Scholars@Duke
Kyle Jason Rehder

Kyle Jason Rehder

Dr. Glenn A. Kiser and Eltha Muriel Kiser Professor of Pediatrics
Pediatrics, Critical Care Medicine
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Selected Publications

Ketamine Use in the Intubation of Critically Ill Children with Neurological Indications: A Multicenter Retrospective Analysis.

Journal Article Neurocrit Care · February 2024 BACKGROUND: Ketamine has traditionally been avoided for tracheal intubations (TIs) in patients with acute neurological conditions. We evaluate its current usage pattern in these patients and any associated adverse events. METHODS: We conducted a retrospect ... Full text Link to item Cite

Association Between Dead Space to Tidal Volume Ratio and Duration of Respiratory Support After Extubation in Critically Ill Children.

Journal Article Respir Care · November 2023 BACKGROUND: The dead-space-to-tidal-volume ratio (VD/VT) has been used to successfully predict extubation failure in children who are critically ill. However, a singular reliable measure to predict the level and duration of respiratory support after libera ... Full text Link to item Cite

Characteristics, Identification, Training, and Perception of Leaders in Respiratory Care.

Journal Article Respir Care · October 2023 BACKGROUND: Leadership is critical to high-functioning teams; however, data are lacking for what defines successful respiratory therapist (RT) leadership. Leaders need a wide range of skills to be successful, although the exact characteristics, behaviors, ... Full text Link to item Cite

Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU.

Journal Article Crit Care Med · July 1, 2023 OBJECTIVES: To evaluate implementation of a video laryngoscope (VL) as a coaching device to reduce adverse tracheal intubation associated events (TIAEs). DESIGN: Prospective multicenter interventional quality improvement study. SETTING: Ten PICUs in North ... Full text Link to item Cite

Mechanical Ventilation during ECMO: Best Practices.

Journal Article Respir Care · June 2023 Adults and children who require extracorporeal membrane oxygenation for respiratory failure remain at risk for ongoing lung injury if ventilator management is not optimized. This review serves as a guide to assist the bedside clinician in ventilator titrat ... Full text Link to item Cite

Enhancing Respiratory Therapists' Well-Being: Battling Burnout in Respiratory Care.

Journal Article Respir Care · May 2023 Burnout is a major problem in health care and is associated with adverse sequelae for patients, health care workers, and organizations. Burnout among respiratory therapists (RTs) is as high as 79% and is associated with poor or ineffective leadership, inad ... Full text Link to item Cite

Teamwork Before and During COVID-19: The Good, the Same, and the Ugly….

Journal Article J Patient Saf · January 1, 2023 OBJECTIVES: The COVID 19 pandemic placed unprecedented strain on healthcare systems and workers, likely also impacting patient safety and outcomes. This study aimed to understand how teamwork climate changed during that pandemic and how these changes affec ... Full text Open Access Link to item Cite

Strengthening patient-family engagement amidst a pandemic: Lessons learned and paths forward

Journal Article Patient Experience Journal · January 1, 2023 The COVID-19 pandemic was highly disruptive to healthcare and negatively affected healthcare worker and patient experience on multiple levels. Patient Family Advisors serve an important role in partnering with health systems to improve patient experience, ... Full text Cite

Burnout Among Respiratory Therapists Amid the COVID-19 Pandemic.

Journal Article Respir Care · December 2022 BACKGROUND: Burnout is a major challenge in health care and is associated with poor overall well-being, increased medical errors, worse patient outcomes, and low job satisfaction. There is scant literature focused on the respiratory therapist's (RT) experi ... Full text Link to item Cite

Factors Associated With a Positive View of Respiratory Care Leadership.

Journal Article Respir Care · October 2022 BACKGROUND: Burnout within health care is prevalent, and its effects are detrimental to patient outcomes, organizations, and individuals. Effects stemming from burnout include anxiety, depression, excessive alcohol and drug use, cardiovascular problems, ti ... Full text Link to item Cite

The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings.

Journal Article J Patient Saf · September 1, 2022 OBJECTIVES: The current study aimed to guide the assessment and improvement of psychological safety (PS) by (1) examining the psychometric properties of a brief novel PS scale, (2) assessing relationships between PS and other safety culture domains, (3) ex ... Full text Open Access Link to item Cite

Mechanical Ventilation and Respiratory Support in the Pediatric Intensive Care Unit.

Journal Article Pediatr Clin North Am · June 2022 Children admitted to the pediatric intensive care unit often require respiratory support for the treatment of respiratory distress and failure. Respiratory support comprises both noninvasive modalities (ie, heated humidified high-flow nasal cannula, contin ... Full text Link to item Cite

Extracorporeal membrane oxygenation in critically ill neonatal and pediatric patients with acute respiratory failure: a guide for the clinician.

