Attitudes and responses of Victorian paediatric intensive care doctors to the detection and reporting of child maltreatment.

Aim: To determine the attitudes and responses of Victorian paediatric intensive care doctors to the detection and reporting of child maltreatment.

Methods: A prospective study conducted in a 30-bed paediatric intensive care unit of a university teaching hospital using data collected from a questionnaire completed by paediatric intensive care consultants and registrars. The questionnaire covered the following domains - doctors' knowledge of Victorian mandatory reporting legislation, doctors' history of reporting and doctors' current role in the detection and reporting of child maltreatment.

Leadership during airway management in the intensive care unit: A video-reflexive ethnography study.

Effective leadership is crucial to team performance within the intensive care unit. This novel study aimed to explore how staff members from an intensive care unit conceptualize leadership and what facilitators and barriers to leadership exist within a simulated workplace. It also aimed to identify factors that intersect with their perceptions of leadership.

Leadership in intensive care: A review.

An integrative review of the literature specific to leadership within the intensive care unit was planned to guide future research. Four databases were searched. Study selection was based on predetermined inclusion and exclusion criteria and a quality check was done.

ECMO for Neonatal Sepsis in 2019.

Sepsis and septic shock in newborns causes mortality and morbidity depending on the organism and primary site. ECMO provides cardiorespiratory support to allow adequate organ perfusion during the time for antibiotics and source control surgery (if needed) to occur. ECMO mode and cannulation site vary depending on support required and local preference.

Death and Dying in the ICU: Personal Reflection of 30 Years' Experience.

Objective: To describe individual perspective over ~30 years in a mixed Cardiac and General ICU, which includes the State Trauma Center, National Cardiac Transplant and Complex Cardiac Center, Extracorporeal Membrane Oxygenation Center, Home Ventilation Program, and the major PICU for 6 million people.

Data Sources: Personal experience and reflection, complemented by published local data.

Study Selection: Illustrative publications of local other data.

When a Child Dies in the PICU Despite Ongoing Life Support.

Objectives: To examine the circumstance of death in the PICU in the setting of ongoing curative or life-prolonging goals.

Data Sources: Multidisciplinary author group, international expert opinion, and use of current literature.

Data Synthesis: We describe three common clinical scenarios when curative or life-prolonging goals of care are pursued despite a high likelihood of death.

Outcomes of children admitted to intensive care after out-of-hospital cardiac arrest in Victoria, Australia.

Objectives: Paediatric out-of-hospital cardiac arrest (OHCA) is an uncommon event but is associated with high mortality and severe neurological sequelae among survivors. Most studies of paediatric OHCA are population-based, with very few reports on the cohort admitted to the paediatric intensive care unit (PICU). We sought to determine outcomes and predictors of neurologically intact survival in these children admitted to the PICU.

A Case-Control Analysis of Postoperative Fluid Balance and Mortality After Pediatric Cardiac Surgery.

Objectives: A positive fluid balance after cardiac surgery may be associated with poor outcomes; however, previous studies looking at this association have been limited by the number of deaths in the study population. Our primary aim was to determine the relationship between postoperative cumulative fluid balance and mortality in cardiac surgical patients. Secondary aims were to study the association between fluid balance and duration of mechanical ventilation, intensive care and hospital length of stay.

The characteristics, pattern of injury and outcome of children admitted to a paediatric intensive care unit following an inflicted injury.

Objective: To describe the characteristics, pattern of injury and outcome of children admitted to a paediatric intensive care unit (PICU) following an inflicted injury.

Design, Setting And Participants: A retrospective review of hospital records from a 30-bed PICU in a university teaching hospital, examining data for children admitted to the PICU after an inflicted injury from 1 January 2005 to 31 December 2013.

Main Outcome Measures: The hospital records of 46 children with an inflicted injury were reviewed.

Vitamin D status in critically ill children.

Background: Hypovitaminosis D is an independent risk factor for cardiovascular disease, muscle weakness, impaired metabolism, immune dysfunction, and compromised lung function. Hypovitaminosis D is common in critically ill adults and has been associated with adverse outcomes. The prevalence of hypovitaminosis D and its significance in critically ill children are unclear.

