Lidia Casanueva - Academia.edu (original) (raw)

Uploads

Papers by Lidia Casanueva

Paediatric Intensive Care Society and British Association for Paediatric Nephrology, 2017

Aim Retrospective clinical audit to evaluate the impact of early referral to the Royal Brompton C... more Aim Retrospective clinical audit to evaluate the impact of early referral to the Royal Brompton Children’s Long Term Ventilation Service (RBH LTVS) of preterm infants dependent on respiratory support. Methodology Retrospective analysis of all preterm infants referred to RBH LTVS and subsequently discharged home on long-term ventilation via tracheostomy (tr-LTV). Patients categorised as those referred before (Group I) and after (Group II) an active engagement process to encourage early referral, supported by specialist commissioners during 2012. Referral gives access to clinical support, web based discharge pathway, and regional education programme. The time from tracheostomy to referral, median hospital length of stay (LOS), and median LOS when medically ‘fit for discharge’ (FFD) from hospital, were measured and compared between the two groups using Kruskall Wallis test. Results During the study period 42 ex-premature infants referred to RBH LTVS were discharged home on tr-LTV. Using tracheostomy as a surrogate marker of need for LTV, 70% of patients in Group II were referred within 30 days of tracheostomy, compared with only 46% in Group I. The median LOS reduced from 461 (355–540) days in Group I to 339 (282–435) days in Group II (p=0.02) with greatest impact on FFD LOS, reduced from 226 (109–305) to 41 (29–130) days (p=0.001). The average number of hospital days when a patient was medically ‘fit for discharge’ reduced from average of 221 to 93. Abstract G461(P) Table 1 Media (IQR)LOS Group I Group II Hospital to Home LOS 2006–12 2012–2016 Total days 461(355–40) 344(209,503) Medical FFD (days) 226 (109,305) 41(29,130) LOS from tache to discharge home (days) 310 (194,336) 149(117,213) The total duration of intensive care stay was 335 (IQR 259– 418) days in Group I and 315 (IQR 260–379) days, which was not statistically significant (p=0.47). Conclusions Enabling early referral of preterm infants dependent on respiratory support to a specialised LTV service can significantly reduce hospital length of stay, particularly when the child is medically fit for discharge. There was no change in the number of ICU days per patient indicating no change in the underlying population’s dependence on critical care.

Paediatric Intensive Care Society and British Association for Paediatric Nephrology, 2017

Aims Tracheostomy can be an infrequent procedure in PICU and has significant associated risks in ... more Aims Tracheostomy can be an infrequent procedure in PICU and has significant associated risks in particular tube occlusion or accidental decannulation.1 In 2014 the National Tracheostomy Safety Project Paediatric team developed national algorithms for managing common tracheostomy emergencies. These had recently been incorporated into updated tracheostomy guidelines within our institution. A tracheostomy quality improvement (QI) team was set up to embed best practice within daily tracheostomy management. The project aim was to improve tracheostomy safety within PICU by achieving 100% compliance with the display of bedhead forms, emergency algorithms and the contents of the patient’s tracheostomy box in the bedspace of all patients with a tracheostomy within 4 months. Method An inter-professional QI project group was established April 2016 comprising PICU and Children’s Long Term Ventilation team staff. The team used Plan Do Study Act (PDSA) cycles to repeatedly evaluate interventions and then refine changes in response. Efficacy was measured and recorded on run charts to track progress (Figures 1 and 2). Results The initial compliance with tracheostomy emergency contents was 60%–70%. Appropriate bedhead signs and emergency algorithms were not being displayed in the bedspace (0% compliance). In total 25 PDSA cycles were undertaken. The run chart (figure 2) demonstrates a consistent improvement in percentage compliance with required emergency box contents during this phase of the project to 92%). The annotated PDSA cycles refer to the examples of interventions: Tracheostomy safety checklist developed for use at bedside Tracheostomy box contents list aligned to match latest practice recommendations One required item not stocked, therefore made readily available Bedside training and coaching around the differing risks between managing new and established tracheostomies Abstract G459 Figure 1 Compliance with tracheostomy box contents. Figure 2 Emergency algorithm and bedhead sign display Both outcomes demonstrated consistent, sustained improvement during the study period. Conclusion During early PDSA cycles a number of previously unrecognised contributing factors were identified as preventing compliance with the established project aim. The QI methodology incorporating PDSA cycles allowed rapid changes to clinical practice in response to issues identified. Multiple factors affecting compliance were addressed during the project. Reference Kremer B et al (2001) ‘Indications, complications, and surgical techniques for paediatric tracheostomies—An update’ J Ped Surg Vol 37, Issue 11, Pages 1556–1562

