Chani Traube - Academia.edu (original) (raw)
Papers by Chani Traube
Critical Care Explorations
Pediatric intensivists often use an “analgosedation” approach in mechanically ventilated children... more Pediatric intensivists often use an “analgosedation” approach in mechanically ventilated children. By prioritizing analgesia and minimizing sedation, patients experience less delirium. However, when COVID-19 surged, our pediatric intensive care unit providers were tasked with caring for adults with severe acute hypoxemic respiratory failure (AHRF). As documented in the literature, adults with COVID-19-AHRF received significantly higher doses of sedatives than matched cohorts with non-COVID-19 AHRF. Surprisingly, when the pediatric intensive care unit returned to caring for children, a quality review showed that we were unintentionally using far more sedatives than that prior to COVID-19. This experience is not unique to our institution, or to COVID-19. Lingering effects of crisis care can persist beyond the event itself. We seek to share our experience in order to extend the conversation regarding the unexpected effects of crises on best practices and to stress the need for high-qua...
Pediatric emergency care, Dec 1, 2018
A9.4-kg (38th percentile) 1-year-old girl was found, by her parents, to be difficult to arouse, a... more A9.4-kg (38th percentile) 1-year-old girl was found, by her parents, to be difficult to arouse, and they took her to a pediatric emergency department by private vehicle. Her father reported having found her in her crib this morning sweaty, limp, and difficult to arouse even when lifted. He stated that she “felt like dead weight in my arms.” When being carried into the emergency department, she had her eyes open, but her tone was low, and she was not lifting her head or moving her extremities. In the resuscitation bay, her eyes were open, she was diaphoretic, and she responded weakly to painful stimuli such as nailbed pressure or sternal rub; she occasionally did show some slight spontaneous movement of the extremities. There were no signs of external trauma, and she did not appear to be in pain. Rectal temperature was 35.5°C, and pulse was 50 beats/min and regular, with some variability with stimulation, but still remaining slower than normal for age. The blood pressure was 135/78 mm Hg; oxygen saturation measured by noninvasive pulse oximetry was
Children (Basel), May 1, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Pediatric Intensive Care, Nov 24, 2022
Pediatric Critical Care Medicine, Mar 1, 2021
Pediatric Critical Care Medicine, Oct 8, 2020
Objectives: We describe the process by which a PICU and a PICU care team were incorporated into a... more Objectives: We describe the process by which a PICU and a PICU care team were incorporated into a hospital-wide ICU care model during the coronavirus disease 2019 pandemic. Design: A descriptive, retrospective report from a single-center PICU. Setting: Twenty-three bed, quaternary PICU, within an 862-bed hospital. Patients: Critically ill adults, with coronavirus disease 2019-related disease. Interventions: ICU care provided by pediatric intensivists with training and support from medical intensivists. Measurements and Main Results: Within the context of the institution’s comprehensive effort to centralize and systematize care for adults with severe coronavirus disease 2019 disease, the PICU was transitioned to an adult coronavirus disease 2019 critical care unit. Nurses and physicians underwent just-in-time training over 3 days and 2 weeks, respectively. Medical ICU physicians and nurses provided oversight for care and designated hospital-based teams were available for procedures and common adult emergencies. Over a 7-week period, the PICU cared for 60 adults with coronavirus disease 2019-related critical illness. Fifty-three required intubation and mechanical ventilation for a median of 18 days. Eighteen required renal replacement therapy and 17 died. Conclusions: During the current and potentially in future pandemics, where critical care resources are limited, pediatric intensivists and staff can be readily utilized to meaningfully contribute to the care of critically ill adults.
Pediatric Critical Care Medicine, Jun 1, 2017
Pediatric Blood & Cancer, Dec 30, 2022
Critical Care Medicine, Dec 15, 2022
Critical Care Medicine, Dec 16, 2021
Critical Care Clinics, Apr 1, 2023
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine
OBJECTIVES: Assess clinical outcomes following PICU Liberation ABCDEF Bundle utilization. DESIGN:... more OBJECTIVES: Assess clinical outcomes following PICU Liberation ABCDEF Bundle utilization. DESIGN: Prospective, multicenter, cohort study. SETTING: Eight academic PICUs. PATIENTS: Children greater than 2 months with expected PICU stay greater than 2 days and need for mechanical ventilation (MV). INTERVENTIONS: ABCDEF Bundle implementation. MEASUREMENT AND MAIN RESULTS: Over an 11-month period (3-mo baseline, 8-mo implementation), Bundle utilization was measured for 622 patients totaling 5,017 PICU days. Risk of mortality was quantified for 532 patients (4,275 PICU days) for correlation between Bundle utilization and MV duration, PICU length of stay (LOS), delirium incidence, and mortality. Utilization was analyzed as subject-specific (entire PICU stay) and day-specific (single PICU day). Median overall subject-specific utilization increased from 50% during the 3-month baseline to 63.9% during the last four implementation months (p < 0.001). Subject-specific utilization for element...
