Gregory Hansen

Jim Pattison Children's Hospital

Background: In neonatal hypoxic ischemic encephalopathy (HIE), hypo- and hyperglycemia have been associated with poor outcomes. However, glucose variability has not been reported in this population. Objective: To examine the association between serum glucose variability within the first 24 hours and two-year neurodevelopmental outcomes in neonat...

Background: Providing acutely ill children in isolated communities access to specialized care is challenging. This study aimed to evaluate remote presence robotic technology (RPRT) for enhancing pediatric remote assessments, expediting initiation of treatment, refining triaging, and reducing the need for transport. Methods: We conducted a pilot...

Introduction: Although the interfacility transport (IFT) of critically ill pediatric patients from rural to tertiary health centres may improve outcomes, the impact of IFTs on the rural referring centre is not known. The purpose of this study was to investigate how the IFT of critically ill children affects staffing and functionality of rural emerg...

Objective: In preterm infants, early diagnosis and management of a raised intracranial pressure (ICP) may be important to improve neurodevelopmental outcomes. While invasive ICP monitoring is not recommended, ultrasonography of the optic nerve sheath diameter (ONSD) could provide a noninvasive alternative to evaluate ICP. The objective of this pil...

Background: The COVID-19 pandemic overwhelmed Canadian hospitals with adult admissions. A large number required critical care therapies, placing significant strain on hospital resources. In order to decompress adult Intensive Care Units (ICUs), Pediatric ICUs (PICUs) introduced adapted models of traditional care to lessen these burdens. Objective...

Background: With the legalization of cannabis in Canada, safety concerns for children should be considered. Despite packaging and dose regulations for edibles and inhaled cannabis, unintentional poisonings are a clinical risk, and its impact on pediatric healthcare resources have not been clearly delineated. Methods: This retrospective cross-secti...

In a community hospital setting, Remote Presence Robotic Technology (RPRT) has been used for pediatric intensive care consultations. Two casesare presented where RPRT was used for acute resuscitation, delivering bad news, and discussions regarding end-of-life care. Although the medical contexts of the cases differed, RPRT demonstrateda versatility...

In response to the burden of coronavirus disease 2019 (COVID-19) and overwhelmed intensive care unit (ICU) resources, some pediatric intensive care units (PICUs) have had to adapt. The purpose of this study was to assess the criticality, scope of diagnosis, and outcomes of an adult cohort admitted to a Canadian PICU. A retrospective chart review wa...

Objective: Severity of illness scoring during pediatric critical care transport may provide objective data to determine illness trajectory and disposition and contribute to quality assurance data for pediatric transport programs. The objective of this study was to ascertain the breadth of severity of illness scoring tool application among North Ame...

Introduction Pediatric complex chronic care patients present unique challenges regarding healthcare provision: complex medical regimes, complicated family/provider dynamics, and multiple healthcare teams that can result in inconsistent care. This study examined subspecialty providers’ perspectives regarding pediatric complex chronic care patients a...

Objectives: The objective of this study was to evaluate serial Transport Risk Assessment in Pediatrics (TRAP) scoring during pediatric critical care transport as a potential measure for specialized pediatric transport teams (PTTs). Methods: This was a retrospective study with a provincial PTT from a tertiary hospital pediatric intensive care unit....

Continuous renal replacement therapy (CRRT) has become a pillar of care in pediatric intensive care units (PICUs) over the past few decades. Quality indicators (QIs) have been evaluated that reflect safe and accountable CRRT. However, there is a paucity of data on outcomes and QIs in smaller-volume CRRT programming. The purpose of this retrospectiv...

Background: As the majority of severe pediatric traumatic brain injuries (TBI) are received and managed in the emergency department (ED), the ED trauma center is vital to optimizing management. This study aimed to evaluate current management guidelines, and to recognize other high-risk components of TBI management.

Objectives: According to the World Health Organization (WHO), an early and consistent international and national response is needed to control a pandemic’s spread. In this analysis, we evaluate the coordination of Canada’s early response to the coronavirus (COVID-19) pandemic in terms of public health interventions implemented in each provinces and...