Paediatric educators’ special interest group (PEdSIG), 2020

Discussion Simprovisation is an innovative style of simulationbased education that allows learner... more Discussion Simprovisation is an innovative style of simulationbased education that allows learners to effectively define and address their own learning needs. Placing the learner in control of the content of the study day is the principal difference between Simprovisation and standard models of simulation. We found that medical students were able to highlight and address learning needs that may not have been fully covered through our existing portfolio of simulation scenarios. We found learners used the opportunity to build on knowledge and share it with peers.

British Paediatric Respiratory Society

Archives of disease in childhood, Jan 5, 2018

The use of long-term ventilation (LTV) in children is growing in the UK and worldwide. This refle... more The use of long-term ventilation (LTV) in children is growing in the UK and worldwide. This reflects the improvement in technology to provide LTV, the growing number of indications in which it can be successfully delivered and the acceptability of LTV to families and children. In this article, we discuss the various considerations to be made when deciding to initiate or continue LTV, describe the process that be followed, as decided by a consensus of experienced physicians, and outline the options available for resolution of conflict around LTV decision making. We recognise the uncertainty and hope provided by novel and evolving therapies for potential disease modification. This raises the question of whether LTV should be offered to allow time for a therapy to be trialled, or whether the therapy is unlikely to be effective, LTV would simply prolong suffering. We put this consensus view forward as an ethical framework for decision making in children requiring LTV.

Cardiology in the young, Jan 16, 2014

Although mortality is low after the modified Fontan procedure, there is a significant percentage ... more Although mortality is low after the modified Fontan procedure, there is a significant percentage of patients with prolonged postoperative recovery. The objective of this study is to evaluate the usefulness of postoperative administration of oral sildenafil and inhaled nitric oxide on early postoperative outcome. A prospective interventional and comparison study with a historical cohort was conducted. Between January, 2010 and March, 2013, 16 patients received oral sildenafil during immediate modified Fontan postoperative period. Inhaled nitric oxide was also administered if the patient was kept intubated 12 hours after surgery. Early postoperative outcome was compared with a historical cohort of 32 patients on whom the modified Fontan procedure was performed between March, 2000 and December, 2009. Postoperative administration of sildenafil and nitric oxide had no influence on early postoperative outcome after the modified Fontan procedure in terms of duration of pleural effusions, m...

Intensive Care Medicine, 2012

presence of some illegible element (59 %). Legibility was the element of prescription experiencin... more presence of some illegible element (59 %). Legibility was the element of prescription experiencing the greatest reduction in error rate, from 4.1 % of prescriptions with one or more illegible elements in period 1 to 0.2 % in period 2. Tenfold overdosage decreased from two cases in period 1 to one case in period 2. The attending physician and on-call physician were associated with more PEs in both periods. The number of prescriptions with two or more errors decreased from 3.1 to 0.7 %. Errors reaching the patient were scarce, 14 (0.63 %) in period 1 and 6 (0.34 %) in period 2, without adverse events. Conclusions: Implementation of an educational program for physicians may significantly reduce the prescribing error rate in a PICU.

Se analizó a los pacientes en conjunto y distribuidos por la especie infectante (para aquellos gr... more Se analizó a los pacientes en conjunto y distribuidos por la especie infectante (para aquellos grupos con ≥15 pacientes). Se incluyó un total de 125 candidiasis invasivas: 47 por C. albicans, 37 por C. parapsilosis, 19 por C. tropicalis, 4 por C. glabrata, y 18 casos por otras especies. Hasta un 66% de las candidiasis invasivas por C. albicans y un 75,7% de las causadas por C. parapsilosis ocurrieron en niños ≤24 meses, mientras que el porcentaje de niños con >60 meses fue mayor en el grupo de candidiasis invasiva por C. tropicalis. La candidemia fue la infección más frecuente en el grupo de infecciones por C. tropicalis (78,9%) o C. parapsilosis (83,8%), pero las infecciones del tracto urinario fueron tan frecuentes como la bacteremia entre las infecciones por C. albicans (31,9% y 38,3%, respectivamente). La fiebre refractaria a antimicrobianos fue el criterio de huésped más frecuente (46,4% pacientes), pero con igual frecuencia que la neutropenia prolongada en la candidiasis in...

