one of the leading causes of death among children (European Sepsis Alliance)(Sepsis Alliance). In Europe, sepsis claims a life every minute across all age groups, including children, though specific figures for paediatric deaths are less readily available. However, it is known that sepsis causes significant mortality and morbidity in children throughout the region (European Sepsis Alliance)(World Health Organization (WHO)). These figures demonstrate the urgent need for improved sepsis detection and treatment, particularly in vulnerable populations like children. #HealthcareInnovation #PediatricCare #SepsisAwareness #MedicalAdvancements #Innovation #Medical #MedicalDiagnosis https://lnkd.in/erdreGRb

Respiratory failure is far and away the number one query at every hospital we consult at. I think the ACDIS white paper highlighted by Brian Murphy is great, except this statement: "Acute hypoxic respiratory failure is defined as PaO2 < 60 mmHg, SaO2 <88%–90% on room air, oxygen needs of 30% or greater to maintain SaO2 > 90%" I agree with the <88-90% (hospital dependent) but the 30% use of oxygen is not based on science or accepted standard from any pediatric organization. Exactly how much oxygen a patient is getting isn't even clear when on nasal cannula or face mask. There are some guidelines people use that discuss each LPM (liter per minute) being X% of oxygen, but most pulmonologists don't agree with those numbers. So does a child need to be on 2-3 LPM of oxygen to qualify for resp failure? Absolutely not. Any amount of oxygen needed to maintain saturations > 88-90% plus acute resp symptoms should qualify for "acute resp failure" according to the many children's hospitals that my team at Pediatric Resource Group (PRG) represents. I don't want hospitals to limit their use of this diagnosis/query based on that 30% (2-3 LPM) criteria in this paper.

Groundbreaking Study: Precision Medicine for Paediatric Sepsis Shows Promise In a significant leap forward for paediatric healthcare, researchers have unveiled promising results from a new study focusing on precision medicine for sepsis in children. Sepsis, a critical condition that remains the leading cause of mortality among children globally, has long been a challenge due to its varied symptoms and responses to treatment. The study, which represents a collaborative effort across multiple healthcare institutions, suggests that a tailored approach to sepsis treatment could dramatically improve outcomes for young patients. By analysing individual variations in genetic makeup and immune response, the researchers have developed a protocol that can more accurately target the underlying causes of sepsis, offering hope for more effective interventions. This advancement in precision medicine could mark a turning point in the fight against paediatric sepsis, potentially saving countless lives and setting a new standard for care in critical conditions.

More than 400 delegates – including researchers, scientists, doctors, nurses, therapists and members of staff – joined together for the Royal Free London’s (RFL’s) second research symposium. We caught up with Professor Derralynn Hughes, clinical director of research and innovation at the RFL, to share some highlights from the event. New and improved treatments, clinical trials and qualitative research and case studies were all on the agenda at this week’s two-day event. A wide variety of topics included the impact of new liver cancer treatments, the positive results of a trial for people with Neimann-Pick disease and evaluation of an early pregnancy loss support clinic. Delegates to the symposium were welcomed by Professor Derralynn Hughes and Lucy Parker, research and development directors. The event also included an evening reception and a prize-giving ceremony. Professor Derralynn Hughes, clinical director of research and innovation at the RFL, said: “Clinical research is usually considered to be how we understand more about conditions and ways of treating them, but research for a large organisation like the Royal Free London is about so much more – it is about our place in science and how we work with universities, and about how we do research to make services better for patients and staff experience. Lucy Parker, interim research and development director, said: “By collaborating and sharing our experiences and stories at events like this, we can all grow in our own areas of research which ultimately helps our patients.” The RFL’s ambition is to be among the NHS’ top ten 10 research trusts, achieving the best access, experience and outcomes for patients and staff.