Journal Article Expert Rev Respir Med · October 2021 Intro: Extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure continues to demonstrate improving outcomes, largely due to advances in technology along with refined management strategies despite mounting patient acuity and comple ... Full text Link to item Cite

The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being.

Journal Article Arch Pathol Lab Med · September 1, 2021 CONTEXT.—: Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover. OBJECTIVE.—: To describe the state of the science regardin ... Full text Open Access Link to item Cite

Performance of an Electronic Decision Support System as a Therapeutic Intervention During a Multicenter PICU Clinical Trial: Heart and Lung Failure-Pediatric Insulin Titration Trial (HALF-PINT).

Journal Article Chest · September 2021 BACKGROUND: The use of electronic clinical decision support (CDS) systems for pediatric critical care trials is rare. We sought to describe in detail the use of a CDS tool (Children's Hospital Euglycemia for Kids Spreadsheet [CHECKS]), for the management o ... Full text Link to item Cite

High-Flow Nasal Cannula in Pediatric Critical Asthma.

Journal Article Respir Care · August 2021 BACKGROUND: High-flow nasal cannula (HFNC) has been used in the treatment of pediatric asthma, although high-quality data comparing HFNC to aerosol mask nebulizer are lacking. We hypothesized that HFNC would perform similarly to the aerosol mask for meanin ... Full text Link to item Cite

Ketamine Use in the Intubation of Critically Ill Children with Neurological Indications: A Multicenter Retrospective Analysis.

Journal Article Neurocrit Care · February 2024 BACKGROUND: Ketamine has traditionally been avoided for tracheal intubations (TIs) in patients with acute neurological conditions. We evaluate its current usage pattern in these patients and any associated adverse events. METHODS: We conducted a retrospect ... Full text Link to item Cite

Association Between Dead Space to Tidal Volume Ratio and Duration of Respiratory Support After Extubation in Critically Ill Children.

Journal Article Respir Care · November 2023 BACKGROUND: The dead-space-to-tidal-volume ratio (VD/VT) has been used to successfully predict extubation failure in children who are critically ill. However, a singular reliable measure to predict the level and duration of respiratory support after libera ... Full text Link to item Cite

Characteristics, Identification, Training, and Perception of Leaders in Respiratory Care.

Journal Article Respir Care · October 2023 BACKGROUND: Leadership is critical to high-functioning teams; however, data are lacking for what defines successful respiratory therapist (RT) leadership. Leaders need a wide range of skills to be successful, although the exact characteristics, behaviors, ... Full text Link to item Cite

Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU.

Journal Article Crit Care Med · July 1, 2023 OBJECTIVES: To evaluate implementation of a video laryngoscope (VL) as a coaching device to reduce adverse tracheal intubation associated events (TIAEs). DESIGN: Prospective multicenter interventional quality improvement study. SETTING: Ten PICUs in North ... Full text Link to item Cite

Mechanical Ventilation during ECMO: Best Practices.

Journal Article Respir Care · June 2023 Adults and children who require extracorporeal membrane oxygenation for respiratory failure remain at risk for ongoing lung injury if ventilator management is not optimized. This review serves as a guide to assist the bedside clinician in ventilator titrat ... Full text Link to item Cite

Enhancing Respiratory Therapists' Well-Being: Battling Burnout in Respiratory Care.

Journal Article Respir Care · May 2023 Burnout is a major problem in health care and is associated with adverse sequelae for patients, health care workers, and organizations. Burnout among respiratory therapists (RTs) is as high as 79% and is associated with poor or ineffective leadership, inad ... Full text Link to item Cite

Teamwork Before and During COVID-19: The Good, the Same, and the Ugly….

Journal Article J Patient Saf · January 1, 2023 OBJECTIVES: The COVID 19 pandemic placed unprecedented strain on healthcare systems and workers, likely also impacting patient safety and outcomes. This study aimed to understand how teamwork climate changed during that pandemic and how these changes affec ... Full text Open Access Link to item Cite

Strengthening patient-family engagement amidst a pandemic: Lessons learned and paths forward

Journal Article Patient Experience Journal · January 1, 2023 The COVID-19 pandemic was highly disruptive to healthcare and negatively affected healthcare worker and patient experience on multiple levels. Patient Family Advisors serve an important role in partnering with health systems to improve patient experience, ... Full text Cite

Burnout Among Respiratory Therapists Amid the COVID-19 Pandemic.