The World Brain Death Project clarified many aspects of the diagnosis of brain death/death by neurologic criteria. Clearer descriptions than previously published were presented concerning the etiology, prerequisites, minimum clinical criteria, apnea testing targets, and indications for ancillary testing. Nevertheless, there remained many epistemic...

Acute medical management of traumatic brain injury (TBI) can be challenging outside of the resuscitation bay, specifically while obtaining a computed tomography (CT) scan of the brain. We sought out to determine the management practices of Canadian traumatologists for pediatric patients with severe TBI requiring CT in the emergency department (ED)....

Introduction: Recommendations for children with severe altered states of consciousness does not include ketogenic nutrition. The purpose of this study was to evaluate short-term quality control outcomes for a ketogenic diet in this population, document challenges, and guide next steps. Methods: We performed a 19-month descriptive cohort study that...

Objective The aim of this study was to evaluate if the presence of a physician in the neonatal transport team (NTT) affects transport-related outcomes and procedural success. Design Retrospective cohort study with propensity score matching. Setting Canadian national study. Patients Neonatal transports from nontertiary centres between January 201...

Objective: Timely detection of elevated intracranial pressure (ICP) in highrisk preterm infants may be critical to avoid permanent neurologic sequelae. Size of optic nerve sheath diameter (ONSD) is highly correlated with changes in ICP. Normal ultrasonographic ONSD values for preterm infants have been published. This study sought to compare these d...

Background: The 2014–2016 Ebola outbreak in West Africa recapitulated that nosocomial spread of Ebola virus could occur and that health care workers were at particular risk including notable cases in Europe and North America. These instances highlighted the need for centers to better prepare for potential Ebola virus cases; including understanding...

A country’s early pandemic response is critical for controlling the disease outbreak. During COVID-19, a number of southeast Asian countries utilized a centralized, coordinated, rapid and comprehensive approach that involved smart technology (“techno-driven”). In comparison, Canada’s approach appeared to be decentralized, uncoordinated, and slow, a...

Background Children with complex chronic conditions present unique challenges to the pediatric intensive care unit, including prolonged length of stay, complex medical regimens, and complicated family dynamics. Objectives To examine perspectives of pediatric intensive care unit health care providers regarding pedi- atric patients with complex chron...

Background: Photovoice is a qualitative research tool increasingly utilized in the healthcare field to understand the illness experience from the patient and caregiver perspective. This is the first study to evaluate photovoice in the context of amyotrophic lateral sclerosis (ALS). Objective: A patient and caregiver centered research tool was ut...

Background: As the majority of severe pediatric traumatic brain injuries (TBI) are received and managed in the emergency department (ED), the ED trauma center is vital to optimizing management. This study aimed to evaluate current management guidelines, and to recognize other high-risk components of TBI management. Methods: A retrospective chart r...

The recent report from the World Brain Death Project guides countries in the revision or development of brain death (BD) protocols. Through a robust collaborative effort, its objective appeared to address the extensive gap of international practices and perceptions of BD. However, the navigation of sensitive cultural differences about brain death c...

Background: As the majority of severe pediatric traumatic brain injuries (TBI) are received and managed in the emergency department (ED), the ED trauma center is vital to optimizing management. This study aimed to evaluate current management guidelines, and to recognize other high-risk components of TBI management. Methods: A retrospective chart r...

UNSTRUCTURED Canada’s COVID-19 response during its first 100 cases was compared to nations and jurisdictions that were affected by the Middle East Respiratory Syndrome and/or Severe Acute Respiratory Syndrome. Canada’s “human-driven” approach was decentralized and uncoordinated, while a number of Asian nations demonstrated “tech driven” approaches...

Objectives: The objective of this study was to evaluate serial Transport Risk Assessment in Pediatrics (TRAP) scoring during pediatric critical care transport as a potential measure for specialized pediatric transport teams (PTTs). Methods: This was a retrospective study with a provincial PTT from a tertiary hospital pediatric intensive care unit....

