Karen Choong

McMaster University | McMaster · Department of Pediatrics

Objectives: To develop and implement a tool to improve daily patient goal setting, team collaboration and communication. Design: Quality improvement implementation project. Setting: Tertiary-level PICU. Patients: Inpatient children less than 18 years old requiring ICU level care. Intervention: A "Glass Door" daily goals communication tool...

OBJECTIVES: Children with chronic critical illness (CCI) are hypothesized to be a high-risk patient population with persistent multiple organ dysfunction and functional morbidities resulting in recurrent or prolonged critical care; however, it is unclear how CCI should be defined. The aim of this scoping review was to evaluate the existing literatu...

Objectives: Children with chronic critical illness (CCI) are hypothesized to be a high-risk patient population with persistent multiple organ dysfunction and functional morbidities resulting in recurrent or prolonged critical care; however, it is unclear how CCI should be defined. The aim of this scoping review was to evaluate the existing literat...

The aim of this study was to understand the lived experiences of delirium in critically ill children. We conducted phenomenological qualitative interviews with critically ill pediatric survivors aged 0 to 18 years who had experienced delirium, along with their family caregivers and health care providers, from pediatric intensive care units in two t...

Objectives: To identify a PICU Core Outcome Measurement Set (PICU COMS), a set of measures that can be used to evaluate the PICU Core Outcome Set (PICU COS) domains in PICU patients and their families. Design: A modified Delphi consensus process. Setting: Four webinars attended by PICU physicians and nurses, pediatric surgeons, rehabilitation...

Vitamin D is an important fat-soluble prohormone with pleiotropic effects on human health, such as immunomodulation of the innate and adaptive immune system. There is an unmet clinical need for a rapid screening platform for 25-hydroxyvitamin D (25OH-D) determination without chromatographic separation that offers better precision and accuracy than...

Importance The COVID-19 pandemic created the need for rapid and urgent guidance for clinicians to manage COVID-19 among patients and prevent transmission. Objective To appraise the quality of clinical practice guidelines (CPGs) using the National Academy of Medicine (NAM) criteria. Evidence Review A search of MEDLINE, EMBASE, and the Cochrane Cen...

Background: Delirium, bed immobilization, and heavy sedation are among the major contributors of pediatric post-intensive care syndrome. Recently, the Society of Critical Care Medicine has proposed the implementation of daily interventions to minimize the incidence of these morbidities and optimize children functional outcomes and quality of life....

Background Improvements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at a significant risk of recurrent and prolonged critical illne...

Objectives: To evaluate current international practice in PICUs regarding components of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Sedation, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Engagement/Empowerment" ("ABCDEF") bundle. Design: Online surveys conducted between 2017 and 2019. S...

BACKGROUND Improvements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at a significant risk of recurrent and prolonged critical illne...

The identification of children with traumatic brain injury (TBI) who are at risk of death or poor global neurological functional outcome remains a challenge. Magnetic resonance imaging (MRI) can detect several brain pathologies that are a result of TBI, however, the types and locations of pathology that are the most predictive remain to be determin...

Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and soc...

Objective: To synthesize the available evidence examining the efficacy and safety of levetiracetam compared with phenytoin or fosphenytoin in benzodiazepine-refractory pediatric status epilepticus. Data sources: We searched (from inception until April 27, 2020) Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Tri...

The COVID-19 pandemic has placed surgical and medical facemask PPE in high demand. Their use spans a variety of healthcare settings and many hospitals have implemented universal masking policies. Furthermore, the emergence of COVID-19 variants with greater transmissibility and infectivity has led some countries to recommend or mandate widespread pu...

Due to improvements in the delivery of intensive care, survival of even the most critically ill of children has increased, leading to a growing proportion of children with chronic and/or complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at significant risk of recurrent critical illness and persistent...

Purpose: This study evaluated the sensitivity of nonconvulsive seizure detection by non-neurophysiologist physicians and nurses using a panel of quantitative EEG (QEEG) trends in the setting of a pediatric intensive care unit. Methods: Forty-five 1-hour QEEG epochs were obtained retrospectively from 10 patients admitted to the McMaster Children'...

Objectives: To evaluate mobilization practices, barriers, and mobility-related adverse events in Canadian PICUs. Design: National 2-day point prevalence study. Setting: Thirteen PICUs across Canada. Patients: Children with a minimum 72-hour PICU length of stay on the allocated study day. Interventions: None. Measurements and main results:...

