About
184
Publications
16,437
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
2,059
Citations
Citations since 2017
Introduction
Additional affiliations
July 2011 - present
July 2003 - present
Publications
Publications (184)
Background:
Over 50% of all critically ill children develop preventable intensive care unit-acquired morbidity. Early and progressive mobility is associated with improved outcomes in critically ill adults including shortened duration of mechanical ventilation and improved muscle strength. However, the clinical effectiveness of early and progressiv...
Objectives:
Pediatric delirium (PD) is a neuropsychiatric syndrome caused by a complex interplay between predisposing factors (e.g., age, cognitive impairment), acute illness, and environmental triggers. PD is associated with substantial morbidity and mortality. The objective of this study is to systematically review and evaluate factors associate...
Objectives:
To provide an updated review of the literature on nonpulmonary treatments for pediatric acute respiratory distress syndrome (PARDS) from the Second Pediatric Acute Lung Injury Consensus Conference.
Data sources:
MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).
Study selection:
Searches were limited to children wi...
Objectives:
We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed.
Design:
International consensus conference serie...
Background:
Greater mobility and activity among hospitalized patients has been linked to key outcomes, including decreased length of stay, increased odds of home discharge, and fewer hospital-acquired morbidities. Systematic approaches to increasing patient mobility and activity are needed to improve patient outcomes during and following hospitali...
Background
Children with congenital heart disease often have medical and surgical complexity and prolonged and complicated recovery time in the intensive care unit. Limited data are published describing sleep duration, timing and quality in this population.
Aim
To describe sleep patterns of children with congenital heart disease in the immediate p...
The Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network originated over 20 years ago to foster research to optimize the care of critically ill infants and children. Over this period, PALISI has seen two major evolutions: formalization of our network infrastructure and a broadening of our clinical research focus. First, the network...
Objective:
Admission to the PICU may result in substantial short- and long-term morbidity for survivors and their families. Engaging caregivers in discussion of prognosis is challenging for PICU clinicians. We sought to summarize the literature on prognostic, goals-of-care conversations (PGOCCs) in the PICU in order to establish current evidence-b...
The Pediatric Intensive Care Unit (PICU) provides lifesaving interventions to critically ill patients from infancy through adolescence and young adulthood. However, PICU care and its environment often disrupts circadian rhythm (CR) and sleep, which are imperative for healing and healthy growth and development in this vulnerable pediatric population...
Background:
Healthy sleep is an important component of childhood development. Changes in sleep architecture, including sleep stage composition, quantity, and quality from infancy to adolescence are a reflection of neurologic maturation. Hospital admission for acute illness introduces modifiable risk factors for sleep disruption that may negatively...
Purpose
Studies have shown that most critical events that occur in the post-anesthesia care unit (PACU), including cardiac arrests, are preventable and respiratory in origin. Admission to the PACU necessitates transfer of care from anesthesiology staff to PACU nurses. The aim of the study is to assess a) feasibility in implementing an in-situ curri...
Background:
Mobilization and acute rehabilitation are essential in the intensive care unit (ICU), with substantial evidence supporting their benefits. This study aimed to characterize ICU mobilization practices during the COVID-19 pandemic for patients with and without COVID-19.
Methods:
This was a secondary analysis of an international point pr...
Purpose
Intensive care unit (ICU) survivors suffer from physical weakness and challenges returning to daily life. With the importance of rehabilitating patients in the pediatric intensive care unit being increasingly recognized, we evaluated the prevalence of physical and occupational therapy (PT/OT)-provided rehabilitation and factors affecting it...
Plasma biomarkers associated with respiratory failure (RF) following hematopoietic cell transplantation (HCT) have not been identified. Therefore, we aimed to validate early (days 7 and 14 post-HCT) risk biomarkers for RF within the first 100 days post-HCT. Using tandem mass-spectrometry discovery, we compared plasma obtained at day 14 post-HCT fro...
Objectives:
Melatonin has been trialed with reported increasing use for sleep dysregulation and prevention of ICU delirium in critically ill adults; however, reports of use in hospitalized pediatric patients are limited. We anecdotally observed an increase in prescribing of melatonin in our tertiary care children's hospital and therefore aimed to...
Comfort of the critically unwell pediatric patient is paramount to ensuring good outcomes. Analgesia-based, multimodal sedative approaches are the foundation for comfort, whereby pain is addressed first and then sedation titrated to a predefined target based on the goals of care. Given the heterogeneity of patients within the pediatric critical car...
Background: Data regarding delivery of evidence-based care to critically ill patients in Intensive Care Units (ICU) during the COVID-19 pandemic is crucial but lacking. This study aimed to evaluate the implementation rate of the ABCDEF bundle, which is a collection of six evidence-based ICU care initiatives which are strongly recommended to be inco...
Background: Pulmonary and critical care societies, including the American Thoracic Society, the American College of Chest Physicians, and the Society of Critical Care Medicine have large memberships that gather at academic conference events, attracting thousands of attendees. Objective: With the growth of social media use among pulmonary and critic...
Background & aims
Nutrition therapy for Intensive Care Unit (ICU) patients involves complex decision-making, especially during the COVID-19 pandemic. We investigated the use of nutrition therapy in ICU patients with and without COVID-19 infections.
Methods
Nutrition therapy was evaluated during a world-wide one-day prevalence study focused on impl...