Background: To characterize pediatric patients supported with continuous positive airway pressure and bilevel positive airway pressure (CPAP/BiPAP) or high flow nasal cannula (HFNC) during interfacility transport (IFT). Methods: A retrospective study with a provincial pediatric transport team from a tertiary hospital pediatric intensive care unit....

Background: Diagnostic delay in amyotrophic lateral sclerosis (ALS) is common. In a recent Canadian study evaluating provincial differences in care, Saskatchewan had the longest delay at 27 months. Since Saskatchewan has a large rural population, this study sought to determine whether geographically determined access to a neurologist at tertiary c...

During the first week of life, a sudden deterioration in a newborn commonly includes investigations to rule out infections, lung pathologies, cardiac lesions, neurological insults, metabolic disorders or gastrointestinal emergencies. It is unusual, however, to consider malignancy as the primary causative factor. In this case report, we describe a r...

The diagnosis of brain death (BD †) is legally and medically accepted. Recently, several high-profile cases have led to discussions regarding the integrity of current criteria, and many physiologic problems have been identified to support the necessity for their reevaluation. These include a global variability of the criteria, the suggestion of a c...

Background: There are currently limited data for the use of specific antiviral therapies for the treatment of Ebola virus disease (EVD). While there is anecdotal evidence that supportive care may be effective, there is a paucity of direct experimental data to demonstrate a role for supportive care in EVD. We studied the impact of ICU-level support...

Please note that four authors (Logan Banadyga, Alixandra Albietz, Brad Pickering, and Gary Wong) have been erroneously omitted from the author list in the published original article [1].

Introduction: Improving communication between all providers involved with rural trauma and urgent care patients may be beneficial. In our proof of concept study, we examine the potential of an open architecture and flexible smart phone system, utilizing an affordable, off-the-shelf and secure application called Wickr. Methods: Two patient scenario...

Titrating ventilator settings to minimize pulmonary arterial pressures and optimize both ventilation and oxygen delivery can be challenging following cardiac arrest. Erroneous ventilator adjustments can lead to unnecessary strain on the right ventricle that may be particularly vulnerable during the acute recovery. We report a child with fulminant m...

Background: Delivery of noninvasive ventilation commonly occurs in the pediatric intensive care unit (PICU). With the advent of high flow nasal cannula (HFNC), patients with respiratory distress may be rescued on the ward without a PICU admission. We evaluated our ward HFNC algorithm to determine its safety profile and independent predictors for no...

Pediatric ARDS continues to be a management challenge in the ICU with prolonged hospitalizations and high mortality. Thromboembolic pulmonary embolism and in situ pulmonary artery thrombosis might represent underappreciated thrombotic processes for a subset of these patients. Although well described in the adult literature, descriptions of pulmonar...

Indigenous children living in rural and remote Canada have limited access to paediatric specialty services. As such, they experience a high rate of medical transport out of their home communities. The Truth and Reconciliation Commission’s calls to action has prioritized access to health care that is culturally safe and community directed. Remote pr...

Purpose: The purpose of this study was to determine the opinions and reported nutrition practices of Canadian Registered Dietitians (RDs) with regard to feeding patients with severe sepsis. Methods: In 2017, surveys were sent to 112 eligible Canadian RDs in 10 provinces who were practicing in an intensive care environment. The survey included embe...

Purpose: Multidisciplinary clinics (MDC) have become the standard of care for management of amyotrophic lateral sclerosis (ALS). No studies however, have captured patients' perspectives during a transition to ALS MDCs. Recently, an ALS MDC emerged from a single-physician clinic in Saskatoon, Canada, providing patients with a unique exposure to two...

Objective: Determining care disposition for pediatric patients during interfacility transport is often challenging. Severity of illness scoring can assist with this process. The purpose of this retrospective study was to compare currently utilized scoring systems and their ability to reliably match pediatric transport patients' severity of illness...

