Article
Pediatrics
William J. H. Ford, David G. Bundy, Suzette Oyeku, Moonseong Heo, Lisa Saiman, Rebecca E. Rosenberg, Patricia DeLaMora, Barbara Rabin, Philip Zachariah, Parsa Mirhaji, Elizabeth Klein, Oghale Obaro-Best, Michael Drasher, Alexandre Peshansky, Michael L. Rinke
Summary: This study evaluated the salvage of CVC in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. The results showed that CVC salvage was frequently attempted and was successful in many cases, with specific factors such as underlying diagnosis, CVC type, and absence of candidemia being associated with attempted and successful salvage.
Article
Critical Care Medicine
Scott Mayer, Colin Bonhag, Patrick Jenkins, Brendon Cornett, Paula Watts, Dmitriy Scherbak
Summary: This retrospective observational cohort study found that the administration of probiotics to ICU patients with central venous catheters is associated with a substantial rate of probiotic-associated bloodstream infections, leading to increased mortality. Powder formulations of probiotics have a higher rate of infection compared to nonpowder formulations.
CRITICAL CARE MEDICINE
(2023)
Article
Medicine, General & Internal
Zhenhua Yang, Xiaobo Ma, Yu Chen, Yiqing Cao, Qianyu Li, Xiaoting Pan, Lu Wang
Summary: This study demonstrated that using the PDCA method to manage central catheters effectively reduced the incidence of infections among hemodialysis patients, while also improving nursing satisfaction and quality of life.
AMERICAN JOURNAL OF THE MEDICAL SCIENCES
(2021)
Article
Public, Environmental & Occupational Health
Vassiliki Pitiriga, John Bakalis, Elsa Kampos, Petros Kanellopoulos, George Saroglou, Athanasios Tsakris
Summary: This study demonstrates that the duration of CVC placement remains a significant risk factor for CLABSIs in hospitalized patients, even after the implementation of preventive bundles. The high prevalence of multidrug-resistant organisms in our setting highlights an urgent public health concern.
ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL
(2022)
Article
Infectious Diseases
Marcus Hentrich, Boris Boell, Daniel Teschner, Jens Panse, Timo Schmitt, Jan-Hendrik Naendrup, Martin Schmidt-Hieber, Julia Neitz, Eva Fiegle, Enrico Schalk
Summary: This study compared the risk of catheter-related bloodstream infections (CRBSI) between femoral venous (FV) insertion of central venous catheters (CVC) and subclavian/internal jugular (IJV/SCV) insertion in cancer patients. The findings suggest that, in the short term, FV CVC insertion in cancer patients does not increase the risk of CRBSI compared to IJV/SCV CVC insertion.
Article
Public, Environmental & Occupational Health
Rebeca Cruz-Aguilar, Jonathan Carney, Vanessa Mondaini, Maria J. G. T. Vehreschild, Matas Griskaitis, Jon Salmanton-Garcia, Boris Boell, Matthias Kochanek, Harald Seifert, Lena M. Biehl, Fedja Farowski
Summary: The introduction of antiseptic barrier caps (ABCs) did not significantly reduce the central line-associated bloodstream infections (CLABSI) rate in high-risk populations, and multivariate analysis did not confirm ABCs as an independent protective factor. There were no significant differences between the groups in terms of time to CLABSI and the proportion of catheters removed due to suspicion of infection.
AMERICAN JOURNAL OF INFECTION CONTROL
(2021)
Article
Computer Science, Information Systems
Lorne W. Walker, Andrew J. Nowalk, Shyam Visweswaran
Summary: This study utilized machine learning to predict outcomes of salvage of infected central venous catheters in pediatric CLABSI, showing that the infection recurrence model outperformed the CVC removal model. The research illustrated the variability of predictors over time.
JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION
(2021)
Article
Public, Environmental & Occupational Health
Rehab Nasser AL-Shukri, Omar M. AL-Rawajfah, Liala Al -Daken, Mujahid Al-Busaidi
Summary: This study investigated the prevalence, causative microorganisms, and associated risk factors of ICU-acquired central line-associated bloodstream infections (CLABSIs) among adult ICU patients in Oman. The results showed a higher prevalence of ICU-acquired CLABSIs in Oman compared to developed countries, with gram-positive bacteria being the most common isolates. Risk factors for ICU-acquired CLABSIs included heart failure, female gender, presence of other infections, tracheostomy, and Total Parenteral Nutrition.
