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Arch Dis Child. 2019 Apr;104(4):322-327. doi: 10.1136/archdischild-2017-314658. Epub 2018 Jun 2.

ABSTRACT

OBJECTIVE: We aimed to determine paediatric hospital preparedness for a mass casualty disaster involving children in both prehospital and hospital settings. The study findings will serve to generate recommendations, guidelines and training objectives.

DESIGN AND SETTING: The AMAVI-PED study is a cross-sectional survey. An electronic questionnaire was sent to French physicians with key roles in specialised paediatric acute care.

RESULTS: In total, 81% (26 of 32) of French University Hospitals were represented in the study. A disaster plan AMAVI with a specific paediatric emphasis was established in all the paediatric centres. In case of a mass casualty event, paediatric victims would be initially admitted to the paediatric emergency department for most centres (n=21; 75%). Paediatric anaesthesiologists, paediatric surgeons and paediatric radiologists were in-house in 20 (71%), 5 (18%) and 12 (43%) centres, respectively. Twenty-three (82%) hospitals had a paediatric specialised mobile intensive care unit and seven (25%) of these could provide a prehospital emergency response. Didactic teaching and simulation exercises were implemented in 20 (71%) and 22 (79%) centres, respectively. Overall, physician participants rated the level of readiness of their hospital as 6 (IQR: 5-7) on a 10-point readiness scale.

CONCLUSION: Paediatric preparedness is very heterogeneous between the centres. Based on the study findings, we suggest that a national programme must be defined and guidelines generated.

PMID:29860227 | DOI:10.1136/archdischild-2017-314658

Arch Pediatr. 2022 May;29(4):326-329. doi: 10.1016/j.arcped.2022.02.007. Epub 2022 Mar 26.

ABSTRACT

BACKGROUND: Due to the lack of available evidence on pediatric trauma care organization, no French national guideline has been developed. This survey aimed to describe the management of pediatric trauma patients in France.

METHODS: In this cross-sectional survey, an electronic questionnaire (previously validated) was distributed to intensive care physicians from tertiary hospitals via the GFRUP (Groupe Francophone de Réanimation et Urgences Pédiatriques) mailing list.

RESULTS: We collected 37 responses from 28 centers with available data, representing 100% of French level-1 pediatric trauma centers. Most of the pediatric centers (n = 21, 75%) had a written local protocol on pediatric trauma care. In most centers (n = 17, 61%), patients with severe trauma could be admitted in various locations, including the adult or pediatric emergency department or the intensive care unit. Usually, the location of the trauma room depended on the patients' age and/or severity of trauma. In 12 centers in which trauma could be managed by adult physicians (n = 12/18, 70%), a physician with pediatric expertise (anesthesiologist or intensive care physician) could be called according to the patient's age or severity of trauma. The cut-off patient age for considering pediatric expertise was mainly 3-5 years (n = 10, 83%).

CONCLUSION: Although most French level-1 pediatric trauma centers have a local protocol for pediatric trauma management, organization is very heterogeneous in France. Guidelines should focus on collaboration between professionals and hospital facilities in order to improve outcomes of children with trauma.

PMID:35351342 | DOI:10.1016/j.arcped.2022.02.007

Arch Pediatr. 2014 Jan;21(1):34-43. doi: 10.1016/j.arcped.2013.10.018. Epub 2013 Dec 4.

ABSTRACT

INTRODUCTION AND OBJECTIVES: To identify the knowledge of caregivers of pediatric intensive care units (PICUs) on the French law related to patients' rights and end of life, their views on withholding/withdrawing life-sustaining treatment (WWLST) decisions, and their feelings about how these decisions were made and implemented.

MATERIALS AND METHODS: A multicenter survey in 24 French PICUs during the fourth trimester 2010.

RESULTS: One thousand three hundred and thirty-nine professional healthcare workers (1005 paramedics and 334 physicians) responded. Over 85% of caregivers had good knowledge of the WWLST decision-making processes required by law. More than 80% of caregivers accepted mechanical ventilation, hemodiafiltration, or hemodynamic support withdrawal or withholding. Nevertheless, the withdrawal of artificial nutrition and hydration generated reluctance or opposition for the majority of respondents. While paramedics' participation in the decision-making process was deemed necessary by all caregivers, paramedics found more often than physicians that they were insufficiently involved. The quality of end-of-life care was judged very positively by caregivers. The answers on how WWLST was applied suggest very different interpretations of the law. Some caregivers respect the principles of palliative care as stated in the public health code and 40% of doctors and 64% of caregivers consider it "acceptable" to hasten death if resulting from a collaborative decision-making process.

