Careplan

    Pneumonia (Pediatric Inpatient)

    Nov.08.2021

    Pneumonia (Pediatric Inpatient)

    Clinical Description

    • Care of the hospitalized child experiencing an infection of the pulmonary parenchyma that occurs as either a primary disease or as a complication of another condition.

    Key Information

    • Knowledge of previous antimicrobial therapy exposure and drug resistance patterns in the patient’s local area may influence choice of empiric antimicrobial therapy (e.g., methicillin, beta-lactam, macrolide).
    • De-escalated (narrowing antibiotic therapy or changing from combination to monotherapy) rather than fixed antibiotic regimens are suggested for patients with hospital-acquired pneumonia and ventilator-associated pneumonia.

    Clinical Goals

    By transition of care

    A. The patient will achieve the following goals:
    • Fluid Balance

    • Resolution of Infection Signs and Symptoms

    • Effective Oxygenation and Ventilation

    B. Patient, family or significant other will teach back or demonstrate education topics and points:
    • Education: Overview
    • Education: Self Management
    • Education: When to Seek Medical Attention

    Correlate Health Status

    • Correlate health status to:

      • history, comorbidity, congenital anomaly
      • age, developmental level
      • sex, gender identity
      • baseline assessment data
      • physiologic status
      • response to medication and interventions
      • psychosocial status, social determinants of health
      • barriers to accessing care and services
      • child and family/caregiver:
        • health literacy
        • cultural and spiritual preferences
      • safety risks
      • family interaction
      • plan for transition of care

    Fluid Imbalance

    Signs/Symptoms/Presentation: Fluid Deficit

    • capillary refill delayed
    • eyes sunken
    • fatigue
    • fontanel sunken (infant)
    • irritability
    • listless
    • mucous membranes dry
    • peripheral pulse strength decreased
    • skin turgor decreased
    • tearing decreased or absent
    • thirst
    • urinary output decreased
    • urine concentration increased

    Signs/Symptoms/Presentation: Fluid Excess

    • acute weight gain
    • bounding pulses
    • breath sounds change
    • crackles in lungs
    • edema
    • neck and hand veins distended
    • positive fluid balance
    • restlessness
    • shortness of breath
    • wheezing

    Vital Signs

    • heart rate increased or decreased
    • blood pressure increased or decreased

    Laboratory Values

    • BUN (blood urea nitrogen) abnormal
    • Hct (hematocrit) abnormal
    • serum sodium abnormal
    • urine specific gravity abnormal

    Problem Intervention

    Monitor and Manage Fluid Balance

    • Assess fluid requirements to determine fluid therapy strategy.
    • Keep accurate intake, output and daily weight; monitor trends.
    • Monitor laboratory value trends and need for treatment adjustment.
    • Assess need for ongoing intravenous fluid therapy; encourage oral intake when able.
    • Assess neurologic status frequently due to risk of hyponatremia.

    Associated Documentation

    • Fluid/Electrolyte Management

    Infection

    Signs/Symptoms/Presentation

    • appetite change
    • capillary refill delayed
    • chest discomfort
    • chills
    • diaphoresis
    • fatigue
    • feeding pattern and tolerance change
    • irritability
    • lethargic
    • listless
    • lymphadenopathy
    • malaise
    • mental status change
    • night sweats
    • pallor
    • respiratory pattern change
    • restlessness
    • shivering
    • skin cool and moist
    • skin flushed
    • skin mottled
    • skin warm
    • sleepiness
    • urinary output decreased

    Vital Signs

    • heart rate increased
    • respiratory rate increased
    • blood pressure increased or decreased
    • SpO2 (peripheral oxygen saturation) decreased
    • body temperature elevated

    Laboratory Values

    • ABG (arterial blood gas) abnormal
    • CBC (complete blood count) with differential abnormal
    • blood glucose level abnormal
    • CRP (C-reactive protein) elevated
    • culture positive
    • ESR (erythrocyte sedimentation rate) elevated
    • gram stain positive
    • PCT (procalcitonin) increased
    • serum lactate elevated

