Stories about: intensive care

In the ICU, nurse experience and education can mean life or death

Morning rounds on the pediatric cardiac ICU.
Morning rounds on the pediatric cardiac intensive care unit.

Registered nurses (RNs) remain the largest group of health care providers and typically account for the greatest share of most U.S. hospitals’ operating budgets, about 60 percent. In adult hospitals, research has shown a consistently positive effect of increasing percentages of nurses with baccalaureate educations, and linked increased RN staffing and healthy work environments with improved patient outcomes.

However, this assessment has not been conducted in children’s hospitals—until now.

In a study in the Journal of Nursing Administration, nursing leaders from 38 free-standing children’s hospitals explored which nursing and organizational characteristics influence mortality for children undergoing congenital heart surgery.

The study, involving 20,407 pediatric patients and 3,413 pediatric critical care nurses, was led by Patricia Hickey, PhD, MBA, RN, from the Heart Center at Boston Children’s Hospital.

In pediatrics, congenital heart disease is the most common birth defect requiring surgical intervention for survival. Due to their critical care needs, these patients consume a disproportionate share of U.S. hospital resources.

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Raising an early warning in the ICU: T3

How can ICU clinicians manage the data from all these monitors?

With the Internet’s meteoric rise in the last 20 years—to the point of being available 24/7 in your pocket—technology pundits, psychologists and sociologists have been sounding ever louder warnings about information overload: the constant onslaught of communication, information and media coming at us all the time, and in ever greater volume.

Now imagine you’re a doctor or nurse in an intensive care unit (ICU). For you, information overload isn’t just a daily reality—it’s a necessary one. To make the right decisions at the right time for each patient, you must keep tabs on numerous bedside monitors—in the ICUs at Boston Children’s Hospital, that’s 10 or more for each child.

Melvin C. Almodovar, MD, medical director of Boston Children’s Cardiac Intensive Care Unit (CICU), and his colleagues wanted a better way to assess the patient’s physiologic state and catch crises before they happen.

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Got vitamin D? Study finds low levels in critically ill children

The sun helps us get some of the vitamin D we need, but not enough of it. A new study finds that critically ill kids are more than twice as likely as kids generally to be vitamin D deficient. (nichole ★/Flickr)

When a child is admitted to a hospital’s intensive care unit (ICU), probably one of the last things on anyone’s mind is, “Are they getting enough vitamin D?”

But this question could be a very important one, according to Kate Madden, MD, and Adrienne Randolph, MD, critical care medicine specialists at Boston Children’s Hospital. In a study of children admitted to Boston Children’s ICU, they found that those with very low vitamin D levels—below what the American Association of Pediatrics (AAP) considers deficient—tended to have more severe illness.

So what’s so important about vitamin D? Turns out, a lot more than most people think.

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Brains, babies and battlefields: Taking pediatric neurocritical care to the bedside

Evacuation of a soldier injured by a roadside bomb, June 17, 2011, Kandahar province of Afghanistan (DVIDSHUB/Flickr)

From the time he was 11, Robert Tasker knew he wanted to be a doctor. The son of a serviceman, he was drawn to battlefield surgery, evacuations and managing traumatic injuries. Instead, he ended up on a different kind of battlefield, where what’s at stake are the highly vulnerable, still developing brains of infants and children – and where it’s critical to be mobile and show up on time.

Tasker directs the Pediatric NeuroCritical Care program at Children’s Hospital Boston, the first of its kind in the world. His goal is to protect brain function not only in children suffering direct head injury, but children undergoing major surgery, children with stroke, children hospitalized for critical illness, children on ventilators, children with nervous-system infections like meningitis and more.

Born in Hong Kong and raised throughout the globe,

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