Interhospital transfer of children in respiratory failure: a clinician interview qualitative study.

Autor: Odetola FO; Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI; Child Health Evaluation and Research Unit of the Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI. Electronic address: fodetola@med.umich.edu., Anspach RR; Department of Sociology, University of Michigan, Ann Arbor, MI., Han YY; Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO., Clark SJ; Child Health Evaluation and Research Unit of the Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2017 Feb; Vol. 37, pp. 162-172. Date of Electronic Publication: 2016 Oct 04.
DOI: 10.1016/j.jcrc.2016.09.022
Abstrakt: Purpose: To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care.
Methods: Interviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao 2 )/Fio 2 (32%), and inflation pressure (16%). Poor clinical response was signified by high OI, inflation pressure, and Fio 2 , and low Pao 2 /Fio 2 . At EP 1, 18 of 19 respondents would initiate high-frequency oscillatory ventilation, and 1 would transfer. At EP 2, 15 of 18 respondents would maintain high-frequency oscillatory ventilation, 9 of them calling to discuss transfer. All respondents would transfer if escalated therapies failed to reverse the patient's clinical deterioration.
Conclusion: Interhospital transfer of children in respiratory failure is triggered by poor response to escalation of locally available care modalities. This finding provides new insight into decision making underlying interhospital transfer of children with respiratory failure.
Competing Interests: The authors have no conflicts of interest relevant to this article to disclose.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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