Critical Care Commons^™

Establishment Of Neonatal Sepsis Predictors Utilizing Non-Invasive Monitoring Techniques, Dalton Janssen

Dissertations

Neonatal sepsis remains one of the leading causes of global neonatal mortality. Reactionary approaches for diagnosis and treatment have dominated the tactics in addressing neonatal sepsis but clinical intuition is an untapped resource that could lead to earlier prediction of sepsis onset. Nurses and other staff with specialized training and experience who have served as routine caregivers for a specific patient are able to identify when the patient’s status is altered. This clinical intuition may be substantiated by referencing specific patient trends in non-invasive measures over time. This retrospective, exploratory study examined whether variation in non-invasive monitoring variables could serve …

A Guideline-Based Approach To Increase Early Mobilization In The Pediatric Patient Following Cardiothoracic Surgery, Kayla Keeven

Dissertations

A Guideline-Based Approach to Increase Early Mobilization in the Pediatric Patient Following Cardiothoracic Surgery

Problem: Prolonged bedrest during the post-operative period contributes to complications that lengthen hospital stay and increase mortality and medical costs. Early mobilization is recognized as safe and feasible in critically ill children. However, there is no standardized procedure nor method of identifying patients who are safe to mobilize in a pediatric cardiac intensive care unit (ICU).

Method: The quality improvement (QI) project employed a descriptive observational design utilizing a retrospective-prospective method to assess the effects of implementing an early mobilization guideline in a pediatric cardiac ICU. …

Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke

Dissertations

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …

Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs

Dissertations

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …

Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen

Dissertations

Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost

Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …

Eye Care Protocol In Critically Ill Pediatric Patients On Neuromuscular Blockage, Jinnie Tkach

Dissertations

Abstract

Problem: Patients admitted to the pediatric intensive care unit (PICU) are at increased risk for the development of ocular surface disease (OSD) due to impaired ocular mechanisms while intubated, sedated, and on continuous neuromuscular blockade. The purpose of this project is to prevent OSD and vision impairments by increasing the frequency of eye care in accordance with a PICU eye care protocol.

Methods: An observational descriptive study was conducted utilizing retrospective and prospective chart review. Comparisons were drawn between the 2021 pre intervention group and the 2022 post intervention group regarding the impact of linking lubricating eye ointment orders …

Biomarkers And Factors Related To Risk Of Acute Kidney Injury, Mary Ann David

Dissertations

Background: Acute kidney injury (AKI) is associated with increased mortality, morbidity, length of hospital stay, and in-hospital cost. Timely intervention is needed to prevent disease progression, but the delay in diagnostic process often results in delayed treatment. Recent studies show a significant increase in novel urine biomarkers (UB), TIMP-2 and IGFBP7, has been linked to an increased risk of AKI.

Objectives: The purpose of this study was to examine the relationships among participants’ sociodemographic and clinical characteristics, including select biomarkers, care management processes, treatments, and patient outcomes in a sample of hospitalized critically ill patients in southern California.

Findings: Study …