Abstract Background Pediatric critical care is often accompanied by a variety of functional impairments. Preliminary evidence suggests children’s participation in home activities has a slow trajectory post-pediatric intensive care unit (PICU) discharge, however, additional and more granular knowledge on specific problematic activities is needed to...

Background Outcomes in pediatric critical care research are typically selected by the researcher. Objectives (1) To identify outcomes prioritized by patients and their families following a critical illness and (2) to determine the overlap between patient-centered and researcher-selected study outcomes. Methods An exploratory descriptive qualitati...

Severe acute respiratory syndrome coronavirus 2 is a novel cause of organ dysfunction in children, presenting as either coronavirus disease 2019 with sepsis and/or respiratory failure or a hyperinflammatory shock syndrome. Clinicians must now consider these diagnoses when evaluating children for septic shock and sepsis-associated organ dysfunction....

Background The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse. Aim Identify and synthesize data from original research evaluating interventions to decontaminat...

During the COVID-19 pandemic, a shortage of personal protective equipment (PPE), namely surgical masks, N95 masks, and gowns, has been experienced by some hospitals and could be expected in others due to a rapidly increased need. The Centres for Disease Control and Prevention (CDC) specifically recommends N95 filtering facepiece respirators (FFRs)...

Background: The high demand for personal protective equipment (PPE) during the novel coronavirus outbreak has created global shortages and prompted the need to develop strategies to conserve supply. Surgical mask PPE have a broad application of use in a pandemic setting, but little is known regarding decontamination interventions to allow for their...

As the global spread of novel coronavirus (SARS-CoV-2) escalates, the high demand for personal protective equipment (PPE) has created shortages of this equipment globally and prompted the need to ensure appropriate stewardship and develop strategies to conserve supply. Surgical masks have broad and commonplace applications as PPE, including in the...

Purpose: To describe and evaluate physical rehabilitation research in critically ill children, including physical rehabilitation intervention reporting. Methods: We searched five electronic databases to 31 December 2018 for prospective physical rehabilitation studies conducted in pediatric intensive care units (PICU). Screening was conducted indepe...

Objectives To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. Design A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public...

Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three pu...

In 2001, the Surviving Sepsis Campaign (SSC) began to develop evidence-based guidelines and recommendations for the resuscitation and management of patients with sepsis. With the 2016 edition, the Society of Critical Care Medicine and European Society of Intensive Care Medicine recommended a separate task force be dedicated to guideline formulation...

Date Presented 04/06/19 Trends in participation-focused strategies used by caregivers of critically ill children who did and did not receive PICU rehabilitation services were identified. Strategies were coded as child focused or to an environmental chapter of the ICF-CY. Caregivers can identify participation-focused strategies, but may benefit from...

Objectives: The primary objectives are to assess the most common type of caregiver strategy (remedial vs compensatory) reported for supporting their child's home participation after critical illness and identify themes in compensatory strategies described, with a secondary objective to describe themes in strategy use as reported by caregivers of c...

Objectives To evaluate intravenous (IV) fluid prescription practice patterns in critically ill children in the first 72 hours of pediatric intensive care unit (PICU) admission and to evaluate the incidence and predictors of hyperchloremic metabolic acidemia (HCMA) and the association between HCMA and adverse outcomes. Materials and Methods This ret...

An estimated 14.1 million patients survive sepsis each year. Many survivors experience poor long-term outcomes, including new or worsened neuropsychological impairment; physical disability; and vulnerability to further health deterioration, including recurrent infection, cardiovascular events, and acute renal failure. However, clinical trials and g...

Cerebrospinal fluid sample collection and analysis is imperative to better elucidate central nervous system injury and disease in children. Sample collection methods are varied and carry with them certain ethical and biologic considerations, complications, and contraindications. Establishing best practices for sample collection, processing, storage...

OBJECTIVES: Characterize current practices for PICU-based rehabilitation, and physician perceptions and attitudes, barriers, resources, and outcome assessment in contemporary PICU settings. DESIGN: International, self-administered, quantitative, cross-sectional survey. SETTING: Online survey distributed from March 2017 to April 2017. PATIENTS OR...

OBJECTIVE(s): Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over six months post-PICU discharge. DESIGN: Sub-study of a data from Wee-Cover, a prospective cohort study. SETTING: Two PICU sites. PARTICIPANTS: Caregi...

Objective To characterize how early mobilization is defined in the published literature and describe the evidence on safety and efficacy on early mobilization in critically ill children. Study design Systematic search of randomized and nonrandomized studies assessing early mobilization-based physical therapy in critically ill children under 18 yea...