Extracorporeal life support: an update of Rogers' Textbook of Pediatric Intensive Care.

Introduction: The field of extracorporeal life support, which has focused predominantly on extracorporeal membrane oxygenation in the past, is undergoing rapid expansion following years of stagnation as newer devices and improved technology have become available. Additionally, new cannulae and cannulation techniques have allowed extracorporeal life support to be expanded to many groups who would have been excluded from support in the past.

Review: This update will review the current state of the art since Rogers' Textbook of Pediatric Intensive Care (Fourth Edition) was published several years ago.

A synthetic haemoglobin-based oxygen carrier and the reversal of cardiac hypoxia secondary to severe anaemia following trauma.

We report a case of compassionate use of a haemoglobin-based oxygen carrier in a severely injured Jehovah's Witness patient, for whom survival was considered unlikely. Severe anaemia and cardiac hypoxia were reversed after slow infusion of this agent. No vasoactive side effects were associated with the treatment, possibly due to the slow infusion, and the patient survived.

Rotating inotrope therapy in a pediatric population with decompensated heart failure.

Objective: To describe the clinical course of a group of patients who received a rotating inotrope regimen, including levosimendan, for decompensated congestive heart failure.

Design: Case series.

Setting: Pediatric intensive care unit in a tertiary care children's hospital.

Long-distance transport of critically ill children on extracorporeal life support in Australia.

Background: The Royal Children's Hospital, Melbourne, Victoria, provides extracorporeal life support (ECLS) for infants and children from all around Australia. Since 2003, we have offered a mobile ECLS service to retrieve critically ill children whose condition is too unstable for conventional transport. The retrieval team comprises a paediatric intensive care unit specialist, an ECLS nurse specialist, a perfusionist and a cardiac surgeon.

The long-term outcome of children managed with extracorporeal life support: an institutional experience.

Objective: To evaluate the long-term functional status and quality of life of infants and children who have received extracorporeal life support (ECLS), and to determine how and when death occurred.

Design: Long-term, prospective follow-up study.

Setting: 16-bed paediatric intensive care unit in a university teaching hospital.

Sildenafil prevents rebound pulmonary hypertension after withdrawal of nitric oxide in children.

Rationale: Rebound pulmonary hypertension (PHT) can complicate the weaning of nitric oxide (NO), and is in part related to transient depletion of intrinsic cyclic guanosine monophosphate. Rebound is characterized by increased pulmonary arterial (PA) pressure, cardiopulmonary instability, and in some cases, the need to continue NO beyond the intended period of use. There is anecdotal evidence that sildenafil, a phosphodiesterase-5 inhibitor, may prevent recurrence of rebound.

Early experience with Levosimendan in children with ventricular dysfunction.

Objective: To describe our preliminary experience with Levosimendan, a new calcium-sensitizing agent in critically unwell infants and children with severe heart failure.

Design: Retrospective cohort analysis.

Setting: Pediatric intensive care unit.

Extending the limits of extracorporeal membrane oxygenation: lung rest for a child with non-specific interstitial pneumonia.

Objective: Veno-venous extracorporeal membrane oxygenation (ECMO) is an established therapy for the treatment of respiratory failure. Traditionally ECMO has been used to support patients with an acute, reversible disease process, with a predictable outcome. We report the successful use of veno-venous ECMO for an unusual indication.

Effect of peritoneal dialysis on intra-abdominal pressure and cardio-respiratory function in infants following cardiac surgery.

Objective: To investigate the relationship between dialysate volume, intra-abdominal pressure, and cardio-respiratory function in infants following cardiac surgery.

Design: Prospective pilot study.

Setting: Paediatric intensive care unit.

Comparison of indirect methods of measuring intra-abdominal pressure in children.

Objective: To determine the most accurate indirect method of measuring intra-abdominal pressure (IAP) in children.

Design And Setting: Single-centre, prospective, clinical study in a 23-bed specialist paediatric intensive care unit in Australia.

Patients And Participants: 20 children admitted to paediatric intensive care with a peritoneal dialysis catheter in situ following congenital cardiac surgery.