Core Topics in Cardiothoracic Critical Care

Journal of paediatrics and child health, 2021

Paediatric Intensive Care Society and British Association for Paediatric Nephrology, 2017

Aim Retrospective clinical audit to evaluate the impact of early referral to the Royal Brompton C... more Aim Retrospective clinical audit to evaluate the impact of early referral to the Royal Brompton Children’s Long Term Ventilation Service (RBH LTVS) of preterm infants dependent on respiratory support. Methodology Retrospective analysis of all preterm infants referred to RBH LTVS and subsequently discharged home on long-term ventilation via tracheostomy (tr-LTV). Patients categorised as those referred before (Group I) and after (Group II) an active engagement process to encourage early referral, supported by specialist commissioners during 2012. Referral gives access to clinical support, web based discharge pathway, and regional education programme. The time from tracheostomy to referral, median hospital length of stay (LOS), and median LOS when medically ‘fit for discharge’ (FFD) from hospital, were measured and compared between the two groups using Kruskall Wallis test. Results During the study period 42 ex-premature infants referred to RBH LTVS were discharged home on tr-LTV. Using tracheostomy as a surrogate marker of need for LTV, 70% of patients in Group II were referred within 30 days of tracheostomy, compared with only 46% in Group I. The median LOS reduced from 461 (355–540) days in Group I to 339 (282–435) days in Group II (p=0.02) with greatest impact on FFD LOS, reduced from 226 (109–305) to 41 (29–130) days (p=0.001). The average number of hospital days when a patient was medically ‘fit for discharge’ reduced from average of 221 to 93. Abstract G461(P) Table 1 Media (IQR)LOS Group I Group II Hospital to Home LOS 2006–12 2012–2016 Total days 461(355–40) 344(209,503) Medical FFD (days) 226 (109,305) 41(29,130) LOS from tache to discharge home (days) 310 (194,336) 149(117,213) The total duration of intensive care stay was 335 (IQR 259– 418) days in Group I and 315 (IQR 260–379) days, which was not statistically significant (p=0.47). Conclusions Enabling early referral of preterm infants dependent on respiratory support to a specialised LTV service can significantly reduce hospital length of stay, particularly when the child is medically fit for discharge. There was no change in the number of ICU days per patient indicating no change in the underlying population’s dependence on critical care.

Paediatric Intensive Care Society and British Association for Paediatric Nephrology, 2017

Aims Tracheostomy can be an infrequent procedure in PICU and has significant associated risks in ... more Aims Tracheostomy can be an infrequent procedure in PICU and has significant associated risks in particular tube occlusion or accidental decannulation.1 In 2014 the National Tracheostomy Safety Project Paediatric team developed national algorithms for managing common tracheostomy emergencies. These had recently been incorporated into updated tracheostomy guidelines within our institution. A tracheostomy quality improvement (QI) team was set up to embed best practice within daily tracheostomy management. The project aim was to improve tracheostomy safety within PICU by achieving 100% compliance with the display of bedhead forms, emergency algorithms and the contents of the patient’s tracheostomy box in the bedspace of all patients with a tracheostomy within 4 months. Method An inter-professional QI project group was established April 2016 comprising PICU and Children’s Long Term Ventilation team staff. The team used Plan Do Study Act (PDSA) cycles to repeatedly evaluate interventions and then refine changes in response. Efficacy was measured and recorded on run charts to track progress (Figures 1 and 2). Results The initial compliance with tracheostomy emergency contents was 60%–70%. Appropriate bedhead signs and emergency algorithms were not being displayed in the bedspace (0% compliance). In total 25 PDSA cycles were undertaken. The run chart (figure 2) demonstrates a consistent improvement in percentage compliance with required emergency box contents during this phase of the project to 92%). The annotated PDSA cycles refer to the examples of interventions: Tracheostomy safety checklist developed for use at bedside Tracheostomy box contents list aligned to match latest practice recommendations One required item not stocked, therefore made readily available Bedside training and coaching around the differing risks between managing new and established tracheostomies Abstract G459 Figure 1 Compliance with tracheostomy box contents. Figure 2 Emergency algorithm and bedhead sign display Both outcomes demonstrated consistent, sustained improvement during the study period. Conclusion During early PDSA cycles a number of previously unrecognised contributing factors were identified as preventing compliance with the established project aim. The QI methodology incorporating PDSA cycles allowed rapid changes to clinical practice in response to issues identified. Multiple factors affecting compliance were addressed during the project. Reference Kremer B et al (2001) ‘Indications, complications, and surgical techniques for paediatric tracheostomies—An update’ J Ped Surg Vol 37, Issue 11, Pages 1556–1562

Paediatric educators’ special interest group (PEdSIG), 2020

Discussion Simprovisation is an innovative style of simulationbased education that allows learner... more Discussion Simprovisation is an innovative style of simulationbased education that allows learners to effectively define and address their own learning needs. Placing the learner in control of the content of the study day is the principal difference between Simprovisation and standard models of simulation. We found that medical students were able to highlight and address learning needs that may not have been fully covered through our existing portfolio of simulation scenarios. We found learners used the opportunity to build on knowledge and share it with peers.

