Risk Factors Associated With Pressure Injury in Pediatric Congenital Heart Disease Patients

Pediatric congenital heart disease (CHD) patients have unique risk factors associated with the pathophysiology of abnormal heart function. This vulnerable population is likely at an increased risk of acquiring a pressure injury during hospitalization. There are limited studies that include congenital heart disease patients and more specifically, factors unique to these patients. The purpose of this study was to identify risk factors associated with development of pressure injury in pediatric CHD patients. This retrospective study used a convenience sample from hospital-acquired data including subjects with congenital heart disease. The results demonstrated an association between pressure injury development and variables both known in literature and those specific to the population. Corticosteroid and anticoagulation use were most likely to result in the development of a pressure injury. The study findings inform nursing practice and demonstrate a need to implement further prevention practices

Improvements in Bilateral Differences in Lean Mass and Strength in Persons with Parkinson’s Disease Presenting Unilateral Motor Symptoms

In persons with Parkinson’s disease (PD), individuals present altered motor symptoms such as rigidity, tremors and bradykinesia. These motor symptoms typically present in the early stages of PD unilaterally. Resistance training with instability (RTI) and cadence walking (CW) are effective in improving markers of fragility and motor function. The benefit of combining RTI and CW and its effects on lean mass and strength hav not been studied. PURPOSE: to examine the effects of RTI, CW and RTI+CW on lean mass in affected and unaffected sides and strength in persons with PD. METHODS: individuals diagnosed with mild to moderate PD (N=18 ( 6 female, 12 males); MHY stage=1.53 + 0.50; age = 63.67 + 7.23 y; BMI = 27.38 + 3.88 kg/m2) were randomized into RTI, CW or RTI+CW exercise groups for 8-weeks. RTI and CW were performed 3 days/week and RTI+CW was performed 4 days/week (2 days RTI and 2 days CW). RTI included full-body machine and free-weight exercises with volume (reps and sets) and instability progressions. CW included volume (time) and intensity (speed) progressions for 8-weeks. DXA scans and strength assessments were performed at pre- and post-assessments. RESULTS: A significant difference was present between affected and unaffected sides of lean mass in the upper and lower body of PD participants, with the unaffected side averaging more lean mass for all groups. The average lean mass at pre-assessments in the unaffected arm was 2.92 + 1.05 kg versus the affected arm at 2.80 + 0.99 kg, p=0.043. The difference in the unaffected and affected arms’ lean mass decreased and was no longer significant at post-assessments (unaffected 2.9 + 1.01 kg and affected 2.88 + 1.00 kg, p=0.165), indicating a significant time effect. There was not a significant difference in lean mass for the affected and unaffected legs. A significant group x time effect was observed for RTI and RTI+CW in comparison to CW alone for lean mass differences in affected and unaffected arms at post-assessments (p=0.048 and p=0.44). A significant difference was noted between RTI and RTI+CW in comparison to CW alone in chest press improvements at post-assessments (RTI 30.00 + 16.43 lbs, CW 7.50 + 11.29 lbs, p=0.033 and RTI+CW 18.33 + 7.53 lbs, p=0.47). Interestingly, no group differences in leg press were noted. CONCLUSION: Bilateral differences exist in lean mass DXA results in the affected and unaffected arms of persons with PD who present motor symptoms unilaterally. The bilateral differences in lean mass are improved in RTI and RTI+CW but not in CW alone

Prevalence of ICU delirium in postoperative pediatric cardiac surgery patients

OBJECTIVES: The objective of this study was to determine the prevalence of ICU delirium in children less than 18 years old that underwent cardiac surgery within the last 30 days. The secondary aim of the study was to identify risk factors associated with ICU delirium in postoperative pediatric cardiac surgical patients. DESIGN: A 1-day, multicenter point-prevalence study of delirium in pediatric postoperative cardiac surgery patients. SETTING: Twenty-seven pediatric cardiac and general critical care units caring for postoperative pediatric cardiac surgery patients in North America. PATIENTS: All children less than 18 years old hospitalized in the cardiac critical care units at 06:00 on a randomly selected, study day. INTERVENTIONS: Eligible children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the study team in collaboration with the bedside nurse. MEASUREMENT AND MAIN RESULTS: Overall, 181 patients were enrolled and 40% (n = 73) screened positive for delirium. There were no statistically significant differences in patient demographic information, severity of defect or surgical procedure, past medical history, or postoperative day between patients screening positive or negative for delirium. Our bivariate analysis found those patients screening positive had a longer duration of mechanical ventilation (12.8 vs 5.1 d; p = 0.02); required more vasoactive support (55% vs 26%; p = 0.0009); and had a higher number of invasive catheters (4 vs 3 catheters; p = 0.001). Delirium-positive patients received more total opioid exposure (1.80 vs 0.36 mg/kg/d of morphine equivalents; p \u3c 0.001), did not have an ambulation or physical therapy schedule (p = 0.02), had not been out of bed in the previous 24 hours (p \u3c 0.0002), and parents were not at the bedside at time of data collection (p = 0.008). In the mixed-effects logistic regression analysis of modifiable risk factors, the following variables were associated with a positive delirium screen: 1) pain score, per point increase (odds ratio, 1.3; 1.06-1.60); 2) total opioid exposure, per mg/kg/d increase (odds ratio, 1.35; 1.06-1.73); 3) SBS less than 0 (odds ratio, 4.01; 1.21-13.27); 4) pain medication or sedative administered in the previous 4 hours (odds ratio, 3.49; 1.32-9.28); 5) no progressive physical therapy or ambulation schedule in their medical record (odds ratio, 4.40; 1.41-13.68); and 6) parents not at bedside at time of data collection (odds ratio, 2.31; 1.01-5.31). CONCLUSIONS: We found delirium to be a common problem after cardiac surgery with several important modifiable risk factors