ICU Liberation with Dr. Kristina Betters & Dr. Brooke Light -- Part 2
Dec 9, 2024
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Dr. Kristina Betters, a pediatric intensivist and delirium researcher at Vanderbilt University, joins aspiring intensivist Dr. Brooke Light to discuss vital topics in pediatric critical care. They delve into the challenges of diagnosing delirium in young patients, highlighting the importance of screening tools. The duo advocates for early mobility interventions tailored to developmental needs and emphasizes family involvement in the ICU to enhance recovery. Their insights on implementing ICU bundles reveal how even partial strategies can lead to improved outcomes.
Utilizing validated screening tools like CAPD and PCAM is essential for accurately diagnosing delirium in pediatric patients.
Implementing early mobility protocols and engaging families significantly enhance recovery outcomes and reduce risks in pediatric ICU settings.
Deep dives
Understanding Delirium in Pediatric ICU Patients
Delirium is defined as a disturbance of consciousness accompanied by inattention and cognitive or perceptual disturbances that develop over a short time. Diagnosing delirium in pediatric patients is particularly challenging, as validated screening tools like the CAPD and PCAM are necessary to assess their mental state accurately. Many signs that might resemble delirium, such as withdrawal or pain, can lead to misdiagnosis if not assessed properly. This highlights the importance of utilizing these tools consistently, regardless of the patient’s level of care, to avoid overlooking a common condition affecting up to 50% of severely ill pediatric patients.
Strategies for Delirium Prevention
Preventing delirium involves several multifaceted strategies, with early mobility being a critical component. Research indicates that implementing early mobility protocols in adult ICUs significantly reduces the incidence of delirium, and while data in pediatrics is less robust, preliminary studies show similar trends. Optimizing the patient environment, ensuring proper sleep patterns, and encouraging family involvement are also crucial to minimize the risk of delirium. Effective family engagement, such as having caregivers present during medical procedures and offering comforting interactions, can greatly aid in the patient’s recovery and mental well-being, reducing the likelihood of delirium.
Implementing Early Mobility Protocols
Early mobility in the pediatric ICU is tailored to each patient's developmental stage and acuity level, ranging from passive range of motion for the sickest patients to more active participation for those stable enough to engage. The implementation of a structured protocol ensures that patient safety is prioritized while maximizing the therapeutic benefits of physical movement. Multidisciplinary collaboration is necessary, with physical and occupational therapists guiding safe mobility practices, while nurses play a crucial role in monitoring and facilitating these sessions. Continuous education and support from the entire medical team help maintain the effectiveness of early mobility initiatives in pediatric care.
The Role of Family Engagement in Pediatric Critical Care
Family involvement is vital in pediatric critical care, as caregivers can significantly contribute to their child's recovery and emotional well-being. Engaging families through practices such as family-centered rounds and providing a 'family engagement menu' empowers them to assist with simple bedside activities that promote comfort. Research suggests that active family participation not only enhances the child's care but also positively impacts the caregivers' psychological health, reducing the risks associated with post-intensive care syndrome. Supporting families during their child's stay in the ICU fosters a collaborative environment that benefits both the patients and their caregivers, enhancing overall outcomes.
Kristina Betters, MD is an Associate Professor of Pediatrics in the division of Critical Care Medicine at Vanderbilt University and a pediatric intensivist at Monroe Carell Jr. Children’s Hospital. Dr. Betters' research interests are focused on early mobility, rehabilitation of the ICU patient, sedation, and delirium in critically ill children. She was an author of the 2022 SCCM PANDEM guidelines.
Brooke Light, MD is a pediatric resident physician at Prisma Health in Greenville, SC. Prior to residency, she completed her MD at the Medical University of South Carolina. She is (obviously) an aspiring pediatric intensivist, and we are so happy she reached out to coordinate this episode.
Learning Objectives:
By the end of this podcast, listeners should be able to discuss:
The rationale supporting the use of an ICU liberation bundle.
Key components of the A to F ICU liberation bundle.
An expert’s approach to implementing the A to F ICU liberation bundle
References:
Smith et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med. 2022 Feb 1;23(2):e74-e110.
Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF Bundle in Critical Care. Crit Care Clin. 2017 Apr;33(2):225-243.
Curley et al; RESTORE Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators Network. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial. JAMA. 2015 Jan 27;313(4):379-89.
Madden K, Wolf M, Tasker RC, Figueroa J, McCracken C, Hall M, Kamat P. Antipsychotic Drug Prescription in Pediatric Intensive Care Units: A 10-Year U.S. Retrospective Database Study. J Pediatr Intensive Care. 2021 Oct 22;13(1):46-54.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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