Journal Article Respir Care · December 2022 BACKGROUND: Burnout is a major challenge in health care and is associated with poor overall well-being, increased medical errors, worse patient outcomes, and low job satisfaction. There is scant literature focused on the respiratory therapist's (RT) experi ... Full text Link to item Cite

Factors Associated With a Positive View of Respiratory Care Leadership.

Journal Article Respir Care · October 2022 BACKGROUND: Burnout within health care is prevalent, and its effects are detrimental to patient outcomes, organizations, and individuals. Effects stemming from burnout include anxiety, depression, excessive alcohol and drug use, cardiovascular problems, ti ... Full text Link to item Cite

The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings.

Journal Article J Patient Saf · September 1, 2022 OBJECTIVES: The current study aimed to guide the assessment and improvement of psychological safety (PS) by (1) examining the psychometric properties of a brief novel PS scale, (2) assessing relationships between PS and other safety culture domains, (3) ex ... Full text Open Access Link to item Cite

Mechanical Ventilation and Respiratory Support in the Pediatric Intensive Care Unit.

Journal Article Pediatr Clin North Am · June 2022 Children admitted to the pediatric intensive care unit often require respiratory support for the treatment of respiratory distress and failure. Respiratory support comprises both noninvasive modalities (ie, heated humidified high-flow nasal cannula, contin ... Full text Link to item Cite

Extracorporeal membrane oxygenation in critically ill neonatal and pediatric patients with acute respiratory failure: a guide for the clinician.

Journal Article Expert Rev Respir Med · October 2021 Intro: Extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure continues to demonstrate improving outcomes, largely due to advances in technology along with refined management strategies despite mounting patient acuity and comple ... Full text Link to item Cite

The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being.

Journal Article Arch Pathol Lab Med · September 1, 2021 CONTEXT.—: Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover. OBJECTIVE.—: To describe the state of the science regardin ... Full text Open Access Link to item Cite

Performance of an Electronic Decision Support System as a Therapeutic Intervention During a Multicenter PICU Clinical Trial: Heart and Lung Failure-Pediatric Insulin Titration Trial (HALF-PINT).

Journal Article Chest · September 2021 BACKGROUND: The use of electronic clinical decision support (CDS) systems for pediatric critical care trials is rare. We sought to describe in detail the use of a CDS tool (Children's Hospital Euglycemia for Kids Spreadsheet [CHECKS]), for the management o ... Full text Link to item Cite

High-Flow Nasal Cannula in Pediatric Critical Asthma.

Journal Article Respir Care · August 2021 BACKGROUND: High-flow nasal cannula (HFNC) has been used in the treatment of pediatric asthma, although high-quality data comparing HFNC to aerosol mask nebulizer are lacking. We hypothesized that HFNC would perform similarly to the aerosol mask for meanin ... Full text Link to item Cite

Prevalence of Burnout Among Respiratory Therapists Amidst the COVID-19 Pandemic.

Journal Article Respir Care · July 16, 2021 Background: Burnout is a major challenge in health care, but its prevalence has not been evaluated in practicing respiratory therapist (RTs). The purpose of this study was to identify RT burnout prevalence and factors associated with RT burnout.Methods: An ... Full text Link to item Cite

Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds.

Journal Article Jt Comm J Qual Patient Saf · July 2021 BACKGROUND: Interventions to decrease burnout and increase well-being in health care workers (HCWs) and improve organizational safety culture are urgently needed. This study was conducted to determine the association between Positive Leadership WalkRounds ... Full text Open Access Link to item Cite

Resilience and Burnout Resources in Respiratory Care Departments.

Journal Article Respir Care · May 2021 BACKGROUND: Burnout is a major problem in health care, with rates of approximately 33% and 50% in nurses and physicians, respectively, prior to the COVID-19 pandemic. Respiratory therapist (RT) burnout rates and drivers have not been specifically examined. ... Full text Link to item Cite

High-Frequency Jet Ventilation in Neonatal and Pediatric Subjects: A Narrative Review.

Journal Article Respir Care · May 2021 High-frequency ventilation is commonly utilized with neonates and with children with severe respiratory failure. Both high-frequency oscillatory ventilation (HFOV) and high-frequency jet ventilation (HFJV) are used extensively in neonates. HFJV can also be ... Full text Link to item Cite

Can We Finally Agree: How We Round Really Matters?

Journal Article Pediatr Crit Care Med · April 1, 2021 Full text Link to item Cite

Sustained Improvement in Tracheal Intubation Safety Across a 15-Center Quality-Improvement Collaborative: An Interventional Study From the National Emergency Airway Registry for Children Investigators.

