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PICU Evidence Update
December 2017
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Your Outreach Librarian – Helen Pullen
Whatever your information needs, the library is here to help. Just email us at [email protected]
Outreach: Your Outreach Librarian can help facilitate evidence-based practice for all in the team, as well as assisting with academic study and research. We also offer one-to-one or
small group training in literature searching, critical appraisal and medical statistics. Get in touch: [email protected]
Literature searching: We provide a literature searching service for any library member. For those embarking on their own research it is advisable to book some time with one of the
librarians for a one-to-one session where we can guide you through the process of creating a well-focused literature research. Please email requests to [email protected]
Training Calendar 2017/18
December (12.00-13.00)
7th (Thu) Statistics
14th (Thu) Literature Searching
20th (Wed) Critical Appraisal
January (13.00-14.00)
4th (Thu) Statistics
8th (Mon) Literature Searching
18th (Thu) Critical Appraisal
24th (Wed) Statistics
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Journal Tables of Contents
The most recent issues of key journals. Click on the hyperlinked titles (+ Ctrl) to for
contents tables. If you would like any of the papers in full text then get in touch:
Acta Paediatrica
Volume 106, Issue 12 Pages 1889 - 2069, December 2017
Treatment methods for respiratory syncytial virus bronchiolitis need to be evaluated
before they are introduced on a large scale (pages 1900–1901)
Bill Hesselmar
Boys have better short-term and long-term survival rates after intensive care admissions
than girls (pages 1973–1978)
E Johansson Frigyesi, P Andersson and A Frigyesi
National high-flow nasal cannula and bronchiolitis survey highlights need for further
research and evidence-based guidelines (pages 1998–2003)
Paula Sokuri, Paula Heikkilä and Matti Korppi
Low age, low birthweight and congenital heart disease are risk factors for intensive care
in infants with bronchiolitis (pages 2004–2010)
Minna Mecklin, Paula Heikkilä and Matti Korppi
Archives of Disease in Childhood
December 2017 - Volume 102 – Issue 12
Critical Care Medicine
December 2017 – Volume 45 - Issue 12
Current Opinion in Pediatrics
December 2017 - Volume 29 – Issue 6
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European Journal of Pediatrics
Volume 176 Number 12
Congenital pulmonary airway malformations: state-of-the-art review for pediatrician’s
use (Claire Leblanc, Marguerite Baron, Emilie Desselas, et al)
Routine gastric residual volume measurement and energy target achievement in the
PICU: a comparison study (Lyvonne N. Tume, Anna Bickerdike, Lynne Latten, et al)
A mixed methods evaluation of paediatric trainee preparedness to manage
cardiopulmonary arrests (Órla Walsh, Sinéad Lydon & Paul O’Connor)
Medication errors in pediatric inpatients: a study based on a national mandatory
reporting system (Rikke Mie Rishoej, Anna Birna Almarsdóttir et al)
Frontiers in Pediatrics Section: "Pediatric Critical Care”
Intensive Care Medicine
November 2017 - Volume 43 - Issue 11
New England Journal of Medicine
http://www.nejm.org/
Pediatric Anesthesia
December 2017 - Volume 27 - Issue 12
The anatomy of the pediatric airway: Has our knowledge changed in 120 years? A
review of historic and recent investigations of the anatomy of the pediatric larynx
Josef Holzki, Karen A. Brown, Robert G. Carroll and Charles J. Coté
Version of Record online: 17 NOV 2017 | DOI: 10.1111/pan.13281
Pediatric Critical Care Medicine November 2017 - Volume 18 - Issue 11
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Database Articles
Below is a selection of articles recently added to the healthcare databases. If you
would like any of the following articles in full text, or if you would like a more focused
search on your own topic, then get in touch: [email protected]
Guedj R, Chappuy H, Titomanlio L, et al. Do All Children Who Present With a Complex Febrile
Seizure Need a Lumbar Puncture? (Ann Emerg Med 2017; 70:52)
STUDY OBJECTIVE We assess the prevalences of bacterial meningitis and herpes simplex virus
meningoencephalitis (HSV-ME) in children with a complex febrile seizure and determine these
prevalences in the subgroup of children with a clinical examination result not suggestive of
meningitis or encephalitis.
METHODS This multicenter retrospective study was conducted in 7 pediatric emergency
departments (EDs) in the region of Paris, France. Visits of patients aged 6 months to 5 years for
a complex febrile seizure from January 2007 to December 2011 were analyzed. We defined a
subgroup of patients whose clinical examination result was not suggestive of meningitis or
encephalitis. Bacterial meningitis and HSV-ME were sequentially sought for by analyzing
bacteriologic and viral data at the visit, looking for data from a second visit to the hospital after
the index visit, and telephoning the child's parents.
RESULTS From a total of 1,183,487 visits in the 7 pediatric EDs, 839 patients presented for a
complex febrile seizure, of whom 260 (31.0%) had a lumbar puncture. The outcomes bacterial
meningitis and HSV-ME were ascertainable for 715 (85%) and 657 (78.3%) visits, respectively,
and we found 5 cases of bacterial meningitis (0.7% [95% confidence interval [CI]0.2% to 1.6%])
and no HSV-ME (0% [95% CI 0% to 0.6%]). Among the 630 visits of children with a clinical
examination result not suggesting meningitis or encephalitis, we found no bacterial meningitis
(0% [95% CI 0% to 0.7%]) and no HSV-ME (0% [95% CI 0% to 0.8%]).
