Patricia S Fontela

McGill University | McGill · Department of Pediatrics

Background The rate of vitamin D deficiency (VDD) in critically ill children worldwide has been estimated at 50%. These children are at risk of multiple organ dysfunction, chronic morbidity, and decreased health related quality of life (HRQL). Pediatric and adult ICU clinical trials suggest that VDD is associated with worse clinical outcomes, altho...

CONTEXT PICUs across Canada restricted family presence (RFP) in response to the COVID-19 pandemic from allowing two or more family members to often only one family member at the bedside. The objective of this study was to describe the experiences and impact of RFP on families of critically ill children to inform future policy and practice. HYPOTHE...

Objective To describe antibiotic treatment durations that pediatric infectious diseases (ID) and critical care clinicians usually recommend for bloodstream infections in critically ill children. Design Anonymous, online practice survey using five common pediatric-based case scenarios of bloodstream infections. Setting Pediatric intensive care uni...

Objectives We used modified contingent valuation methodology to determine how noninferiority margin sizes influence clinicians’ willingness to accept clinical trial results that compare mortality in critically ill children. Methods We surveyed pediatric infectious diseases and critical care clinicians in Canada, Australia, and New Zealand and rand...

Background Bloodstream infections (BSIs) cause significant morbidity and mortality in critically ill children but treatment duration is understudied. We describe the durations of antimicrobial treatment that critically ill children receive and explore factors associated with treatment duration. Methods We conducted a retrospective observational co...

The need for child-specific knowledge acquisition through high-quality clinical trials is clear. Due to differences in drug metabolism or pathophysiology, children may respond differently than adults to various therapies, even when used to treat the same disease.¹ This is reflected in the stated need from regulators, such as the US Food and Drug Ad...

Rationale: Understanding the magnitude of moral distress and its associations may point to solutions. Objective: To understand the magnitude of moral distress and other measures of wellness in Canadian critical care physicians, to determine any associations among these measures, and to identify potentially modifiable factors. Methods: This was...

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:...

To the Editor Neonatal sepsis remains a common diagnostic challenge. The diagnostic criterion standard is a microbiologically confirmed infection often requiring 24 to 48 hours; clinicians seek biomarkers to aid in rapid and accurate diagnosis. The meta-analysis by Brown et al¹ evaluated the test characteristics of C-reactive protein (CRP) for late...

Objectives: We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries. Design: Cross-sectional survey. Setting: PICUs in Canada, the United States, France, Italy, Saudi Arabia, Japan, Thailand, and Brazil....

Objectives: Children with congenital heart disease are at high risk for developmental sequelae. Most studies focus on preoperative and intraoperative predictors of developmental impairment, with less attention to the postoperative period. The relationship between patient-related factors specific to the postoperative course in the PICU following ca...

Background: Nasal continuous positive airway pressure (NCPAP) is a well-studied treatment for respiratory problems in preterm infants. However, the best strategy for NCPAP weaning is unknown. Objective: We aimed to compare the success of progressive pressure wean versus sudden wean for discontinuation of NCPAP in preterm infants. Methods: We c...

Aim: We evaluated the influence of early fluid overload on critically ill children admitted to a pediatric intensive care unit by examining mechanical ventilation (MV), mortality, length of stay and renal replacement therapy. Methods: This retrospective cohort study covered January 2015 to December 2016 and focused on all episodes of MV support...

Objectives This study aims to assess the impact of a quality improvement initiative to increase assessments of pain, agitation, and iatrogenic withdrawal syndrome, on the use of sedative and analgesic medication in a pediatric intensive care unit. Design and setting This is a retrospective pre‐ and post, observational, quality improvement study co...

One-fourth of patients with bronchiolitis seen in US emergency departments between 2007 and 2015 received antibiotics; 70% of them had no documented bacterial coinfection. Macrolides were prescribed in 38% of the cases. Antibiotic use did not decrease after national recommendations against routine prescribing. Efforts are needed to reduce unnecessa...

Background and objectives C-reactive protein (CRP) has been proposed to guide the use of antibiotics. However, study results are controversial regarding the benefits of such a strategy. We synthesised the evidence of CRP-based algorithms on antibiotic treatment initiation and on antibiotic treatment duration in adults, children and neonates, as wel...

We performed a molecular and epidemiologic study of a healthcare-associated rhinovirus outbreak to better understand transmission in neonatal intensive care settings. Sequencing of the 7 outbreak strains revealed 4 distinct clades, indicating multiple sources. A single clade infected 3 patients in adjacent rooms, suggesting horizontal transmission....

Purpose of review: We aim to review recent literature about the use of biomarkers to guide the initiation and duration of antibiotic treatments for suspected bacterial infections. Recent findings: Several good quality meta-analyses show that procalcitonin can be safely used to guide antibiotic-related decisions, especially for respiratory infect...

Background: Prolonged use of indwelling catheters is associated with hospital-acquired urinary tract infections (UTIs). Literature is scarce about the factors influencing urinary catheter removal and maintenance in children. This study aims to describe the determinants of urinary catheter removal in pediatric intensive care unit (PICU) patients....