    Diagnostic Results

    • chest ultrasound abnormal
    • CXR (chest x-ray) abnormal

    Problem Intervention

    Prevent Infection Progression

    • Implement transmission-based precautions and isolation, as indicated, to prevent spread of infection.
    • Obtain cultures prior to initiating antimicrobial therapy when possible. Do not delay treatment for laboratory results in the presence of high suspicion or clinical indicators.
    • Administer ordered antimicrobial therapy promptly; reassess need regularly.
    • Monitor laboratory value, diagnostic test and clinical status trends for signs of infection progression.
    • Identify early signs of sepsis, such as increased heart rate or temperature, as well as changes in mental state, respiratory pattern or peripheral perfusion.
    • Prepare for rapid sepsis management, including lactate level, intravenous access, fluid administration and oxygen therapy.
    • Provide fever-reduction and comfort measures.

    Associated Documentation

    • Fever Reduction/Comfort Measures
    • Infection Management
    • Isolation Precautions

    Respiratory Compromise

    Signs/Symptoms/Presentation

    • breath sounds abnormal
    • breathing pattern ineffective
    • breathlessness
    • confusion
    • cough impaired
    • cough increased
    • cyanosis
    • feeding difficulty
    • irritability
    • restlessness
    • shortness of breath
    • sputum (amount, color or consistency) change
    • swallow function impaired
    • work of breathing increased

    Vital Signs

    • heart rate increased
    • respiratory rate increased
    • SpO2 (peripheral oxygen saturation) decreased

    Laboratory Values

    • ABG (arterial blood gas) abnormal

    Diagnostic Results

    • chest ultrasound abnormal
    • CXR (chest x-ray) abnormal

    Problem Intervention

    Promote Airway Secretion Clearance

    • Assess the effectiveness of pulmonary hygiene and ability to perform airway clearance techniques.
    • Promote early mobility or ambulation; match activity to ability and tolerance.
    • Encourage deep breathing and lung expansion therapy to prevent atelectasis; adjust treatment to patient’s response.
    • Anticipate the need to splint chest or abdominal wall with cough to minimize discomfort; assist if needed.
    • Initiate cough-enhancement and airway-clearance techniques with instruction.
    • Consider pharmacologic therapy, such as beta-2 agonist, mucolytic, corticosteroid, antimicrobial, that may improve inflammation, mucus clearance, cough response and air flow.

    Associated Documentation

    • Breathing Techniques/Airway Clearance
    • Cough And Deep Breathing

    Problem Intervention

    Optimize Oxygenation and Ventilation

    • Assess and monitor airway, breathing and circulation for effective oxygenation and ventilation; consider oxygenation and ventilation parameters and goal.
    • Maintain head of bed elevation with regular position changes to minimize ventilation-perfusion mismatch and breathlessness; consider prone positioning to maximize alveolar recruitment.
    • Provide oxygen therapy judiciously to avoid hyperoxemia; adjust to achieve oxygenation goal.
    • Monitor fluid balance closely to minimize the risk of fluid overload.
    • Consider positive pressure ventilation to enhance oxygenation and ventilation, as well as reduce work of breathing.