Mechanical ventilation strategies in pediatric acute respiratory distress syndrome (pARDS) continue to advance. Optimizing positive end expiratory pressure (PEEP) and ventilation to recruitable lung can be difficult to clinically achieve. This is in part, due to disease evolution, unpredictable changes in lung compliance, and the inability to asses...

Objective: Determining pediatric severity of ill- ness in referring centers may be useful for establishing appropriate patient disposition and interfacility trans- port. For this retrospective review, the authors evalu- ated the Canadian Paediatric Triage and Acuity Scale (PaedCTAS) tool in regards to individual patient dis- position and outcomes....

This report summarizes a case of a 4-year-old girl with poststreptococcal glomerulonephritis and diffuse alveolar hemorrhage, an atypical presentation in this age group and type of vasculitic disease. We propose that her rapid improvement in clinical status was due to her treatment, continuous renal replacement therapy (CRRT). This mechanism would...

Objective: This retrospective study reviewed hospital and intensive care unit (ICU) admissions for patients with amyotrophic lateral sclerosis (ALS) in Saskatoon, Canada, between 2005 and 2017. The purpose was to understand hospital utilization and admission patterns for patients with ALS in the absence of coordinated multidisciplinary care. Meth...

Introduction: Mobile emergency simulation offers innovative continuing medical educational support to regions that may lack access to such opportunities. Furthermore, satisfaction is a critical element for active learning. Together, the authors evaluated Canadian rural healthcare providers’ satisfaction from high fidelity emergency simulation train...

Objective Stroke guideline compliance of rural Canadian prehospital emergency medical services (EMS) care in acute stroke is unknown. In this quality assurance study, we sought to compare rural and urban care by prehospital EMS evaluation/management indicators from patients assessed at an urban Canadian stroke center. Materials and Methods One hun...

Critical care needs have been rising in recent decades as populations age and comorbidities increase. Sepsis-related admissions to critical care contribute up to 50% of volume and septic shock carries a 35–54% fatality rate. Improvements in sepsis-related care and mortality would have a significant impact of a resource-intensive area of health care...

Objective: Acute kidney injury occurs early in PICU admission and increases risks for poor outcomes. We evaluated the feasibility of a multicenter acute kidney injury biomarker urine collection protocol and measured diagnostic characteristics of urine neutrophil gelatinase-associated lipocalin, interleukin-18, and liver fatty acid binding protein...

A patient who has been declared brain dead is considered to be both legally and clinically dead. However, we report 2 pediatric cases in which the patients demonstrated clinical signs of brain stem function that are not recognized or tested in current Canadian or US guidelines.

Objective: Intracranial hypertension is an infrequent but serious acute complication of pediatric diabetic ketoacidosis (DKA). Subclinical elevations of intracranial pressures however, may be more common, and can be indirectly evaluated with ultrasonography of the optic nerve sheath diameter (ONSD). In this pilot study, we report serial data on ON...

Background: Ultrasound measurement of optic nerve sheath diameter (ONSD) appears to be a promising, rapid, non-invasive bedside tool for identification of elevated intra-cranial pressure. With improvements in ultrasound technology, machines are becoming smaller; however, it is unclear if these ultra-portable handheld units have the resolution to ma...

Objectives: Pre-trauma center care is a critical component in severe pediatric traumatic brain injury (TBI). For geographically large trauma catchment areas, optimizing increased intracranial pressure (ICP) management may potentially improve outcomes. This retrospective study examined ICP management in nontrauma centers and during interfacility tr...

Objectives: Subclinical cerebral edema has been reported in pediatric patients with type 1 diabetes and diabetic ketoacidosis (DKA) through magnetic resonance imaging. Ultrasonography of the optic nerve sheath diameter (ONSD) has been used to evaluate intracranial pressure. The objective of this study was to examine the utility of ONSD ultrasonogr...

This prospective case series documented hypoxemia and potential complications associated with apneic oxygenation in critically ill pediatric patients during rapid sequence intubation. Forty-four patients received apneic oxygenation via nasal cannula at rates of 5, 10, and 15 L/min for ages <4, 4 to 12, and 12 to 18 years, respectively. Pre- and pos...

