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CONTEXT In uncontrolled clinical studies, prone positioning appeared to be safe and to improve oxygenation in pediatric patients with acute lung injury. However, the effect of prone positioning on clinical outcomes in children is not known. OBJECTIVE To test the hypothesis that at the end of 28 days infants and children with acute lung injury treated with(More)
OBJECTIVE To develop a trigger tool for identifying adverse events occurring in critically ill pediatric patients; to identify and characterize adverse events and preventable adverse events experienced by critically ill pediatric patients; and to characterize the patients who experience preventable adverse events. DESIGN Retrospective chart review using a(More)
Efforts to improve patient safety require an understanding of organizational culture. In a survey of inpatient healthcare providers in a children's hospital, physician perceptions of teamwork were higher than those of all other staff (P < .001). Recognition of the impact of stress and fatigue was low, and job satisfaction was high for all groups. A majority(More)
IMPORTANCE Protocolized sedation improves clinical outcomes in critically ill adults, but its effect in children is unknown. OBJECTIVE To determine whether critically ill children managed with a nurse-implemented, goal-directed sedation protocol experience fewer days of mechanical ventilation than patients receiving usual care. DESIGN, SETTING, AND(More)
PURPOSE This paper describes the methodology of a clinical trial of prone positioning in pediatric patients with acute lung injury (ALI). Nonrandomized studies suggest that prone positioning improves oxygenation in patients with ALI/acute respiratory distress syndrome without the risk of serious iatrogenic injury. It is not known if these improvements in(More)
Adverse event reporting is a key element for improving patient safety. This study describes a new voluntary, anonymous reporting system that facilitates reporting of near-miss and patient harm events and an assessment of patient harm by the bedside care provider in a pediatric intensive care unit. The results demonstrated the effectiveness of the Patient(More)
OBJECTIVES Sedation-related adverse events in critically ill pediatric patients lack reproducible operational definitions and reference standards. Understanding these adverse events is essential to improving the quality of patient care and for developing prevention strategies in critically ill children. The purpose of this study was to test operational(More)
OBJECTIVE To compare oxygen consumption (Vo(2)) measured by indirect calorimetry before and after a packed red blood cell (PRBC) transfusion in patients with isovolemic anemia. DESIGN Prospective, repeated-measures clinical study. SETTING Outpatient pediatric hematology-oncology clinic. PATIENTS A total of 17 pediatric hematology-oncology outpatients(More)
INTRODUCTION Positive blood cultures guide clinicians to prescribe specific therapy based on in vitro susceptibility. Delays in appropriate antibiotic therapy increase morbidity associated with positive blood culture. HYPOTHESIS Time from clinician notification of positive blood culture to administration of targeted antimicrobial therapy should follow(More)
OBJECTIVE Care of critically ill children includes sedation but current therapies are suboptimal. To describe dexmedetomidine use in children supported on mechanical ventilation for acute respiratory failure. DESIGN Secondary analysis of data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial. SETTING Thirty-one(More)