Background: The aim of the study was to examine the relationship between serum total cortisol (TC) and free cortisol (FC) levels in children with septic shock and the relationship of these levels with baseline illness severity. Methods: A sub-study of a randomized controlled trial (RCT) of hydrocortisone vs. placebo in pediatric septic shock con...

Objectives: To evaluate functional outcomes and evaluate predictors of an unfavorable functional outcome in children following a critical illness. Design: Prospective observational longitudinal cohort study. Setting: Two tertiary care, Canadian PICUs: McMaster Children's Hospital and London Health Sciences. Patients: Children 12 months to 17...

Objectives: To identify, in addition to survival, preferred outcome measures of PICU family care providers and PICU healthcare professionals for interventional trials enrolling critically ill children, and to describe general attitudes of family care providers and healthcare professionals regarding research in the PICU. Design: Cross-sectional s...

Children with traumatic brain injury are reported to have deficits in performance monitoring, but the mechanisms underlying these deficits are not well understood. Four performance monitoring hypotheses were explored by comparing how 28 children with traumatic brain injury and 28 typically developing controls (matched by age and sex) performed on t...

Rationale: Engagement promotes and supports the active participation of patients and families in health care and research to strengthen their influence on decision-making. We sought to characterize how citizens wish to be engaged in care and research in the intensive care unit (ICU). Methods: Interviewers administered questionnaires to visitors...

Objectives: To determine the feasibility of conducting a full trial evaluating the efficacy of early mobilization using in-bed cycling as an adjunct to physiotherapy, on functional outcomes in critically ill children. Design: Single center, pilot, randomized controlled trial. Setting: Twelve-bed tertiary care, medical-surgical PICU at McMaster...

p> ABSTRACT Background: Stress ulcer prophylaxis is commonly used in pediatric critical care, to prevent upper gastrointestinal bleeding. The most frequently used agents are histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). The risk–benefit ratio for stress ulcer prophylaxis is uncertain, because data from randomized cli...

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Objectives: To describe the use of deferred and prior informed consent models in the context of a low additional risk to standard of care, placebo-controlled randomized controlled trial of corticosteroids in pediatric septic shock. Design: An observational substudy of consent processes in a randomized controlled trial of hydrocortisone versus pl...

Background Children with traumatic brain injury (TBI) are frequently at risk of long-term impairments of attention and executive functioning but these problems are difficult to predict. Although deficits have been reported to vary with injury severity, age at injury and sex, prognostication of outcome remains imperfect at a patient-specific level....

Objectives: The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock." Design: Society of Cri...

Background Despite sparse pediatric data on effectiveness, the majority of critically ill children receive medications to prevent gastrointestinal (GI) bleeding. Stress ulcer prophylaxis may have unintended consequences—increasing the risk of nosocomial infections—which may be more serious and common than the bleeding which these drugs are prescrib...

Objective: To determine the feasibility of conducting a randomized controlled trial of corticosteroids in pediatric septic shock. Design: Randomized, double-blind, placebo controlled trial. Setting: Seven tertiary level PICUs in Canada. Patients: Children newborn to 17 years old inclusive with suspected septic shock. Intervention: Administ...

Buy Article Permissions and Reprints Abstract Prolonged immobility is associated with significant short- and long-term morbidities in critically ill adults and children. The majority of critically ill children remain immobilized while in the pediatric intensive care unit (PICU) due to limited awareness of associated morbidities, lack of comfort an...

Objectives: High-quality, adequately powered, randomized controlled trials are needed to inform the care of critically ill children. Unfortunately, such evidence is not always available. Our objective was to identify barriers and facilitators of conducting high-quality randomized controlled trials in pediatric critical care, from the perspective o...

Objective: To evaluate all published pediatric randomized controlled trials of patients with septic shock from any cause to examine the outcome measures used, the strengths and limitations of these measurements and whether the trial outcomes met feasibility criteria. Data sources: We used a previously published database of pediatric critical car...

Background Delirium is a syndrome characterized by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk, and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged duration of ICU and hospital length of stay, and increased mortality. Melatonin...

Background Current pediatric septic shock resuscitation guidelines from the American College of Critical Care Medicine focus on the early and goal-directed administration of intravascular fluid followed by vasoactive medication infusions for persistent and fluid-refractory shock. However, accumulating adult and pediatric data suggest that excessive...

Objectives: Data concerning outcomes of Canadian patients with diabetic foot ulcers (DFUs) are limited. The objectives of this study were to evaluate the healing rates and identify the predictors of poor outcomes following advanced wound care in patients presenting with DFUs. Methods: We conducted retrospective cohort study of adult patients who...