CONCLUSION: This study is the first to show that caregivers of French PICUs have good knowledge of the French law concerning the end of life. Yet, there is still confusion about the limits of practice during the end-of-life period.

PMID:24315107 | DOI:10.1016/j.arcped.2013.10.018

Pediatr Crit Care Med. 2020 Jun;21(6):e342-e353. doi: 10.1097/PCC.0000000000002307.

ABSTRACT

OBJECTIVE: To describe the management of anemia at PICU discharge by pediatric intensivists.

DESIGN: Self-administered, online, scenario-based survey.

SETTING: PICUs in Australia/New Zealand, Europe, and North America.

SUBJECTS: Pediatric intensivists.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered separately in order to assess their effect on the management of anemia. Two-hundred seventeen responses were analyzed. They reported that the mean (± SEM) transfusion threshold was a hemoglobin level of 6.9 ± 0.09 g/dL after hemorrhagic shock, 7.6 ± 0.10 g/dL after cardiac surgery, 7.0 ± 0.10 g/dL after craniofacial surgery, and 7.0 ± 0.10 g/dL after polytrauma (p < 0.001). The most important increase in transfusion threshold was observed in the presence of a cyanotic heart disease (mean increase ranging from 1.80 to 2.30 g/dL when compared with baseline scenario) or left ventricular dysfunction (mean increase, 1.41-2.15 g/dL). One third of respondents stated that they would not prescribe iron at PICU discharge, regardless of the hemoglobin level or the baseline scenario. Most respondents (69.4-75.0%, depending on the scenario) did not prescribe erythropoietin.

CONCLUSIONS: Pediatric intensivists state that they use restrictive transfusion strategies at PICU discharge similar to those they use during the acute phase of critical illness. Supplemental iron is less frequently prescribed than RBCs, and prescription of erythropoietin is uncommon. Optimal management of post-PICU anemia is currently unknown. Further studies are required to highlight the consequences of this anemia and to determine appropriate management.

PMID:32217901 | DOI:10.1097/PCC.0000000000002307

Euro Surveill. 2020 Jun;25(22):2001010. doi: 10.2807/1560-7917.ES.2020.25.22.2001010.

ABSTRACT

End of April 2020, French clinicians observed an increase in cases presenting with paediatric inflammatory multisystem syndrome (PIMS). Nationwide surveillance was set up and demonstrated temporospatial association with the coronavirus disease (COVID-19) epidemic for 156 reported cases as at 17 May: 108 were classified as confirmed (n = 79), probable (n = 16) or possible (n = 13) post-COVID-19 PIMS cases. A continuum of clinical features from Kawasaki-like disease to myocarditis was observed, requiring intensive care in 67% of cases.

PMID:32524957 | PMC:PMC7336112 | DOI:10.2807/1560-7917.ES.2020.25.22.2001010

J Nephrol. 2023 Dec;36(9):2541-2547. doi: 10.1007/s40620-023-01762-1. Epub 2023 Sep 12.

ABSTRACT

BACKGROUND: Use of continuous renal replacement therapy in children receiving anti-infective drugs may lead to inappropriate concentrations with risks related to treatment failure, toxicity and emergence of multidrug-resistant bacteria. We aimed to describe anti-infective prescribing practices in critically ill children undergoing continuous renal replacement therapy.

METHODS: An online survey to assess continuous renal replacement therapy, anti-infective prescribing and therapeutic drug monitoring practices was sent by e-mail to physicians working in pediatric intensive care units through the French-speaking Group of Pediatric Intensive Care and Emergency medicine (GFRUP).

RESULTS: From April 1st, 2021 to May 1st, 2021, 26/40 pediatric intensive care units participated in the survey, corresponding to a response rate of 65%. Twenty-one were located in France and five abroad. All pediatric intensive care units administered continuous renal replacement therapy, primarily with Prismaflex™ System. Anti-infective prescriptions were adjusted to the presence of continuous renal replacement therapy in 23 (88%) pediatric intensive care units mainly according to molecular weight in 6 (23%), molecule protein binding in 6 (23%) and elimination routes in 15 (58%) including residual diuresis in 9 (35%), to the continuous renal replacement therapy flow in 6 (23%) and to the modality of continuous renal replacement therapy used in 15 (58%), pediatric intensive care units. There was broad variability among pediatric intensive care units and among physicians within the same unit. Barriers to therapeutic drug monitoring were mainly an excessive delay in obtaining results in 11 (42%) and the lack of an on-site laboratory in 8 (31%) pediatric intensive care units.

CONCLUSIONS: Our survey reported wide variability in anti-infective prescribing practices in children undergoing continuous renal replacement therapy, thus highlighting a gap in knowledge and the need for education and recommendations.

PMID:37698831 | DOI:10.1007/s40620-023-01762-1