Journal Article Crit Care Med · February 1, 2021 OBJECTIVES: To evaluate the effect of a tracheal intubation safety bundle on adverse tracheal intubation-associated events across 15 PICUs. DESIGN: Multicenter time-series study. SETTING: PICUs in the United States. PATIENTS: All patients received tracheal ... Full text Link to item Cite

The New Trainee Effect in Tracheal Intubation Procedural Safety Across PICUs in North America: A Report From National Emergency Airway Registry for Children.

Journal Article Pediatr Crit Care Med · December 2020 OBJECTIVES: Tracheal intubation carries a high risk of adverse events. The current literature is unclear regarding the "New Trainee Effect" on tracheal intubation safety in the PICU. We evaluated the effect of the timing of the PICU fellow academic cycle o ... Full text Link to item Cite

Respiratory Therapist Intubation Practice in Pediatric ICUs: A Multicenter Registry Study.

Journal Article Respir Care · October 2020 BACKGROUND: Tracheal intubation by respiratory therapists (RTs) is a well-established practice that has been described primarily in adult and neonatal patients. However, minimal data exist regarding RTs' intubation performance in pediatric ICUs. The purpos ... Full text Link to item Cite

Initial Modified Pulmonary Index Score Predicts Hospital Length of Stay for Asthma Subjects Admitted to the Pediatric Intensive Care Unit.

Journal Article Respir Care · September 2020 BACKGROUND: Scoring systems are frequently used to assess the severity of pediatric asthma exacerbations. The modified pulmonary index score (MPIS) has been found to be highly correlated with length of stay (LOS) in the pediatric intensive care unit (PICU) ... Full text Link to item Cite

Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events.

Journal Article Crit Care Med · June 2020 OBJECTIVES: Tracheal intubation in critically ill children with shock poses a risk of hemodynamic compromise. Ketamine has been considered the drug of choice for induction in these patients, but limited data exist. We investigated whether the administratio ... Full text Link to item Cite

Doing Virtually Anything to Educate Students.

Journal Article Pediatr Crit Care Med · May 2020 Full text Link to item Cite

Long-Term Neurobehavioral and Quality of Life Outcomes of Critically Ill Children after Glycemic Control.

Journal Article J Pediatr · March 2020 OBJECTIVES: To investigate adaptive skills, behavior, and quality health-related quality of life in children from 32 centers enrolling in the Heart And Lung Failure-Pediatric INsulin Titration randomized controlled trial. STUDY DESIGN: This prospective lon ... Full text Link to item Cite

Online Learning and Residents' Acquisition of Mechanical Ventilation Knowledge: Sequencing Matters.

Journal Article Crit Care Med · January 2020 OBJECTIVE: Rapid advancements in medicine and changing standards in medical education require new, efficient educational strategies. We investigated whether an online intervention could increase residents' knowledge and improve knowledge retention in mecha ... Full text Link to item Cite

Associations Between a New Disruptive Behaviors Scale and Teamwork, Patient Safety, Work-Life Balance, Burnout, and Depression.

Journal Article Jt Comm J Qual Patient Saf · January 2020 BACKGROUND: Disruptive and unprofessional behaviors occur frequently in health care and adversely affect patient care and health care worker job satisfaction. These behaviors have rarely been evaluated at a work setting level, nor do we fully understand ho ... Full text Open Access Link to item Cite

What's in a Name? Role Clarity Goes Well Beyond a Simple Title.

Journal Article J Patient Exp · December 2019 BACKGROUND: Role clarity is important for patient care but challenging in graduate medical education (GME). METHODS: Badge buddies were integrated for all GME trainees at a single institution, and surveys were conducted prior to and 5 months following impl ... Full text Link to item Cite

A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit.

Journal Article Respir Care · November 2019 BACKGROUND: Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory ther ... Full text Open Access Link to item Cite

Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis.

Journal Article J Surg Res · October 2019 BACKGROUND: Sepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes i ... Full text Link to item Cite

The Current State of Pediatric Acute Respiratory Distress Syndrome.

Journal Article Pediatr Allergy Immunol Pulmonol · June 1, 2019 Pediatric acute respiratory distress syndrome (PARDS) is a significant cause of morbidity and mortality in children. Children with PARDS often require intensive care admission and mechanical ventilation. Unfortunately, beyond lung protective ventilation, t ... Full text Link to item Cite

Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children.

Journal Article Crit Care Med · May 2019 OBJECTIVES: Previous studies report worse short-term outcomes with hypoglycemia in critically ill children. These studies relied on intermittent blood glucose measurements, which may have introduced detection bias. We analyzed data from the Heart And Lung ... Full text Link to item Cite

Work-life balance behaviours cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis.