AMERICAN JOURNAL OF INFECTION CONTROL
(2022)
Review
Public, Environmental & Occupational Health
D. Buonsenso, G. Salerno, G. Sodero, F. Mariani, L. Pisapia, C. Gelormini, M. Di Nardo, P. Valentini, G. Scoppettuolo, D. G. Biasucci
Summary: This study evaluated the treatment strategies for central venous catheter-related bloodstream infections in pediatric patients. The findings suggest that adding an antimicrobial lock solution to systemic antibiotics may be beneficial for successful catheter salvage in children with CRBSI, but no significant difference was found in CLABSI cases between the addition of an antimicrobial lock solution and systemic antibiotic alone.
JOURNAL OF HOSPITAL INFECTION
(2022)
Review
Pediatrics
Zhengrong Deng, Jiangwei Qin, Huanbin Sun, Furong Xv, Yimei Ma
Summary: This study evaluated the efficacy of impregnations for the prevention of catheter-related bloodstream infection in pediatrics. The results showed that impregnated CVCs significantly reduced the risk of CRBSI in pediatric patients, especially in the pediatric group. The study concluded that antimicrobial-impregnated CVCs are beneficial in preventing CVC-related complications in pediatrics.
FRONTIERS IN PEDIATRICS
(2022)
Article
Infectious Diseases
David Odada, Hellen Munyi, Japhet Gatuiku, Ruth Thuku, Jared Nyandigisi, Anne Wangui, Emilie Ashihundu, Beatrice Nyakiringa, Jemimah Kimeu, Martin Musumbi, Rodney D. Adam
Summary: Improvement projects to reduce central line-associated bloodstream infections face challenges and complexities associated with implementing interventions in real-world healthcare settings. Continuous monitoring, evaluation, readjustment, and adaptation of interventions are needed to achieve desired results and sustain improvements in patient outcomes.
BMC INFECTIOUS DISEASES
(2023)
Review
Nutrition & Dietetics
Michelle Gompelman, Carmen Paus, Ashley Bond, Reinier P. Akkermans, Chantal P. Bleeker-Rovers, Simon Lal, Geert J. A. Wanten
Summary: The study found that in patients on home parenteral nutrition (HPN), the addition of an antimicrobial lock solution was more beneficial for successful catheter salvage compared to systemic antibiotics alone. Recurrence rates were lower in studies using antimicrobial lock therapy (ALP) compared to those using systemic antibiotics alone.
AMERICAN JOURNAL OF CLINICAL NUTRITION
(2021)
Review
Health Care Sciences & Services
Sara G. McCleskey, Lili Shek, Jonathan Grein, Hiroshi Gotanda, Laura Anderson, Paul G. Shekelle, Emmett Keeler, Sally Morton, Teryl K. Nuckols
Summary: This systematic review examined economic evaluations of quality improvement interventions to prevent CAUTI in acute care hospitals, finding that QI interventions were associated with a significant decline in infection rates and variable net costs to hospitals. Future research should focus on identifying specific cost-saving practices and assessing the value of comprehensive interventions for hospitals and patients.
BMJ QUALITY & SAFETY
(2022)
Article
Pediatrics
Ilker Devrim, Ozlem Sarac Sandal, Miray Yilmaz celebi, Pinar Hepduman, Ahmet Gonullu, Gulhan Atakul, Aybuke Akaslan Kara, Yeliz Oruc, Gamze Guelfidan, Nuri Bayram, Hasan Agin
Summary: This study suggests that the use of central line bundles not only reduces the incidence of CLABSI but also delays the time to onset of infection in CLABSI patients. Additionally, as a direct consequence of the CLB, the number of CLABSIs caused by gram-positive cocci did not increase, while the proportion of CLABSIs caused by C. parapsilosis decreased.
EUROPEAN JOURNAL OF PEDIATRICS
(2023)
Review
Critical Care Medicine
Adam G. Stewart, Kevin B. Laupland, Alexis Tabah
Summary: Primary and intravascular catheter-associated bloodstream infections (CA-BSIs) are significant clinical entities in the ICU, with high morbidity and mortality rates. Recent studies have shown that failure to remove the catheter in CA-BSI leads to higher mortality. Factors such as severity scores, duration of ICU stay, and catheter insertion increase the risk of CA-BSI. The use of prevention bundles during central venous line insertion can significantly reduce CA-BSI incidence. Differential time-to-positivity of paired blood cultures may aid in the diagnosis of CA-BSI.
CURRENT OPINION IN CRITICAL CARE
(2023)
Article
Pediatrics
Emma Roche, Chun Lim, Meelad Sayma, Annakan Navaratnam, Peter J. Davis, Padmanabhan Ramnarayan, James Fraser, Simon Kenny
Summary: During the 2020 SARS-CoV-2 pandemic, effective clinical leadership and an adaptive workforce enabled an agile response to a rapidly changing situation. Open communication systems across senior clinical and management teams facilitated service planning. Supporting the well-being of the workforce through innovative education solutions was vital in sustaining resilience and planning for future surge capacity in pediatric critical care.