Purpose of review: Approximately one in five children admitted to a pediatric ICU have a new central nervous system injury or a neurological complication of their critical illness. The spectrum of neurologic insults in children is diverse and clinical practice is largely empirical, as few randomized, controlled trials have been reported. This lack...

Background: Ventilation monitoring practice for intubated pediatric patients with severe traumatic brain injury (TBI) during interfacility transport (IFT) has not been well documented. We describe the difference of practices in ventilation monitoring during IFT from the perspective of a level I pediatric trauma center with an enormous catchment ar...

Objective: Pediatric traumatic brain injury (TBI) guidelines should direct patient management. This retrospective study compared ventilation monitoring practices of nontrauma center (NTC) personnel and air medical crews (AMCs) in pediatric patients with severe TBI at NTCs after endotracheal intubation. Methods: Pediatric patient charts for level...

There is no consensus on how effective patient handover in the pediatric intensive care unit should occur. Complex patients with rapidly moving clinical trajectories are difficult to summarize and comprehend. We aimed to redesign our current handover instrument to encourage higher-level cognitive interactions, questioning and understanding for pedi...

Abstract Objective: Hypocarbia during the first 12 h of life is associated with mortality and disability in neonatal hypoxic ischemic encephalopathy (HIE). Notable variation in arterial carbon dioxide tension (PaCO2) during the first 4 d of life is related to severe intraventricular hemorrhages in preterm infants. We examined the association betwee...

Objectives: It remains uncertain whether nonconvulsive seizures and nonconvulsive status epilepticus in pediatric traumatic brain injury are deleterious to the brain and/or impact the recovery from injury. Consequently, optimal electroencephalographic surveillance and management is unknown. We aimed to determine specialists' opinion regarding the...

Key Clinical Message Diagnostic criteria for hemophagocytic lymphohistiocytosis should be reviewed early in critically ill patients with toxic epidermal necrolysis, multisystem dysfunction, and a deteriorating clinical trajectory.

Neurologic complications of pediatric acute liver failure (ALF) are a major determinant of outcome. Management of these complications, including increased intracranial pressure (ICP) is largely supportive. Although hypothermia is an effective treatment for perinatal asphyxia and is used to reduce ICP following traumatic brain injury, it has not bee...

OBJECTIVE:: To describe whether Berlin Heart EXCOR Pediatric pump changes in the ICU are associated with infection, hemodynamic and ventilatory instability, and neurologic injury. DESIGN:: Retrospective, descriptive chart review. SETTING:: Pediatric intensive care unit in a quaternary care childrens hospital. PATIENTS:: Eight patients were supporte...

To examine survival and neurodevelopmental outcomes in neonates having post-operative cardiopulmonary resuscitation (CPR). This inception cohort study included all neonates (6 weeks old or less) who received postoperative CPR (Group 1) after cardiac surgery from 1996 to 2005, matched for heart defect, year of surgery, chromosomal abnormality, and s...

The present study examined the effect of 14 days of exposure to microgravity during the Spacelab Life Sciences-2 (SLS-2) space shuttle mission on the myosin heavy-chain (MHC) content, fibre size and type distributions and metabolic properties of rat diaphragm. Five adult male Sprague-Dawley rats were exposed to 14 days of microgravity (SF, spacefli...

The purpose of this study was to compare the cardiorespiratory adaptations to 12 weeks of endurance cycle training performed using intensities based on the ventilatory equivalents for oxygen and carbon dioxide. Forty-four untrained subjects (9 men and 35 women) were randomly assigned into two groups: a low-intensity training (LIT) group (n = 21) th...

Slow-to-fast fibre transitions and fibre atrophy are typical ultrastructure adaptations of especially slow muscles with short-term (i.e. 4-22 days) exposure to microgravity. However, the effects of spaceflight on respiratory muscles have not been established. The purpose of this study was to quantitatively identify potential fibre transitions and m...