Objective: To describe management practices and the factors guiding admission and treatment decisions for viral bronchiolitis across Canadian pediatric intensive care units (PICUs). Design: Cross-sectional survey. Setting: Canadian PICUs. Subjects: Pediatric intensivists. Measurements and main results: A survey using two case scenarios (no...

Objectives: To evaluate in-situ simulation to prepare a PICU to move to a new, redesigned unit. Methods: The study setting is an academic PICU. This is a cross-sectional study using in-situ simulations of common PICU admissions. Postsimulation, participants completed a survey comparing the perception of preparedness pre- and postsimulation (via...

Objectives: To describe the criteria that currently guide empiric antibiotic treatment in children admitted to Canadian PICUs. Design: Cross-sectional survey. Setting: Canadian PICUs. Subjects: Pediatric intensivists and pediatric infectious diseases specialists. Interventions: None. Measurements and main results: We used focus groups an...

BACKGROUND: Using different indicators and definitions, the present study aimed to describe population antimicrobial use, as well as prevalence and incidence of clinically relevant antimicrobial resistances found in respiratory cultures performed in intensive care unit (ICU) patients. Results obtained with the various methodologies were then compar...

Objective Procalcitonin (PCT) has been increasingly used in the critical care setting to determine the presence of bacterial infection and also to guide antibiotic therapy. We reviewed PCT's physiologic role, as well as its clinical utility for the management of pediatric critically ill patients. Findings PCT is a precursor of the hormone calcitoni...

Although commonly used in pediatric cardiopulmonary bypass (CPB) optimal dose and timing of steroid administration is unclear. We hypothesized that early administration of a commonly used dose of methylprednisolone given the evening before surgery (ultra-early) would be more effective in decreasing CPB-related inflammatory response than when given...

Objective: The optimal way to measure antimicrobial use in hospital populations, as a complement to surveillance of resistance is still unclear. Using respiratory isolates and antimicrobial prescriptions of nine intensive care units (ICUs), this study aimed to identify the indicator of antimicrobial use that predicted prevalence and incidence rate...

Standard values used in the computation of defined daily doses (DDD) and recommended daily doses RDD). (PDF)

Most accurate, second most accurate and least accurate indicators in predicting prevalence of antimicrobial resistance, for different scenarios, with their regression link and their mean absolute error, stratified per ICU type as adjusted for in regression models. (PDF)

Most accurate, second most accurate and least accurate indicators in predicting incidence rates of antimicrobial resistance, for different scenarios, with their regression link and their mean absolute error, stratified per ICU type as adjusted for in regression models. (PDF)

Minimal dataset. (XLSX)

Methodology followed to identify the most accurate, the second most accurate and the least accurate indicators, in predicting prevalence of carbapenem-resistant Pseudomonas sp. in nine intensive care units. DDD: defined daily doses; ICU: intensive care unit; MAE: mean absolute error; RDD: recommended daily doses. (TIF)

We describe how admissions/discharges/transfers datasets were carefully reviewed for the computation of patient days and admissions used to monitor resistance and antimicrobial use in 9 intensive care units. A visual inspection of datasets and comparisons with other data sources improved accuracy, completeness, and consistency of computations. Copy...

Background: Indicators of antimicrobial (AM) use have been described, but the optimal indicator for predicting AM resistance in hospital settings, especially when including pediatric populations, is unknown. This study compared the accuracy of 15 different AM use indicators in the prediction of resistance, in 9 intensive care units (ICUs). Method...

Background: Surveillance and control of hospital antimicrobial (AM) are intended to limit AM resistance. Using 10 different indicators for AM monitoring, we aimed to measure AM use in nine intensive care units in Montral. Methods: AM prescriptions for all patients admitted to participating ICUs (3 neonatal, 2 pediatric, 4 adult) between April 200...

Although commonly used in pediatric cardiopulmonary bypass (CPB) optimal dose and timing of steroid administration is unclear. We hypothesized that early administration of a commonly used dose of methylprednisolone given the evening before surgery (ultra-early) would be more effective in decreasing CPB-related inflammatory response than when given...

The optimal measure to use for surveillance of antimicrobial usage in hospital settings, especially when including paediatric populations, is unknown. This systematic review of literature aims to list, define and compare existing measures of antimicrobial use that have been applied in settings that included paediatric inpatients, to complement surv...

The Quebec central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) Surveillance Program saw a decrease in CLABSI rates in most ICUs. Given the surveillance trends observed in recent years, we aimed to determine what preventive measures have been implemented, if compliance to measures was monitored and its impact on CL...

Background: Little is known about the frequency of antimicrobial resistance in Qubec inpatients. Moreover, the scientific literature suggests various methods to define this resistance. Using different definitions, this study aimed to measure prevalence and incidence of resistance in 9 intensive care units (ICUs) from Montral. Methods: All patients...

