Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU.

OBJECTIVE: To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU. METHODS: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre-established voting thresholds. No industry funding was associated with the guideline development. RESULTS: The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and Population, Intervention, Comparison, Outcome question development. The systematic review search yielded 4,158 reports after deduplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low, and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice. CONCLUSIONS: These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care

Identifying systemic barriers to co-developing Indigenous food systems research within colonial institutions : a case study of Agriculture and Agri-Food Canada

This study aimed to address how colonial research institutions can and should appropriately engage in food systems research and build relationships with Indigenous communities that go beyond tokenistic inclusion and engagement in co-developed research. The research was conducted as a case study with the Indigenous Science Liaison Office (ISLO) within Agriculture and Agri-Food Canada (AAFC). The study included nine semi-structured interviews and one focus group; thematic analysis of the transcripts was used to identify themes in the data. This study found that front-line staff in ISLO identified three primary challenges with respect to co-developed food systems research between AAFC researchers and Indigenous communities: (1) Relationship Building, (2) Administrative Processes and (3) Intercultural Competence and Knowledge. Study participants emphasized that the three themes must be addressed in response to both the historical colonization of Indigenous Peoples in Canada and ongoing power inequalities within Indigenous-Government relations and inequities for Indigenous-led science and research initiatives within colonial institutions. This study includes recommendations for how non-Indigenous institutions can and should address systemic barriers to culturally safe research related to Indigenous food systems. While conversations were specific to ISLO staff, the resulting recommendations are broadly applicable to colonial research institutions at large, such as the AAFC. Ultimately the goal of this study was to support Indigenous food systems research that contributes to Indigenous food security and sovereignty.Land and Food Systems, Faculty ofGraduat

Overfeeding and obesity in young children with positive pressure ventilation via tracheostomy following cardiac surgery

AbstractObjectives:Infants with CHD requiring positive pressure ventilation via tracheostomy are especially vulnerable to malnutrition following cardiac surgery. Current post-operative feeding recommendations may overestimate the caloric needs.Design:We retrospectively studied infants requiring tracheostomy after cardiac surgery. Anthropometric and nutritional data were collected, including caloric goals, weight-for-age z score, length-for-age z score, and weight-for-length z score. Changes in anthropometrics over time were compared to ascertain the impact of nutritional interventions. Data were shown as mean ± standard deviation.Results:Nineteen infants with CHD required tracheostomy at 160 ± 109 days (7–364 days), 13 had reparative surgery, and 6 had palliative surgery for single ventricle. The indications for tracheostomy consisted of airway abnormality/obstruction (n = 13), chronic respiratory failure (n = 7), and/or vocal cord paresis (n = 2). Initial maintenance nutritional target was set at 100–130 cal/kg per day. Fourteen patients (73.7%) became obese (maximum weight-for-length z score: 2.59 ± 0.47) under tracheostomy and gastrostomy feeding, whereas five patients did not (weight-for-length z score: 0.2 ± 0.83). Eight obese patients (weight-for-length z score: 2.44 ± 0.85) showed effective reduction of obesity within 6 months (weight-for-length z score: 0.10 ± 0.20; p &lt; 0.05 compared with pre-adjustment) after appropriate feeding adjustment (40–90 cal/kg per day). Overall mortality was high (31.6%) in this population.Conclusion:Standard nutritional management resulted in overfeeding and obesity in young children with CHD requiring positive pressure ventilation via tracheostomy. Optimal nutritional management in this high-risk population requires close individualised management by multidisciplinary teams.</jats:sec