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine, 2021
Springer eBooks, Dec 11, 2018
Historically, in pediatric critical care, the patient’s ultimate survival has been our overriding... more Historically, in pediatric critical care, the patient’s ultimate survival has been our overriding priority. As mortality rates have decreased in the PICU over the last decades, we can now focus our efforts on minimizing the morbidities that may result from the experience of pediatric critical illness. Evidence indicates that it is time to restructure our traditional approach to sedation in critically ill children, in order to improve patient outcomes. In this chapter, we will review sedation practices that have been embraced in the past and contrast them to a more modern approach. Although still controversial, we will provide data supporting a minimalist approach to sedation in the majority of critically ill children.
Archives of Physical Medicine and Rehabilitation
Journal of Pediatric Intensive Care
Adverse drug events are common in critically ill children and often result from systemic or targe... more Adverse drug events are common in critically ill children and often result from systemic or target organ drug exposure. Methods of drug dosing and titration that consider pharmacokinetic alterations may improve our ability to optimally dose critically ill patients and reduce the risk for drug-related adverse events. To demonstrate this possibility, we explored the exposure-response relationship between midazolam and delirium in critically ill children. We retrospectively examined electronic health records (EHRs) of critically ill children <18 years of age hospitalized in the pediatric intensive care unit at Duke University; these children were administered midazolam during mechanical ventilation and had ≥1 Cornell Assessment of Pediatric Delirium (CAPD) score. We used individual-level data extracted from the EHR and a previously published population pharmacokinetic (PK) model developed in critically ill children to simulate plasma concentrations at the time of CAPD scores in 1,00...
Pediatric Critical Care Medicine
Critical Care Explorations
Pediatric intensivists often use an “analgosedation” approach in mechanically ventilated children... more Pediatric intensivists often use an “analgosedation” approach in mechanically ventilated children. By prioritizing analgesia and minimizing sedation, patients experience less delirium. However, when COVID-19 surged, our pediatric intensive care unit providers were tasked with caring for adults with severe acute hypoxemic respiratory failure (AHRF). As documented in the literature, adults with COVID-19-AHRF received significantly higher doses of sedatives than matched cohorts with non-COVID-19 AHRF. Surprisingly, when the pediatric intensive care unit returned to caring for children, a quality review showed that we were unintentionally using far more sedatives than that prior to COVID-19. This experience is not unique to our institution, or to COVID-19. Lingering effects of crisis care can persist beyond the event itself. We seek to share our experience in order to extend the conversation regarding the unexpected effects of crises on best practices and to stress the need for high-qua...