Often, pediatric intensive care environments are not conducive to healing the sick. Critically ill children experience disruptions in their circadian rhythms, which can contribute to delayed recovery and poor outcomes. We aim to test the hypothesis that children managed via RESTORE Resilience (R²), a nurse-implemented chronotherapeutic bundle, will...
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...
Endotracheal intubation is a life-saving procedure in critically ill pediatric patients and a foundational skill for critical care trainees. Multiple intubation attempts are associated with increased adverse events and increased morbidity and mortality. Thus, we aimed to determine patient and provider factors associated with first pass success of e...
Background The goal of this study was to determine if difficult airway risk factors were similar in children cared for by the difficult airway response team (DART) and those cared for by the rapid response team (RRT). Methods In this retrospective database analysis of prospectively collected data, we analyzed patient demographics, comorbidities, hi...
Purpose:
To determine interrater reliability and construct validity of the Activity Measure for Post-Acute Care (AM-PAC) Inpatient "6-clicks" Short Forms for children in acute care.
Methods:
Eight physical therapists (PTs) scored the AM-PAC Basic Mobility, 30-second walk test (30SWT), and Timed Up and Go (TUG) for 54 patients (4-17 years); 6 occ...
Objectives:
Patients in the pediatric cardiac ICU are frequently exposed to pharmacologic and environmental factors that predispose them to sleep disturbances and may increase the risk of delirium. In this pilot study, we sought to demonstrate the feasibility of actigraphy monitoring in pediatric cardiac ICU patients to investigate the association...
Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute...
Acute illness and hospitalization introduce several risk factors for sleep disruption in children that can negatively affect recovery and healing and potentially compromise long-term cognition and executive function. The hospital setting is not optimized for pediatric sleep promotion, and many of the pharmacologic interventions intended to promote...
Objectives:. To investigate implementation of evidence-based and supportive cares in ICUs, such as the ABCDEF, nutrition therapy, and ICU diary, for patients with coronavirus disease 2019 infection in ICUs and their association with ICU clinical practice and setting.
Design:. A worldwide, 2-day point prevalence study.
Setting:. The study was carrie...
Introduction
Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology pa...
As mortality improves in the pediatric intensive care unit (PICU), patients are surviving with significant functional deficits. Outcomes literature, mostly focused in the adult population, supports early mobility as an approach to mitigate the physical deficits incurred by ICU patients. Research has illustrated numerous benefits of early mobility,...
Despite evidence showing that sleep is integral for the health of children, research shows that children admitted to the pediatric intensive care unit do not get enough sleep during their stay in the hospital. This chapter explains sleep stages, common factors disrupting sleep, and solutions to resolve sleep disruption.
Objectives:
To identify staff-reported factors and perceptions that influenced implementation and sustainability of an early mobilization program (PICU Up!) in the PICU.
Design:
A qualitative study using semistructured phone interviews to characterize interprofessional staff perspectives of the PICU Up!
Program:
Following data saturation, them...
Hospitalized patients often experience unnecessary immobility and inactivity leading to direct harms and poor outcomes. Despite growing evidence that early and regular mobility and activity are safe and helpful for patients in the hospital, there remains substantial room for improvement in clinical practice. Key to improvement is establishing an in...
Since 2014, the Society of Critical Care Medicine has encouraged "live-tweeting" through the use of specific hashtags at each annual Critical Care Congress. We describe how the digital footprint of the Society of Critical Care Medicine Congress on Twitter has evolved at a time when social media use at conferences is becoming increasingly popular....
The goal of this article is to highlight the overlapping nature of symptoms of delirium and acquired brain injury (ABI) in children and similarities and differences in treatment, with a focus on literature supporting an adverse effect of antipsychotic medications on recovery from brain injury. An interdisciplinary approach to education regarding ov...
Objectives:
Many children with cancer have repeated and prolonged hospitalizations, and in-hospital sleep disruption may negatively affect outcomes. Our objective for this study was to characterize sleep quality and quantity in hospitalized children with cancer by using parental surveys and actigraphy, to evaluate the association between subjectiv...
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:...
Background
Although the number of patients with COVID-19 infection is increasing and concerns for their long-term disabilities are increasing, there is a lack of data about the delivery of the ABCDEF-bundle and supportive care in Intensive Care Units (ICUs). The aim of this study is to investigate the implementation of the ABCDEF-bundle and support...
The favourable safety profile and ubiquitous nature of melatonin has led to an increase in its use in various clinical settings in adults and children. We performed a systematic review of published studies on the use of melatonin for anaesthetic indications in paediatric patients. To identify relevant articles, PubMed, EMBASE, Cumulative Index to N...
Broader access to health care, preventive policies, and medical and technological advances have collectively contributed to very low rates of observed mortality from paediatric critical illness in high-income countries. However, increased survival has been paralleled by a substantial increase in children who leave the paediatric intensive care unit...
Background
Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe.
Methods
A 2-day, cross-sectional, multicentre po...
Background: The use of pro re nata (PRN) medication orders increases nursing flexibility and efficiency of bedside patient care. However, misuse and/or ambiguity of PRN medication orders may increase the propensity for medication errors. The Joint Commission (TJC) has Medication Management (MM) standards to mitigate such risks. We aimed to increase...
Objective:
To describe the impact of a strategy for international collaboration and rapid information dissemination on Twitter among the pediatric critical care community during a global pandemic.
Design:
Analysis of #PedsICU and coronavirus disease 2019 Twitter data in the Symplur Signals Database between February 1, 2020, and May 1, 2020.
Set...