    Associated Documentation

    • Airway/Ventilation Management
    • Head of Bed (HOB) Positioning

    Education

    CPG-Specific Education Topics

    Overview

    • description

    • signs/symptoms

    Self Management

    • activity

    • fluid/food intake

    • immunizations

    • infection prevention

    • medication management

    • pulmonary hygiene

    • tobacco use, smoke exposure

    • VTE prevention

    When to Seek Medical Attention

    • unresolved/worsening symptoms

    • VTE symptoms

    General Education Topics

    General Education

    • admission, transition of care

    • orientation to care setting, routine

    • advance care planning

    • diagnostic tests/procedures

    • diet modification

    • opioid medication management

    • oral health

    • medication management

    • pain assessment process

    • safe medication disposal

    • tobacco use, smoke exposure

    • treatment plan

    Safety Education

    • call light use

    • equipment/home supplies

    • fall prevention

    • harm prevention

    • infection prevention

    • MDRO (multidrug-resistant organism) care

    • personal health information

    • resources for support

    References

    • (2018). Heuer, A. J.; Scanlan, C. L. (Eds.), Wilkins' Clinical Assessment in Respiratory Care. St. Louis: Elsevier. [Core Curriculum]
    • (2018). Heuer, A. J.; Scanlan, C. L. (Eds.), Wilkins' Clinical Assessment in Respiratory Care. St. Louis: Elsevier. [Core Curriculum]
    • (2019). Walsh, B. K (Eds.), Neonatal and pediatric respiratory care. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • (2019). Walsh, B. K (Eds.), Neonatal and pediatric respiratory care. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Alobaidi, R.; Morgan, C.; Basu, R. K.; Stenson, E.; Featherstone, R.; Majumdar, S. R.; Bagshaw, S. M. Association between fluid balance and outcomes in critically ill children: A systematic review and meta-analysis. JAMA Pediatrics. 2018;172(3), 257-268. doi:10.1001/jamapediatrics.2017.4540 [Metasynthesis,Meta-analysis,Systematic Review]
    • Alobaidi, R.; Morgan, C.; Basu, R. K.; Stenson, E.; Featherstone, R.; Majumdar, S. R.; Bagshaw, S. M. Association between fluid balance and outcomes in critically ill children: A systematic review and meta-analysis. JAMA Pediatrics. 2018;172(3), 257-268. doi:10.1001/jamapediatrics.2017.4540 [Metasynthesis,Meta-analysis,Systematic Review]
    • Barlam, T. F.; Cosgrove, S. E.; Abbo, L. M.; MacDougall, C.; Schuetz, A. N.; Septimus, E. J.; Srinivasan, A.; Dellit, T. H.; Falack-Ylter, Y. T.; Fishman, N. O.; Hamilton, C. W. Implementing an antibiotic stewardship program: Guidelines by the Infectious Disease Society of American and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases. 2016;62(10), e51-e77. doi:10.1093/cid/ciw118 Source[Quality Measures,Clinical Practice Guidelines]
    • Canada, T. W.; Tajchman, S. K.; Tucker, A. M.; Ybarra, J. V. (2015). A.S.P.E.N. Fluids, electrolytes, and acid-base disorders handbook. Silver Spring, MD: American Society of Parenteral and Enteral Nutrition. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Chatwin, M.; Toussaint, M.; Gonçalves, M. R.; Sheers, N.; Mellies, U.; Gonzales-Bermejo, J.; Sancho, J.; Fauroux, B.; Andersen, T.; Hov, B.; Nygren-Bonnier, M.; Lacombe, M.; Pernet, K.; Kampelmacher, M.; Devaux, C.; Kinnett, K.; Sheehan, D.; Rao, F.; Villanova, M.; Berlowitz, D.; Morrow, B. M. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respiratory Medicine. 2018;136, 98-110. doi:10.1016/j.rmed.2018.01.012 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Chaves, G. S. S.; Freitas, D. A.; Santino, T. A.; Nogueira, P. A. M. S.; Fregonezi, G. A. F.; Mendonça, K. M. P. P. Chest physiotherapy for pneumonia in children. Cochrane Database of Systematic Reviews. 2019;(1) doi:10.1002/14651858.CD010277.pub3 [Metasynthesis,Meta-analysis,Systematic Review]