British Paediatric Respiratory Society

Archives of disease in childhood, Jan 5, 2018

The use of long-term ventilation (LTV) in children is growing in the UK and worldwide. This refle... more The use of long-term ventilation (LTV) in children is growing in the UK and worldwide. This reflects the improvement in technology to provide LTV, the growing number of indications in which it can be successfully delivered and the acceptability of LTV to families and children. In this article, we discuss the various considerations to be made when deciding to initiate or continue LTV, describe the process that be followed, as decided by a consensus of experienced physicians, and outline the options available for resolution of conflict around LTV decision making. We recognise the uncertainty and hope provided by novel and evolving therapies for potential disease modification. This raises the question of whether LTV should be offered to allow time for a therapy to be trialled, or whether the therapy is unlikely to be effective, LTV would simply prolong suffering. We put this consensus view forward as an ethical framework for decision making in children requiring LTV.

Cardiology in the young, Jan 16, 2014

Although mortality is low after the modified Fontan procedure, there is a significant percentage ... more Although mortality is low after the modified Fontan procedure, there is a significant percentage of patients with prolonged postoperative recovery. The objective of this study is to evaluate the usefulness of postoperative administration of oral sildenafil and inhaled nitric oxide on early postoperative outcome. A prospective interventional and comparison study with a historical cohort was conducted. Between January, 2010 and March, 2013, 16 patients received oral sildenafil during immediate modified Fontan postoperative period. Inhaled nitric oxide was also administered if the patient was kept intubated 12 hours after surgery. Early postoperative outcome was compared with a historical cohort of 32 patients on whom the modified Fontan procedure was performed between March, 2000 and December, 2009. Postoperative administration of sildenafil and nitric oxide had no influence on early postoperative outcome after the modified Fontan procedure in terms of duration of pleural effusions, m...

Intensive Care Medicine, 2012

presence of some illegible element (59 %). Legibility was the element of prescription experiencin... more presence of some illegible element (59 %). Legibility was the element of prescription experiencing the greatest reduction in error rate, from 4.1 % of prescriptions with one or more illegible elements in period 1 to 0.2 % in period 2. Tenfold overdosage decreased from two cases in period 1 to one case in period 2. The attending physician and on-call physician were associated with more PEs in both periods. The number of prescriptions with two or more errors decreased from 3.1 to 0.7 %. Errors reaching the patient were scarce, 14 (0.63 %) in period 1 and 6 (0.34 %) in period 2, without adverse events. Conclusions: Implementation of an educational program for physicians may significantly reduce the prescribing error rate in a PICU.

Se analizó a los pacientes en conjunto y distribuidos por la especie infectante (para aquellos gr... more Se analizó a los pacientes en conjunto y distribuidos por la especie infectante (para aquellos grupos con ≥15 pacientes). Se incluyó un total de 125 candidiasis invasivas: 47 por C. albicans, 37 por C. parapsilosis, 19 por C. tropicalis, 4 por C. glabrata, y 18 casos por otras especies. Hasta un 66% de las candidiasis invasivas por C. albicans y un 75,7% de las causadas por C. parapsilosis ocurrieron en niños ≤24 meses, mientras que el porcentaje de niños con >60 meses fue mayor en el grupo de candidiasis invasiva por C. tropicalis. La candidemia fue la infección más frecuente en el grupo de infecciones por C. tropicalis (78,9%) o C. parapsilosis (83,8%), pero las infecciones del tracto urinario fueron tan frecuentes como la bacteremia entre las infecciones por C. albicans (31,9% y 38,3%, respectivamente). La fiebre refractaria a antimicrobianos fue el criterio de huésped más frecuente (46,4% pacientes), pero con igual frecuencia que la neutropenia prolongada en la candidiasis in...

Core Topics in Cardiothoracic Critical Care

Journal of paediatrics and child health, 2021