CONCLUSION In children with a complex febrile seizure, bacterial meningitis and HSV-ME are
unexpected events when the clinical examination after complex febrile seizure is not suggestive
of meningitis or encephalitis.
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Cravero JP, Askins N, Sriswasdi P, et al. Validation of the Pediatric Sedation State Scale. (Pediatrics 2017; 139)
OBJECTIVES Development and validation of the Pediatric Sedation State Scale (PSSS) is intended
to specifically meet the needs of pediatric procedural sedation providers to measure
effectiveness and quality of care.
METHODS The PSSS content was developed through Delphi methods utilizing leading pediatric
sedation experts and published guidelines on procedural sedation in children. Video clips were
created and presented to study participants, who graded the state of patients during
procedures by using the PSSS to evaluate inter- and intrarater reliability by determining the
intraclass correlation coefficient. We also compared the PSSS to the Observational Scale of
Behavioral Distress-revised during 4 clinically relevant phases of a laceration repair procedure.
RESULTS Six sedation states were defined for the PSSS. Each state was assigned a numerical
value with higher numbers for increasing activity states. We included behaviors associated with
adequate and inadequate sedation and adverse events associated with excessive sedation.
Analysis of interrater and intrarater reliability revealed an intraclass correlation coefficient of
0.994 (95% confidence interval: 0.986-0.998) and 0.986 (95% confidence interval: 0.970-0.995),
respectively. Criterion validity was confirmed with respect to the Observational Scale of
Behavioral Distress-revised (Spearman r = 0.96). Construct validity was indicated by significant
differences in PSSS scores (P<.001) between 4 phases of a procedure, each having a different
degree of painful or distressing stimuli.
CONCLUSIONS The PSSS is a 6-point scale that is a valid measure of the effectiveness and quality
of procedural sedation in children within the limits of the testing method used in this study.
Park J.J, Kennedy B. G.T, et al Dispelling the nice or naughty myth: retrospective observational study of Santa Claus (BMJ 2016; 355, 6355) OBJECTIVES To determine which factors influence whether Santa Claus will visit children in hospital on Christmas Day. DESIGN Retrospective observational study. SETTING Paediatric wards in England, Northern Ireland, Scotland, and Wales. PARTICIPANTS 186 members of staff who worked on the paediatric wards (n=186) during Christmas 2015. MAIN OUTCOME MEASURES Presence or absence of Santa Claus on the paediatric ward during Christmas 2015. This was correlated with rates of absenteeism from primary school, conviction rates in young people (aged 10-17 years), distance from hospital to North Pole (closest city or town to the hospital in kilometres, as the reindeer flies), and contextual socioeconomic deprivation (index of multiple deprivation).
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RESULTS Santa Claus visited most of the paediatric wards in all four countries: 89% in England, 100% in Northern Ireland, 93% in Scotland, and 92% in Wales. The odds of him not visiting, however, were significantly higher for paediatric wards in areas of higher socioeconomic deprivation in England (odds ratio 1.31 (95% confidence interval 1.04 to 1.71) in England, 1.23 (1.00 to 1.54) in the UK). In contrast, there was no correlation with school absenteeism, conviction rates, or distance to the North Pole. CONCLUSION The results of this study dispel the traditional belief that Santa Claus rewards children based on how nice or naughty they have been in the previous year. Santa Claus is less likely to visit children in hospitals in the most deprived areas. Potential solutions include a review of Santa’s contract or employment of local Santas in poorly represented regions.
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Latest Evidence
Invasive versus non‐invasive ventilation for acute respiratory failure in neuromuscular disease
and chest wall disorders
Source: Cochrane Database of Systematic Reviews - 04 December 2017
out on neuromuscular patients admitted to a paediatric intensive care unit (PICU). The trial was
excluded as it did not compare NIV to...
Cuffed versus uncuffed endotracheal tubes for general anaesthesia in children aged eight years
and under
Flavia A De Orange, Rebeca GAC Andrade, Andrea Lemos, Paulo SGN Borges, José N Figueiroa,
Pete G Kovatsis
Online Publication Date: November 2017
Dexamethasone as an adjuvant to peripheral nerve block
Carolyne Pehora, Annabel ME Pearson, Alka Kaushal, Mark W Crawford, Bradley Johnston
Online Publication Date: November 2017
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External laryngeal manipulation during endotracheal intubation in children (December 2017)
In a retrospective study of data from an international registry of over 7800 infants and children
undergoing endotracheal intubation in pediatric intensive care units, external laryngeal
manipulation (ELM) was associated with lower first- pass successful intubation compared with
no manipulation (59 versus 68 percent, respectively) [25]. The difference remained significant
after adjustment for potential confounders, although residual confounding may still contribute
to this finding. ELM may improve the glottic view during laryngoscopy in selected patients (eg,
children with anteriorly placed airways due to congenital anomalies or trauma patients with
cervical spinal motion restriction in place), but routine use for endotracheal intubation in
children does not appear to be beneficial. (See "Emergency endotracheal intubation in
children", section on 'Adjusting for suboptimal view'.)
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