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Goal-Directed Resuscitative Interventions During Pediatric Interfacility Transport
Michael H Stroud1, Ronald C Sanders, M Michele Moss
11Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR. 2Section of Critical Care Medicine, Department of Pediatrics, University of Louisville, Louisville, KY. 3Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
Insights
Goal-directed therapy during pediatric interfacility transport reduced hospital length of stay for critically ill children with systemic inflammatory response syndrome. This specialized approach shows potential for improving outcomes in pediatric critical care transport.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Transport Medicine
Background:
- Systemic inflammatory response syndrome (SIRS) critically affects pediatric patients during interfacility transport.
- Optimizing resuscitation protocols during transport is crucial for improving outcomes in critically ill children.
Purpose of the Study:
- To evaluate the impact of goal-directed therapy (GDT) administered by a specialized pediatric transport team on critically ill children with SIRS.
- To determine if GDT during interfacility transport reduces hospital length of stay, prevents multiple organ dysfunction, and decreases intensive care unit (ICU) interventions.
Main Methods:
- Prospective, before-and-after intervention trial involving pediatric interfacility transport patients (1 month to 17 years) with SIRS.
- Implementation of a GDT protocol by a specialized pediatric transport team, with pre- and post-intervention data collection over 10-month periods.
- Transport personnel received specialized training in GDT through didactics and high-fidelity simulation.
Main Results:
- A total of 235 patients with SIRS were enrolled (123 pre-intervention, 112 post-intervention).
- The post-intervention group experienced a significantly shorter hospital stay (mean difference of 1.6 days, p=0.02) and fewer required therapeutic ICU interventions (p=0.04).
- No statistically significant differences were observed in ICU length of stay or the prevalence of organ dysfunction between groups.
Conclusions:
- Goal-directed therapy administered by a specialized pediatric transport team shows potential to positively impact clinical outcomes for critically ill children with SIRS.
- Further multi-institutional studies are warranted to confirm these findings and their broader clinical applicability.
- This approach may offer a valuable strategy for improving the care of critically ill pediatric patients during interfacility transport.
Objectives:
This article reports results of the first National Institutes of Health-funded prospective interfacility transport study to determine the effect of goal-directed therapy administered by a specialized pediatric team to critically ill children with the systemic inflammatory response syndrome. We hypothesized that goal-directed therapy during interfacility transport would decrease hospital length of stay, prevent multiple organ dysfunction, and reduce subsequent ICU interventions.
Design:
Before-and-after intervention trial.
Setting:
During interfacility transport of critically ill patients by a specialized pediatric transport team, back to a tertiary care children's hospital.
Patients:
Before-and-after intervention trial.
Design:
Interfacility pediatric transport patients, age 1 month to 17 years, with systemic inflammatory response syndrome.
Interventions:
Prospective data were collected on all pediatric interfacility transport patients with systemic inflammatory response syndrome transported by the Angel One Transport team at Arkansas Children's Hospital. A 10-month data collection period was followed by institution of a goal-directed resuscitation protocol. Data were subsequently collected for 10 additional months followed by comparison of pre- and postintervention groups. All transport personnel underwent training with didactics and high-fidelity simulation until mastery with goal-directed resuscitation was achieved.
Measurements And Main Results:
All transport patients were screened for systemic inflammatory response syndrome using established variables and 235 (123 preintervention and 112 postintervention) were enrolled. Univariate analysis revealed shorter hospital stay (11 ± 15 d vs 7 ± 10 d; p = 0.02) and fewer required therapeutic ICU interventions in the postintervention group (Therapeutic Intervention Scoring System-28 Scores, 19.4 ± 6.8 vs 17.3 ± 6.6; p = 0.04). ICU stay and prevalence of organ dysfunction were not statistically different. Multivariable analysis showed a 1.6-day (95% CI, 1.3-2.03; p = 0.02) decrease in hospital stay in the postintervention group.
Conclusions:
This study suggests that goal-directed therapy administered by a specialized pediatric transport team has the potential to impact the outcomes of critically ill children. Findings from this study should be confirmed across multiple institutions, but have the potential to impact the clinical outcomes of critically ill children with systemic inflammatory response syndrome.
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