Journal Article BMJ Qual Saf · February 2019 BACKGROUND: Healthcare is approaching a tipping point as burnout and dissatisfaction with work-life integration (WLI) in healthcare workers continue to increase. A scale evaluating common behaviours as actionable examples of WLI was introduced to measure w ... Full text Open Access Link to item Cite

The Association of Nutrition Status Expressed as Body Mass Index z Score With Outcomes in Children With Severe Sepsis: A Secondary Analysis From the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study.

Journal Article Crit Care Med · November 2018 OBJECTIVES: The impact of nutrition status on outcomes in pediatric severe sepsis is unclear. We studied the association of nutrition status (expressed as body mass index z score) with outcomes in pediatric severe sepsis. DESIGN: Secondary analysis of the ... Full text Link to item Cite

Current Use of Invasive and Noninvasive Monitors in Academic Pediatric Intensive Care Units.

Journal Article J Pediatr Intensive Care · September 2018 To describe the current use of noninvasive monitoring compared with traditional invasive monitoring in Pediatric Critical Care Medicine (PCCM) accredited fellowship programs in the United States. A web-based survey with the primary aim of describing the ut ... Full text Link to item Cite

Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs.

Journal Article Cardiol Young · July 2018 UNLABELLED: IntroductionChildren with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.Materials and methodsWe ... Full text Link to item Cite

Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children.

Journal Article Pediatr Crit Care Med · June 2018 OBJECTIVES: Cricoid pressure is often used to prevent regurgitation during induction and mask ventilation prior to high-risk tracheal intubation in critically ill children. Clinical data in children showing benefit are limited. Our objective was to evaluat ... Full text Link to item Cite

Histoplasmosis Myocarditis in an Immunocompetent Host After a Recreational Mud Run.

Journal Article Pediatrics · April 2018 Mud runs are an increasingly popular recreational fitness activity across the United States, combining a running race through an obstacle course with submersion in mud. Recent reports estimate 4 million people have participated in these types of events ove ... Full text Link to item Cite

Site Variability in Regulatory Oversight for an International Study of Pediatric Sepsis.

Journal Article Pediatr Crit Care Med · April 2018 OBJECTIVES: Duplicative institutional review board/research ethics committee review for multicenter studies may impose administrative burdens and inefficiencies affecting study implementation and quality. Understanding variability in site-specific institut ... Full text Link to item Cite

Effect of Location on Tracheal Intubation Safety in Cardiac Disease-Are Cardiac ICUs Safer?

Journal Article Pediatr Crit Care Med · March 2018 OBJECTIVES: Evaluate differences in tracheal intubation-associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. DE ... Full text Link to item Cite

End-Tidal Carbon Dioxide Use for Tracheal Intubation: Analysis From the National Emergency Airway Registry for Children (NEAR4KIDS) Registry.

Journal Article Pediatr Crit Care Med · February 2018 OBJECTIVE: Waveform capnography use has been incorporated into guidelines for the confirmation of tracheal intubation. We aim to describe the trend in waveform capnography use in emergency departments and PICUs and assess the association between waveform c ... Full text Link to item Cite

Clinical Impact of External Laryngeal Manipulation During Laryngoscopy on Tracheal Intubation Success in Critically Ill Children.

Journal Article Pediatr Crit Care Med · February 2018 OBJECTIVES: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia sett ... Full text Link to item Cite

Frequency of Desaturation and Association With Hemodynamic Adverse Events During Tracheal Intubations in PICUs.

Journal Article Pediatr Crit Care Med · January 2018 OBJECTIVES: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association wit ... Full text Link to item Cite

Pediatric Critical Care Medicine Training: 2004–2016*

Journal Article Pediatric Critical Care Medicine · January 2018 Objectives:To describe growth trends in the number of programs, positions, and applicants in pediatric critical care medicine fellowship training as part of the Pediatric Critical Care Me ... Full text Cite

Optimizing care delivery: Quality and performance improvement

Chapter · January 1, 2018 Rapidly rising health care costs and increased focus on patient outcomes and safety have ensured that “business as usual” is no longer acceptable or sustainable. Achieving the highest quality care for patients with congenital and acquired heart disease req ... Full text Cite

High Levels of Morbidity and Mortality Among Pediatric Hematopoietic Cell Transplant Recipients With Severe Sepsis: Insights From the Sepsis PRevalence, OUtcomes, and Therapies International Point Prevalence Study.