To assess the impact of a written cognitive aid on expressed clinical reasoning and quantity and the accuracy of information transfer during resident doctor handover. This study was a randomised controlled trial in an academic paediatric intensive care unit (PICU) of 20 handover events (10 events per group) from residents in their first PICU rotati...

Background: The Quebec Institute of Public Health (INSPQ) launched, in 2003, a provincial surveillance program for CLABSIs (SPIN-BACC). Surveillance results are published annually and are used for benchmarking. Methods: A voluntary survey, using a validated questionnaire (construct, content, face validity, reliability), was sent to participating...

Several national and regional central line-associated bloodstream infections (CLABSI) surveillance programs do not require continuous hospital participation. We evaluated the effect of different hospital participation requirements on the validity of annual CLABSI incidence rate benchmarks for intensive care units (ICUs). We estimated the annual poo...

Simulation involving a national CLABSI surveillance program. (DOC)

Baseline patient acuity variables are insufficient to explain the observed variability in the withdrawal of life-sustaining therapies in severe traumatic brain injury. Hospital- and physician-based variability in end-of-life decision-making and prognostication are well known.1–3 Turgeon and colleagues attempt to draw similar conclusions in severe t...

The burden of central line-associated bloodstream infections (CLABSI) in Canadian intensive care units (ICUs) is not well established. The present study aimed to describe CLABSI epidemiology in Quebec ICUs during 2003-2009. The study population was a retrospective dynamic cohort of 58 ICUs that participated in the Surveillance Provinciale des Infec...

Continuous positive airway pressure (CPAP), used either alone or associated with heliox (CPAP-He), has become a popular therapeutic option for bronchiolitis. This systematic review assesses the impact of CPAP on endotracheal intubation, carbon dioxide pressure (PCO(2) ) and respiratory distress in patients with bronchiolitis. Systematic search incl...

In 2003, the Surveillance Provinciale des Infections Nosocomiales (SPIN) program was launched to gather data on incidence rates of central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) in the Province of Quebec. To improve the generalizability of SPIN benchmarks, in 2007 participation in SPIN became mandatory for a...

Emergency department (ED) presentation of pediatric pandemic H1N1 (pH1N1) infection is not well characterized. Our objective was to describe the clinical manifestations of pH1N1 in the pediatric ED. We also compared these characteristics to seasonal influenza A, and explored risk factors for pH1N1 hospitalization. We conducted a retrospective cohor...

Background: Catheter-related bloodstream infections (CR-BSI) are a major problem in intensive care units (ICUs). In 2003, the Institut National de Sant Publique du Qubec launched the Surveillance Provinciale des Infections Nosocomiales (SPIN) program -- a continuous surveillance program that aims to monitor ICU CR-BSI incidence and mortality rates....

Background: Catheter-related bloodstream infections (CR-BSI) are a major problem in intensive care units (ICUs). They are associated with high case-fatality proportion, prolonged hospital stays and increased costs. Despite their clinical and public health importance, little is known about the epidemiology of CR-BSI in Canada. In 2003, the Institu...

Poor methodological quality and reporting are known concerns with diagnostic accuracy studies. In 2003, the QUADAS tool and the STARD standards were published for evaluating the quality and improving the reporting of diagnostic studies, respectively. However, it is unclear whether these tools have been applied to diagnostic studies of infectious di...

Panton-Valentine Leukocidin (PVL) is an exotoxin produced by strains of Staphylococcus aureus (SA). Its importance as a virulence factor is controversial. We aim to further characterize the role of PVL in pediatric community-acquired SA infections. In a cohort study conducted from July to November 2006, we prospectively collected all strains of SA...

To report a case of posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis and to discuss its pathophysiology and management. Case report and literature review. Pediatric intensive care unit in a tertiary-care center. Twelve days after a motor vehicle accident causing a head injury and facial fr...

To study the possible change on mode of deaths, medical decision practices, and family participation on decisions for limiting life-sustaining treatments (L-LST) over a period of 13 yrs in three pediatric intensive care units (PICUs) located in southern Brazil. Methods: A cross-sectional study based on a retrospective chart review (1988 and 1998) a...

To describe the incidence of extubation failure and its associated risk factors among mechanically ventilated children. Prospective cohort study. Children who were mechanically ventilated for longer than 12 hrs were followed up to 48 hrs after extubation. Cases of upper airway obstruction, accidental extubation, tracheostomy, or death before extuba...

OBJETIVO: descrever o perfil de uso de analgésicos e sedativos em crianças submetidas à ventilação mecânica, internadas em uma UTI pediátrica de referência, em um período de 12 meses, avaliando o tempo de uso dessas drogas, as doses diárias utilizadas e a incidência de síndrome de abstinência. MÉTODOS: estudo de coorte prospectivo (abril de 2001 a...

To describe the pattern of analgesic and sedative infusions in children submitted to mechanical ventilation in a regional pediatric intensive care unit during a 12-month period. To compare the use of these drugs among clinical and surgical patients, as well evaluate the influence of the length of use on the average daily doses and on the incidence...