Pediatric clinicians (of which I’m definitely not one, but I listen well) will frequently tell you: Children are not just little adults. That goes for clinical criteria used to diagnose pediatric conditions, and associated CDI and coding work. And in particular, respiratory failure. I was glad to see ACDIS and the American College of Physician Advisors (ACPA) collaborate on an important new white paper, “Developing Pediatric Respiratory Failure Criteria.” The paper is part 1 of a two-part series addressing respiratory failure in both pediatric and neonatal populations. Part 1 focuses on the pediatric population (patients older than 28 days and younger than 18 years). Neonatal patients will be covered in part 2. Normally ACDIS white papers are for members, but non-members can access it through Nov. 8. See link below. While the paper offers clinical information and definitions, it does not offer a formula for wholesale adoption. Rather, its purpose is to help healthcare organizations develop, refine, and validate their own internal criteria. The paper does offer some helpful baseline criteria. From the paper: 💡 “Respiratory failure is the inability of the respiratory system to meet the body’s oxygenation, ventilation, and/or metabolic requirements. It is important to know the values and presentations that are considered to be within the defined limits of each patient population. Any underlying condition, process, or trauma that interferes with oxygenation or ventilation can result in respiratory failure.” It then adds context for the pediatric population, listing examples of cardiopulmonary diseases, infections, neurologic disorders, traumas, and complications secondary to medical interventions. These are worth reviewing for any CDI or coding professional as the basis for compliant query. It also covers acute, chronic, and acute on chronic respiratory failure, as well as its three types (hypoxic, hypercapnic, combined). Perhaps most useful is discussion on clinical signs, symptoms and diagnostics, which should prove helpful for clinical validation of a respiratory failure diagnosis—potentially staving off payer denials. Per the paper: 💡 “Documentation should include indicators such as: Tachypnea, bradypnea, retractions (e.g., intercostal, subcostal, suprasternal), head bobbing, nasal flaring, grunting, cyanosis, diaphragmatic breathing, diaphoresis, lethargy, confusion, difficulty feeding, tripoding/posturing/ extended airway, wheezing, stridor, crackles (fine/coarse), diminished paradoxical movement, flail chest, tachycardia, bradycardia, hypoglycemia, acidosis (respiratory/metabolic).” Whether “the dark half” (i.e., payers) adopt similar diagnostic criteria to level the playing field and play with a common set of rules remains to be seen. But I applaud the effort. Have you read the paper? Does your organization struggle with pediatric respiratory failure (if you even have a pediatric CDI program)? Leave a comment below.

Abstract BACKGROUND: PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS. METHODS: Children receiving mechanical ventilation and on pressure-controlled volume-guaranteed mode were prospectively assessed for inclusion. PEEP was sequentially changed to 5, 12, 10, 8 cm H2O, and again to 5 cm H2O. After 10 min at each PEEP level, hemodynamic, ventilatory, and oxygenation variables were collected. RESULTS: A total of 31 subjects were included, with median age and weight of 6 months and 6.3 kg, respectively. The main reasons for pediatric ICU admission were respiratory failure caused by acute viral bronchiolitis (45%) and community-acquired pneumonia (32%). Most subjects had mild or moderate ARDS (45% and 42%, respectively), with a median (interquartile range) oxygenation index of 8.4 (5.8–12.7). Oxygen saturation improved significantly when PEEP was increased. However, although no significant changes in blood pressure were observed, the median cardiac index at PEEP of 12 cm H2O was significantly lower than that observed at any other PEEP level (P = .001). Fourteen participants (45%) experienced a reduction in cardiac index of > 10% when PEEP was increased to 12 cm H2O. Also, the estimated oxygen delivery was significantly lower, at 12 cm H2O PEEP. Finally, respiratory system compliance significantly reduced when PEEP was increased. At a PEEP of 12 cm H2O, static compliance had a median reduction of 25% in relation to the initial assessment (PEEP of 5 cm H2O). CONCLUSIONS: Although it may improve arterial oxygen saturation, inappropriately high PEEP levels may reduce cardiac output, oxygen delivery, and respiratory system compliance in pediatric subjects with ARDS with low potential for lung recruitability.

🔍 Demystifying Kaplan-Meier Survival Analysis for Pediatricians 🩺👶 As paediatricians, we’re no strangers to juggling data and clinical decisions, but when it comes to survival analysis, the Kaplan-Meier curve can feel like a mystery! So, let’s break it down—and keep it relevant to our practice in paediatric emergency medicine. What is Kaplan-Meier survival analysis? It’s a statistical method to estimate the time until an event occurs (e.g., recovery, exacerbation, discharge). It’s particularly useful when not all participants reach the event during the study period (hello, censored data). Where does it fit in Paediatric EM studies? Asthma exacerbations: Comparing time-to-next-exacerbation in groups treated with different therapies (e.g., Montelukast vs. Inhaled corticosteroids). Sepsis management: Tracking survival or length of hospital stay under different antibiotic protocols. Bronchiolitis outcomes: Evaluating discharge rates post-intervention (e.g., nebulized hypertonic saline vs. supportive care). Why Kaplan-Meier? Unlike a simple mean time calculation, it accounts for patients who leave the study early or don’t experience the event within the timeframe. This makes it more realistic, especially in clinical research where follow-up isn’t always perfect. Plus, it’s a curve—so it’s easier to visualize trends over time (and who doesn’t love a good graph?). So next time you're evaluating interventions or designing a study, think Kaplan-Meier—it’s got your data covered (and maybe some of your midnight snack breaks too). Curious to hear your thoughts! Where have you applied survival analysis in your practice?