Journal Article Pediatr Crit Care Med · December 2017 OBJECTIVES: Pediatric severe sepsis is a major cause of morbidity and mortality worldwide, and hematopoietic cell transplant patients represent a high-risk population. We assessed the epidemiology of severe sepsis in hematopoietic cell transplant patients, ... Full text Link to item Cite

Promoters and Barriers to Implementation of Tracheal Intubation Airway Safety Bundle: A Mixed-Method Analysis.

Journal Article Pediatr Crit Care Med · October 2017 OBJECTIVES: To describe promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders. DESIGN: Mixed methods. SETTING: Thirteen PIC ... Full text Link to item Cite

The associations between work-life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions.

Journal Article BMJ Qual Saf · August 2017 BACKGROUND: Improving the resiliency of healthcare workers is a national imperative, driven in part by healthcare workers having minimal exposure to the skills and culture to achieve work-life balance (WLB). Regardless of current policies, healthcare worke ... Full text Open Access Link to item Cite

Adjunct Therapies for Refractory Status Asthmaticus in Children.

Journal Article Respir Care · June 2017 Asthma exacerbation is a common reason for children to present to the emergency department. If primary therapies fail to halt the progression of an asthma flare, status asthmaticus often leads to hospital, and potentially ICU, admission. Following the init ... Full text Link to item Cite

Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes.

Journal Article Pediatr Crit Care Med · April 2017 OBJECTIVE: Tracheal intubation in PICUs is a common procedure often associated with adverse events. The aim of this study is to evaluate the association between immediate events such as tracheal intubation associated events or desaturation and ICU outcomes ... Full text Link to item Cite

Quality improvement in pediatrics: past, present, and future.

Journal Article Pediatr Res · January 2017 Almost two decades ago, the landmark report "To Err is Human" compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsust ... Full text Link to item Cite

Intravenous oxygen: a novel method of oxygen delivery in hypoxemic respiratory failure?

Journal Article Expert Rev Respir Med · January 2017 Hypoxemic respiratory failure is a common problem in critical care. Current management strategies, including mechanical ventilation and extracorporeal membranous oxygenation, can be efficacious but these therapies put patients at risk for toxicities associ ... Full text Link to item Cite

New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality.

Journal Article Pediatr Crit Care Med · January 2017 OBJECTIVES: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. DESIGN: Secondary analysis of a prospective, cross-sectional, point prevalence study. SETTING: Inte ... Full text Link to item Cite

Acute Kidney Injury in Pediatric Severe Sepsis: An Independent Risk Factor for Death and New Disability.

Journal Article Crit Care Med · December 2016 OBJECTIVES: The prevalence of septic acute kidney injury and impact on functional status of PICU survivors are unknown. We used data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic acute k ... Full text Link to item Cite

Well-"Rounded" Medical Teams-What Does It Take?

Journal Article Pediatr Crit Care Med · July 2016 Full text Link to item Cite

Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs.

Journal Article Pediatr Crit Care Med · June 2016 OBJECTIVES: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, whi ... Full text Link to item Cite

Family Presence During Pediatric Tracheal Intubations.

Journal Article JAMA Pediatr · March 2016 IMPORTANCE: Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal in ... Full text Link to item Cite

Development of a Quality Improvement Bundle to Reduce Tracheal Intubation-Associated Events in Pediatric ICUs.

Journal Article Am J Med Qual · 2016 Advanced airway management in the pediatric intensive care unit (PICU) is hazardous, with associated adverse outcomes. This report describes a methodology to develop a bundle to improve quality and safety of tracheal intubations. A prospective observationa ... Full text Link to item Cite

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation.

Journal Article Respir Care · January 2016 BACKGROUND: An increasing number of centers are using active rehabilitation and ambulation for critically ill patients on extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation. This investigation assessed the economic impact at a s ... Full text Link to item Cite

Increased Occurrence of Tracheal Intubation-Associated Events During Nights and Weekends in the PICU.

Journal Article Crit Care Med · December 2015 OBJECTIVES: Adverse tracheal intubation-associated events are common in PICUs. Prior studies suggest provider and practice factors are important contributors to tracheal intubation-associated events. Little is known about how the incidence of tracheal intu ... Full text Link to item Cite

Is there still a role for high-frequency oscillatory ventilation in neonates, children and adults?

Journal Article Expert Rev Respir Med · October 2015 Critically ill patients with respiratory pathology often require mechanical ventilation and while low tidal volume ventilation has become the mainstay of treatment, achieving adequate gas exchange may not be attainable with conventional ventilator modaliti ... Full text Link to item Cite

The authors reply.

Journal Article Pediatr Crit Care Med · October 2015 Full text Link to item Cite

Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study.

