Fluid management of the critically Ill child.

PURPOSE OF REVIEW: This review summarizes current literature pertaining to fluid management for critically ill children. It includes an overview on crystalloid fluid used throughout the critical illness course, management of fluid output and complications with fluid overload. RECENT FINDINGS: Observational paediatric studies and adult randomized trials show mixed results regarding risk of mortality and kidney injury with 0.9% saline and crystalloid fluid. A recent adult randomized trial suggests that a fluid restrictive strategy may be well tolerated in critically ill adults with septic shock, but further randomized trials are needed in paediatrics. Fluid overload has been associated with increased morbidity and mortality. Trials exploring ways to decrease fluid accumulation must be done in paediatrics. SUMMARY: Additional high-quality studies are needed to precisely define the type, timing and rate of intravenous fluid critically ill children should receive throughout their clinical illness course.

Creating a Tool to Assess Interpretive Services Perceptions at a Hospital System Level.

The importance of using professional interpretive services (IS) when communicating with patients and families with limited English proficiency (LEP) is well described in the literature. There is no standardized tool to reliably evaluate IS from the point of view of bedside care providers. Collected local qualitative data and literature review informed an anonymous electronic survey that was distributed to physicians and nursing staff at a tertiary care children's hospital. Authors then used exploratory factor analysis to analyze results. Survey response rate was 27%. Seven key factors were identified; the original survey was revised using the two most impactful questions contributing to each factor. Re-analysis showed Pearson correlation coefficients at or above 0.9. Using this simplified 14 question questionnaire, hospital systems can assess the knowledge, attitudes, self-reported utilization and perceived barriers around IS, allowing for targeted interventions to improve the care of LEP patients.