Reducing Human Album Solution Use in the Pediatric Intensive Care Unit.

Evidence for outcome improvement is limited for using 5% human albumin solution (5% albumin) in pediatric intensive care units (PICUs). However, 5% albumin was injudiciously used in our PICU. Therefore, we aimed to decrease 5% albumin use in pediatric patients (17 years old or younger) in the PICU by 50% in 12 months to improve health care efficiency. Methods: We plotted the mean 5% albumin volume used per PICU admission monthly on statistical process control charts through 3 study periods: baseline period before intervention (July 2019-June 2020), phase 1 (August 2020-April 2021), and phase 2 (May 2021-April 2022). With intervention 1, education, feedback, and an alert sign on 5% albumin stocks began in July 2020. This intervention continued until May 2021, when we executed intervention 2, removing 5% albumin from the PICU inventory. We also examined the lengths of invasive mechanical ventilation and PICU stay as balancing measures across the 3 periods. Results: Mean 5% albumin consumption per PICU admission decreased significantly from 48.1 to 22.4 mL after intervention 1 and 8.3 mL after intervention 2, with the intervention effects persisting for 12 months. Costs associated with 5% albumin per PICU admission significantly decreased by 82%. In terms of patient characteristics and balancing measures, the 3 periods were not different. Conclusions: Stepwise quality improvement interventions, including the system change with the elimination of the 5% albumin inventory from the PICU, were effective in reducing 5% albumin use in the PICU with sustained reduction.

Elevated Central Venous to Arterial CO2 Difference Is Not Associated With Poor Clinical Outcomes After Cardiac Surgery With Cardiopulmonary Bypass in Children.

OBJECTIVE: To investigate whether elevated central venous to arterial CO2 difference is associated with delayed extubation and prolonged ICU stay in children after cardiac surgery with cardiopulmonary bypass. DESIGN: Retrospective review of medical records. SETTING: PICU in a tertiary children's hospital. PATIENTS: Pediatric patients younger than 18 years old who underwent cardiac surgery with cardiopulmonary bypass between January 2014 and December 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In total, 114 patients were included in this study. On ICU admission, blood samples were obtained simultaneously from an arterial line and a central venous line. There were no strong correlations between central venous to arterial CO2 difference (median, 11.1 [8.4-13] mm Hg) and other commonly used variables for the assessment of oxygen delivery including arteriovenous oxyhemoglobin saturation difference (R = 0.16) and blood lactate concentration (R = 0.02). When the patients were divided into two groups, based on the CO2 difference, the high group (difference ≥ 6 mm Hg; n = 103 [90%]) and the low group (difference < 6 mm Hg; n = 11 [10%]) showed no difference in the time to extubation (6 vs 5 hr, respectively; p = 0.80) or in the time to discharge from ICU (4 vs 5 d, respectively; p = 0.49). There was no mortality within 30 days of surgery. CONCLUSIONS: Elevation of central venous to arterial CO2 difference on ICU admission in children after cardiac surgery with cardiopulmonary bypass does not appear to be associated with delayed extubation or prolonged ICU stay.