Journal Article Crit Care · September 16, 2015 INTRODUCTION: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underl ... Full text Link to item Cite

Detection of Multiple Respiratory Viruses Associated With Mortality and Severity of Illness in Children.

Journal Article Pediatr Crit Care Med · September 2015 OBJECTIVE: Respiratory viral infection is a common source of morbidity and mortality in children. Coinfection with multiple viruses occurs frequently; however, the clinical significance of concomitant viral pathogens is unclear. We hypothesized that presen ... Full text Link to item Cite

Is there still a role for high-frequency oscillatory ventilation in neonates, children and adults?

Journal Article Expert Rev Respir Med · August 11, 2015 Critically ill patients with respiratory pathology often require mechanical ventilation and while low tidal volume ventilation has become the mainstay of treatment, achieving adequate gas exchange may not be attainable with conventional ventilator modaliti ... Link to item Cite

Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study.

Journal Article Pediatr Crit Care Med · March 2015 OBJECTIVES: Tracheal intubation in PICUs is often associated with adverse tracheal intubation-associated events. There is a paucity of data regarding medication selection for safe tracheal intubations in PICUs. Our primary objective was to evaluate the ass ... Full text Link to item Cite

Standardizing postoperative PICU handovers improves handover metrics and patient outcomes.

Journal Article Pediatr Crit Care Med · March 2015 OBJECTIVES: To improve handover communication and patient outcomes for postoperative admissions to a multidisciplinary PICU. DESIGN: Prospective cohort study. SETTING: Multidisciplinary PICU in a university hospital. SUBJECTS: The multidisciplinary team re ... Full text Link to item Cite

Setting the ventilator in the PICU

Chapter · January 1, 2015 The initiation of mechanical ventilation and selection of initial ventilator settings is a complex process that must address the underlying pathophysiology and the change in clinical status which may follow intubation and the implementation of positive pre ... Full text Cite

Indications for invasive conventional mechanical ventilation

Chapter · January 1, 2015 The spectrum and severity of respiratory illness in the newly born has been changing over the past three decades with the introduction of antenatal steroids, improved management of the fetus during preterm labor and birth, and postnatal exogenous surfactan ... Full text Cite

Non invasive monitoring in mechanically ventilated pediatric patients.

Journal Article Expert Rev Respir Med · December 2014 Cardiopulmonary monitoring is a key component in the evaluation and management of critically ill patients. Clinicians typically rely on a combination of invasive and non-invasive monitoring to assess cardiac output and adequacy of ventilation. Recent techn ... Full text Link to item Cite

Adjunctive treatments in pediatric acute respiratory distress syndrome.

Journal Article Expert Rev Respir Med · December 2014 Acute respiratory distress syndrome (ARDS) is a devastating process that involves pulmonary inflammation, alveolar damage and hypoxemic respiratory failure. Although advances in management approaches over the past two decades have resulted in significantly ... Full text Link to item Cite

A review of the use of adjunctive therapies in severe acute asthma exacerbation in critically ill children.

Journal Article Expert Rev Respir Med · August 2014 Asthma is a common and potentially life threatening childhood condition. Asthma involves not only chronic airway remodeling, but may also include frequent exacerbations resulting from bronchospasm, edema, and mucus production. In children with severe exace ... Full text Link to item Cite

Ambulatory ECMO as a bridge to lung transplant in a previously well pediatric patient with ARDS.

Journal Article Pediatrics · August 2014 Extracorporeal membrane oxygenation (ECMO) is increasingly implemented in patients with end-stage pulmonary disease as a bridge to lung transplant. Several centers have instituted an approach that involves physical rehabilitation and ambulation for patient ... Full text Link to item Cite

Variability in IRBs regarding parental acceptance of passive consent.

Journal Article Pediatrics · August 2014 OBJECTIVE: Passive, opt-out recruitment strategies have the potential to improve efficiency and enlarge the participant pool for clinical studies. We report on the feasibility of using a passive consent strategy for a multicenter pediatric study. METHODS: ... Full text Link to item Cite

The authors reply.

Journal Article Pediatr Crit Care Med · July 2014 Full text Link to item Cite

Survey of in-house coverage by pediatric intensivists: characterization of 24/7 in-hospital pediatric critical care faculty coverage*.

Journal Article Pediatr Crit Care Med · February 2014 OBJECTIVE: To characterize the current state of 24/7 in-hospital pediatric intensivist coverage in academic PICUs, including perceptions of faculty and trainees regarding the advantages and disadvantages of in-hospital coverage. DESIGN: Cross-sectional obs ... Full text Link to item Cite

Perceptions of 24/7 in-hospital intensivist coverage on pediatric housestaff education.