    • College of Respiratory Therapists of Ontario. (2013). Oxygen therapy clinical best practice guideline. Source[Quality Measures,Clinical Practice Guidelines]
    • Cuello-Garcia, C. A.; Mai, S. H. C.; Simpson, R.; Al-Harbi, S.; Choong, K. Early mobilization in critically ill children: A systematic review. Journal of Pediatrics. 2018;203, 25-33. [Metasynthesis,Meta-analysis,Systematic Review]
    • Davis, A. L.; Carcillo, J. A.; Aneja, R. K.; Deymann, A. J.; Lin, J. C.; Nguyen, T. C.; Okhuysen-Cawley, R. S.; Relvas, M. S.; Rozenfeld, R. A.; Skippen, P. W.; Stojadinovic, B. J.; Williams, E. A.; Yeh, T. S.; Balamuth, F.; Brierley, J.; de Caen, A. R.; Cheifetz, I. M.; Choong, K.; Conway Jr., E.; Cornell, T.; Doctor, A.; Dugas, M. A.; Feldman, J. D.; Fitzgerald, J. C.; Flori, H. R.; Fortenberry, J. D.; Graciano, A. L.; Greenwald, B. M.; Hall, M. W.; Han, Y. Y.; Hernan, L. J.; Irazuzta, J. E.; Iselin, E.; van der Jagt, É. W.; Jeffries, H. E.; Kache, S.; Katyal, C.; Kissoon, N.; Kon, A. A.; Kutko, M. C.; MacLaren, G.; Maul, T.; Mehta, R.; Odetola, F.; Parbuoni, K.; Paul, R.; Peters, M. J.; Ranjit, S.; Reuter-Rice, K. E.; Schnitzler, E. J.; Scott, H. F.; Torres Jr., A.; Weingarten-Abrams, J.; Weiss, S. L.; Zimmerman, J. J.; Zuckerberg, A. L. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Critical Care Medicine. 2017;45(6), 1061-1093. doi:10.1097/CCM.0000000000002425 [Quality Measures,Clinical Practice Guidelines]
    • Davis, M. D.; Walsh, B. K.; Sittig, S. E.;Restrepo, R. D.. AARC clinical practice guideline: Blood gas analysis and hemoximetry. Respiratory Care. 2013;58(10), 1694-1703. [Quality Measures,Clinical Practice Guidelines]
    • Dean, P.; Florin, T.A.. Factors associated with pneumonia severity in children: a systematic review. Journal of the Pediatric Infectious Diseases Society. 2018;7(4), 323-334. doi:10.1093/jpids/piy046 [Systematic Review]
    • Evans, L.; Rhodes, A.; Alhazzani, W.; Antonelli, M.; Coopersmith, C. M.; et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Medicine. 2021; doi:10.1007/s00134-021-06506-y Source[Clinical Practice Guidelines]
    • Evans, L.; Rhodes, A.; Alhazzani, W.; Antonelli, M.; Coopersmith, C. M.; et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Medicine. 2021; doi:10.1007/s00134-021-06506-y Source[Clinical Practice Guidelines]
    • Feld, L. G.; Neuspiel, D. R.; Foster, B. A.; Leu, M. G.; Garber, M. D.; Austin, K.; Basu, R. K.; Conway, E. E.; Fehr, J. J.; Hawkins, C.; Kaplan, R. L.; Rowe, E. V.; Waseem, M.; Moritz, M. L. Clinical practice guideline: Maintenance intravenous fluids in children. Pediatrics. 2018, Dec;142(6), e20183083. doi:10.1542/peds.2018-3083 [Quality Measures,Clinical Practice Guidelines]
    • Fuchs, J.; Adams, S. T.; Byerley, J. Current issues in intravenous fluid use in hospitalized children. Reviews on Recent Clinical Trials. 2017;12(4), 284-289. doi:10.2174/1574887112666170816145122 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Gale, B.; Hall, K. K. (2020, Mar). In Sepsis Recognition. Hall, K. K.; Shoemaker-Hunt, S.; Hoffman, L.; et al (Eds.), Making Healthcare Safer III: A critical analysis of existing and emerging patient safety practices [Internet]. Rockville, MD: Agency for Healthcare Research and Quality (US). Source[Policy/Practice Standards,Expert/Committee Opinion]
    • Gerber, J. S.; Jackson, M. A.; Tamma, P. D.; Zaoutis, T. E.; Committee on Infectious Diseases. AAP Policy Statement: Antibiotic Stewardship in Pediatrics. Pediatrics. 2021;147(1) doi:10.1542/peds.2020-040295 Source[Expert/Committee Opinion]
    • Gulanick, M.; Myers, J. (2022). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. St. Louis: Elsevier. [Core Curriculum]