ARCHIVES OF DISEASE IN CHILDHOOD
(2022)
Article
Medicine, General & Internal
Padmanabhan Ramnarayan, Alvin Richards-Belle, Laura Drikite, Michelle Saull, Izabella Orzechowska, Robert Darnell, Zia Sadique, Julie Lester, Kevin P. Morris, Lyvonne N. Tume, Peter J. Davis, Mark J. Peters, Richard G. Feltbower, Richard Grieve, Karen Thomas, Paul R. Mouncey, David A. Harrison, Kathryn M. Rowan
Summary: This study aimed to evaluate the efficacy and safety of high-flow nasal cannula therapy (HFNC) compared to continuous positive airway pressure (CPAP) as the first-line mode of noninvasive respiratory support for acutely ill children. The results showed that HFNC was noninferior to CPAP in terms of time to liberation from respiratory support. Additionally, the HFNC group showed better outcomes in sedation use, duration of critical care stay, and duration of acute hospital stay.
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
(2022)
Article
Critical Care Medicine
Ruth E. C. Evans, Victoria Barber, Sarah Seaton, Padmanabhan Ramnarayan, Patrick Davies, Jo Wray
Summary: Through a survey of parents, it was found that parental presence and choice to travel in the ambulance were associated with a more positive experience, with most parents rating their experience with the transport team highly.
PEDIATRIC CRITICAL CARE MEDICINE
(2022)
Article
Critical Care Medicine
Irene Chang, Karen Thomas, Lauran O'Neill Gutierrez, Sam Peters, Rachel Agbeko, Carly Au, Elizabeth Draper, Gareth A. L. Jones, Lee Elliot Major, Marzena Orzol, John Pappachan, Padmanabhan Ramnarayan, Samiran Ray, Zia Sadique, Doug W. Gould, David A. Harrison, Kathryn M. Rowan, Paul R. Mouncey, Mark J. Peters
Summary: This study aims to evaluate the clinical effectiveness and cost-effectiveness of conservative and liberal oxygen saturation targets in pediatric critical care. It will be conducted in 15 PICUs across England, Wales, and Scotland, with measurements and outcomes recorded to assess the impact of the two targets.
PEDIATRIC CRITICAL CARE MEDICINE
(2022)
Article
Multidisciplinary Sciences
Iain Robert Louis Kean, Joseph Wagner, Anisha Wijeyesekera, Marcus De Goffau, Sarah Thurston, John A. Clark, Deborah K. White, Jenna Ridout, Shruti Agrawal, Riaz Kayani, Roddy O'Donnell, Padmanabhan Ramnarayan, Mark J. Peters, Nigel Klein, Elaine Holmes, Julian Parkhill, Stephen Baker, Nazima Pathan
Summary: Broad-spectrum antimicrobial use during critical illness treatment affects the microbiome and bile acid profile. The compositional shift in Lachnospiraceae may aid in the recovery of bile acid composition. Measurement of faecal bile acids can be used to assess gut microbiota recovery.
SCIENTIFIC REPORTS
(2022)
Editorial Material
Critical Care Medicine
Padmanabhan Ramnarayan, Bronagh Blackwood, Robinder G. Khemani
INTENSIVE CARE MEDICINE
(2022)
Letter
Medicine, General & Internal
Michael K. Gusmano, David Chinitz, Victor Rodwin
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
(2022)
Letter
Medicine, General & Internal
Padmanabhan Ramnarayan, Rebecca Mitting, Elizabeth Whittaker, Maria Marcolin, Ciara O'Regan, Ruchi Sinha, Aisleen Bennett, Moustafa Moustafa, Neil Tickner, Mark Gilchrist, Anthony Kershaw, Tommy Rampling
NEW ENGLAND JOURNAL OF MEDICINE
(2022)
Editorial Material
Critical Care Medicine
Padmanabhan Ramnarayan, Mark J. Peters
Summary: This article provides an overview of the use of noninvasive respiratory support modalities (such as HFNC and CPAP) in critically ill children and discusses the significance of the FIRST-ABC trials and how the trial findings have impacted clinical practice.