Pediatric emergency care, Dec 1, 2018
A9.4-kg (38th percentile) 1-year-old girl was found, by her parents, to be difficult to arouse, a... more A9.4-kg (38th percentile) 1-year-old girl was found, by her parents, to be difficult to arouse, and they took her to a pediatric emergency department by private vehicle. Her father reported having found her in her crib this morning sweaty, limp, and difficult to arouse even when lifted. He stated that she “felt like dead weight in my arms.” When being carried into the emergency department, she had her eyes open, but her tone was low, and she was not lifting her head or moving her extremities. In the resuscitation bay, her eyes were open, she was diaphoretic, and she responded weakly to painful stimuli such as nailbed pressure or sternal rub; she occasionally did show some slight spontaneous movement of the extremities. There were no signs of external trauma, and she did not appear to be in pain. Rectal temperature was 35.5°C, and pulse was 50 beats/min and regular, with some variability with stimulation, but still remaining slower than normal for age. The blood pressure was 135/78 mm Hg; oxygen saturation measured by noninvasive pulse oximetry was
Children (Basel), May 1, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Pediatric Intensive Care, Nov 24, 2022
Pediatric Critical Care Medicine, Mar 1, 2021
Pediatric Critical Care Medicine, Oct 8, 2020
Objectives: We describe the process by which a PICU and a PICU care team were incorporated into a... more Objectives: We describe the process by which a PICU and a PICU care team were incorporated into a hospital-wide ICU care model during the coronavirus disease 2019 pandemic. Design: A descriptive, retrospective report from a single-center PICU. Setting: Twenty-three bed, quaternary PICU, within an 862-bed hospital. Patients: Critically ill adults, with coronavirus disease 2019-related disease. Interventions: ICU care provided by pediatric intensivists with training and support from medical intensivists. Measurements and Main Results: Within the context of the institution’s comprehensive effort to centralize and systematize care for adults with severe coronavirus disease 2019 disease, the PICU was transitioned to an adult coronavirus disease 2019 critical care unit. Nurses and physicians underwent just-in-time training over 3 days and 2 weeks, respectively. Medical ICU physicians and nurses provided oversight for care and designated hospital-based teams were available for procedures and common adult emergencies. Over a 7-week period, the PICU cared for 60 adults with coronavirus disease 2019-related critical illness. Fifty-three required intubation and mechanical ventilation for a median of 18 days. Eighteen required renal replacement therapy and 17 died. Conclusions: During the current and potentially in future pandemics, where critical care resources are limited, pediatric intensivists and staff can be readily utilized to meaningfully contribute to the care of critically ill adults.
Pediatric Critical Care Medicine, Jun 1, 2017
Pediatric Blood & Cancer, Dec 30, 2022
Critical Care Medicine, Dec 15, 2022
Critical Care Medicine, Dec 16, 2021
Critical Care Clinics, Apr 1, 2023
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine
OBJECTIVES: Assess clinical outcomes following PICU Liberation ABCDEF Bundle utilization. DESIGN:... more OBJECTIVES: Assess clinical outcomes following PICU Liberation ABCDEF Bundle utilization. DESIGN: Prospective, multicenter, cohort study. SETTING: Eight academic PICUs. PATIENTS: Children greater than 2 months with expected PICU stay greater than 2 days and need for mechanical ventilation (MV). INTERVENTIONS: ABCDEF Bundle implementation. MEASUREMENT AND MAIN RESULTS: Over an 11-month period (3-mo baseline, 8-mo implementation), Bundle utilization was measured for 622 patients totaling 5,017 PICU days. Risk of mortality was quantified for 532 patients (4,275 PICU days) for correlation between Bundle utilization and MV duration, PICU length of stay (LOS), delirium incidence, and mortality. Utilization was analyzed as subject-specific (entire PICU stay) and day-specific (single PICU day). Median overall subject-specific utilization increased from 50% during the 3-month baseline to 63.9% during the last four implementation months (p < 0.001). Subject-specific utilization for element...
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine, 2021
Springer eBooks, Dec 11, 2018
Historically, in pediatric critical care, the patient’s ultimate survival has been our overriding... more Historically, in pediatric critical care, the patient’s ultimate survival has been our overriding priority. As mortality rates have decreased in the PICU over the last decades, we can now focus our efforts on minimizing the morbidities that may result from the experience of pediatric critical illness. Evidence indicates that it is time to restructure our traditional approach to sedation in critically ill children, in order to improve patient outcomes. In this chapter, we will review sedation practices that have been embraced in the past and contrast them to a more modern approach. Although still controversial, we will provide data supporting a minimalist approach to sedation in the majority of critically ill children.
Archives of Physical Medicine and Rehabilitation
Journal of Pediatric Intensive Care
Adverse drug events are common in critically ill children and often result from systemic or targe... more Adverse drug events are common in critically ill children and often result from systemic or target organ drug exposure. Methods of drug dosing and titration that consider pharmacokinetic alterations may improve our ability to optimally dose critically ill patients and reduce the risk for drug-related adverse events. To demonstrate this possibility, we explored the exposure-response relationship between midazolam and delirium in critically ill children. We retrospectively examined electronic health records (EHRs) of critically ill children <18 years of age hospitalized in the pediatric intensive care unit at Duke University; these children were administered midazolam during mechanical ventilation and had ≥1 Cornell Assessment of Pediatric Delirium (CAPD) score. We used individual-level data extracted from the EHR and a previously published population pharmacokinetic (PK) model developed in critically ill children to simulate plasma concentrations at the time of CAPD scores in 1,00...
Pediatric Critical Care Medicine