Journal Article Pediatrics · January 2014 BACKGROUND: In recent years, the focus on patient safety and housestaff supervision has led to a steady increase in institutions providing 24/7 in-hospital (also known as in-house, henceforth referred to as IH) coverage by pediatric intensivists. Effects o ... Full text Link to item Cite

Acute respiratory failure

Chapter · January 1, 2014 Acute respiratory failure is a common diagnosis among critically ill children and a leading cause of morbidity, mortality, and health care expenditures in the pediatric critical care setting. This chapter examines the anatomic, developmental, and physiolog ... Full text Cite

Extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure: an evidence-based review of the past decade (2002-2012).

Journal Article Pediatr Crit Care Med · November 2013 OBJECTIVE: To provide a comprehensive evidence-based review of extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure. DATA SOURCE: A thorough computerized bibliographic search of the clinical literature regarding the use of ext ... Full text Link to item Cite

Active rehabilitation during extracorporeal membrane oxygenation as a bridge to lung transplantation.

Journal Article Respir Care · August 2013 BACKGROUND: Patients with end-stage lung disease often progress to critical illness, which dramatically reduces their chance of survival following lung transplantation. Pre-transplant deconditioning has a significant impact on outcomes for all lung transpl ... Full text Link to item Cite

Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature.

Journal Article Intensive Care Med · February 2013 Featured Publication BACKGROUND: High flow nasal cannula (HFNC) systems utilize higher gas flow rates than standard nasal cannulae. The use of HFNC as a respiratory support modality is increasing in the infant, pediatric, and adult populations as an alternative to non-invasive ... Full text Link to item Cite

State of the art: strategies for extracorporeal membrane oxygenation in respiratory failure.

Journal Article Expert Rev Respir Med · November 2012 Featured Publication Extracorporeal membrane oxygenation (ECMO) is an important rescue therapy for patients with cardiac and/or respiratory failure, with a growing body of literature supporting its use. Despite widespread use of ECMO, there remains a paucity of data on optimal ... Full text Link to item Cite

Technological advances in extracorporeal membrane oxygenation for respiratory failure.

Journal Article Expert Rev Respir Med · August 2012 Featured Publication Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric cardiac and/or respiratory failure is well established, and its use for adult respiratory failure is rapidly increasing. Management strategies developed over the past 30 years coupled wi ... Full text Link to item Cite

Nontraditional modes of mechanical ventilation: progress or distraction?

Journal Article Expert Rev Respir Med · June 2012 Featured Publication As technology continues to develop, a wide range of novel and nontraditional modes of mechanical ventilation have become available for the management of critically ill patients. Proportional assist ventilation, neurally adjusted ventilatory assist and adap ... Full text Link to item Cite

Targeted interventions improve shared agreement of daily goals in the pediatric intensive care unit.

Journal Article Pediatr Crit Care Med · January 2012 Featured Publication OBJECTIVE: To improve communication during daily rounds using sequential interventions. DESIGN: Prospective cohort study. SETTING: Multidisciplinary pediatric intensive care unit in a university hospital. SUBJECTS: The multidisciplinary rounding team in th ... Full text Link to item Cite

Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach.

Journal Article Crit Care Med · December 2011 Featured Publication OBJECTIVE: Extracorporeal membrane oxygenation as a bridge to lung transplantation has traditionally been associated with substantial morbidity and mortality. A major contributor to these complications may be weakness and overall deconditioning secondary t ... Full text Link to item Cite

Use of extracorporeal life support in adults with severe acute respiratory failure.

Journal Article Expert Rev Respir Med · October 2011 Featured Publication Extracorporeal membrane oxygenation (ECMO) is a recognized and accepted therapeutic option in the treatment of neonatal and pediatric respiratory failure. However, early studies in adults did not demonstrate a survival benefit associated with the utilizati ... Full text Link to item Cite

Extracorporeal membrane oxygenation for severe refractory respiratory failure secondary to 2009 H1N1 influenza A.

Journal Article Respir Care · July 2011 Featured Publication BACKGROUND: Respiratory failure and acute respiratory distress syndrome secondary to H1N1 influenza infection is a source of substantial morbidity and mortality, having caused over 265,000 hospitalizations in the United States in 2009. During the H1N1 pand ... Full text Link to item Cite

Intense pruritus and failure to thrive in Alagille syndrome.

Journal Article J Am Acad Dermatol · February 2008 A 4-year-old girl with failure to thrive and intense pruritus associated with Alagille syndrome is described. The clinical features of this autosomal dominant disorder are reviewed. This case highlights the importance of recognizing the severe pruritus as ... Full text Link to item Cite