PEDIATRIC CRITICAL CARE MEDICINE
(2022)
Article
Emergency Medicine
Olugbenga Akinkugbe, Romit Saxena, Padmanabhan Ramnarayan
Summary: This study aimed to compare transports performed by referring hospital (RH) teams and by specialized pediatric critical care transport (PCCT) teams in terms of timings and patient outcomes for children requiring emergency neurosurgical intervention in the United Kingdom. A retrospective analysis was conducted over a 5-year period, and data on patient characteristics, transfer method, timings, and clinical outcomes were collected. The study found that specialist critical care transport teams were involved in one third of transfers, and there was no significant difference in arrival time and patient outcomes between RH and PCCT team transfers.
PEDIATRIC EMERGENCY CARE
(2023)
Article
Critical Care Medicine
Samer Abu-Sultaneh, Narayan Prabhu Iyer, Analia Fernandez, Michael Gaies, Sebastian Gonzalez-Dambrauskas, Justin Christian Hotz, Martin C. J. Kneyber, Yolanda M. Lopez-Fernandez, Alexandre T. Rotta, David K. Werho, Arun Kumar Baranwal, Bronagh Blackwood, Hannah J. Craven, Martha A. Q. Curley, Sandrine Essouri, Jose Roberto Fioretto, Silvia M. M. Hartmann, Philippe Jouvet, Steven Kwasi Korang, Gerrard F. Rafferty, Padmanabhan Ramnarayan, Louise Rose, Lyvonne N. Tume, Elizabeth C. Whipple, Judith J. M. Wong, Guillaume Emeriaud, Christopher W. Mastropietro, Natalie Napolitano, Christopher J. L. Newth, Robinder G. Khemani
Summary: Pediatric-specific ventilator liberation guidelines are lacking and have led to unnecessary variation in methods used to assess readiness for extubation. An international panel of experts developed evidence-based recommendations for best practices related to pediatric ventilator liberation, including screening, spontaneous breathing trials, respiratory muscle strength assessment, and prevention of upper airway obstruction. However, most recommendations are conditional and based on low certainty of evidence.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2023)
Editorial Material
Critical Care Medicine
Mark J. Peters, Padmanabhan Ramnarayan, Barnaby R. Scholefield, Lyvonne N. Tume, Robert C. Tasker
Summary: Pediatric intensive care research networks have been established globally over the past two decades, including the U.K.'s PCCS-SG. PCCS-SG has successfully conducted randomized clinical trials and achieved a range of research outcomes. The success of PCCS-SG's research can be attributed to factors such as efficient data collection, collaboration with clinical trials units, and support from clinical research staff.
PEDIATRIC CRITICAL CARE MEDICINE
(2022)
Article
Critical Care Medicine
Gareth A. L. Jones, Simon Eaton, Michael Orford, Samiran Ray, Daisy Wiley, Padmanabhan Ramnarayan, David Inwald, Michael P. W. Grocott, Michael Griksaitis, John Pappachan, Lauran R. O'Neill, Paul A. Mouncey, David M. Harrison, Kathryn J. Rowan, Mark Peters
Summary: The study aimed to compare the effects of conservative oxygenation targets and liberal oxygenation targets on the oxidative status of pediatric patients in the intensive care unit. The results showed that the conservative oxygenation group had higher levels of urinary nitrate/nitrite and lower expression of hypoxia-inducible factor (HIF)-1a mRNA in blood.
PEDIATRIC CRITICAL CARE MEDICINE
(2023)
Article
Rheumatology
Samuel Channon-Wells, Ortensia Vito, Andrew J. McArdle, Eleanor G. Seaby, Harsita Patel, Priyen Shah, Ekaterina Pazukhina, Clare Wilson, Claire Broderick, Giselle D'Souza, Ilana Keren, Ruud G. Nijman, Adriana Tremoulet, Daniel Munblit, Rolando Ulloa-Gutierrez, Michael J. Carter, Padmanabhan Ramnarayan, Tisham De, Clive Hoggart, Elizabeth Whittaker, Jethro A. Herberg, Myrsini Kaforou, Aubrey J. Cunnington, Oleg Blyuss, Michael Levin
Summary: This study evaluated immunomodulatory treatments for multisystem inflammatory syndrome in children (MIS-C) and found that glucocorticoids or glucocorticoids plus intravenous immunoglobulin were not significantly different from intravenous immunoglobulin alone in terms of clinical efficacy. Initial treatment with glucocorticoids may be a safe alternative to immunoglobulin or combined therapy.
LANCET RHEUMATOLOGY
(2023)
Article
Health Policy & Services
Enoch Kung, Sarah E. Seaton, Padmanabhan Ramnarayan, Christina Pagel
Summary: A study developed an optimization framework to determine the optimal number of locations for each PICRT, location selection, the number of teams required at each location, and which local hospitals each location should serve. Findings showed that consolidating teams into fewer stations for higher availability led to better performance.