    • Harris, M.; Clark, J.; Coote, N.; Fletcher, P.; Harnden, A.; McKean, M.; Thomson, A. British Thoracic Society guidelines for the management of community acquired pneumonia in children: Update 2011. Thorax. 2011;66(Suppl 2), ii1, ii23. doi:10.1136/thoraxjnl-2011-200598 [Quality Measures,Clinical Practice Guidelines]
    • Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019). Wong's nursing care of infants and children. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019). Wong's nursing care of infants and children. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019). Wong's nursing care of infants and children. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Jochum, F.; Moltu, S. J.; Senterre, T.; Nomayo, A.; Goulet, O.; Iacobelli, S.; Braegger, C.; Bronsky, J.; Cai, W.; Campoy, C.; Carnielli, V. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Fluid and electgrolytes. Clinical Nutrition. 2018;37(6), 2344-2353. doi:10.1016/j.clnu.2018.06.948 Source[Quality Measures,Clinical Practice Guidelines]
    • Joffe, A.; Anton, N.; Lequier, L.; Vandermeer, B.; Tjosvold, L.; Larsen, B.; Hartling, L. Nutritional support for critically ill children. Cochrane Database of Systematic Reviews. 2016;(5) doi:10.1002/14651858.CD005144.pub3 [Metasynthesis,Meta-analysis,Systematic Review]
    • Lassi, Z. S.; Padhani, Z. A.; Das, I. K.; Salam, R. A.; Rhutta, Z. A. Antibiotic therapy versus no antibiotic therapy for children aged 2 to 59 months with WHO-defined non-severe pneumonia and wheeze. Cochrane Database of Systematic Reviews. 2021;1(1) doi:10.1002/14651858.CD009576.pub3 [Systematic Review]
    • Lauwer, E.; Ides, K.; Van Hoorenbeeck, K.; Verhulst, S. The effect of intrapulmonary percussive ventilation in pediatric patients: A systematic review. Pediatric Pulmonology. 2018;53, 1463-1474. doi:10.1002/ppul.24135 [Metasynthesis,Meta-analysis,Systematic Review]
    • Luo, J.; Duke, T.; Chisti, M. J.; Kepreotes, E.; Kalinowski, V.; Li, J. Efficacy of high-flow nasal cannula vs standard oxygen therapy or nasal continuous positive airway pressure in children with respiratory distress: A meta-analysis. The Journal of Pediatrics. 2019, Dec;215, 199-208.e8. doi:10.1016/j.jpeds.2019.07.059 Source[Meta-analysis]
    • Mathur, S.; Fuchs, A.; Bielicki, J.; Van Den Anker, J.; Sharland, M. Antibiotic use for community-acquired pneumonia in neonates and children: WHO evidence review. Paediatrics and International Child Health. 2018;38(Suppl 1), S66-S75. doi:10.1080/20469047.2017.1409455 [Metasynthesis,Meta-analysis,Systematic Review]
    • National Institute for Health and Care Excellence (NICE). (2014). NICE quality standard:  Infection prevention and control. Manchester, England: National Institute for Health and Care Excellence (NICE). [Quality Measures,Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence (NICE). (2019). Pneumonia (community acquired): antimicrobial prescribing [NG138]. Manchester, England: National Institute for Health and Care Excellence (NICE). Source[Quality Measures,Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence (NICE). (2019). Pneumonia (community acquired): antimicrobial prescribing [NG138]. Manchester, England: National Institute for Health and Care Excellence (NICE). Source[Quality Measures,Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence (NICE). (2019). Pneumonia (hospital-acquired): Antimicrobial prescribing. NICE guideline [NG139]. Manchester, England: National Institute for Health and Care Excellence (NICE). Source[Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence (NICE). (2019). Pneumonia (hospital-acquired): Antimicrobial prescribing. NICE guideline [NG139]. Manchester, England: National Institute for Health and Care Excellence (NICE). Source[Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence (NICE). (2021). COVID-19 rapid guideline: managing COVID -19 [NG191]. Source[Quality Measures,Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence. (2015). Intravenous fluid therapy in children and young people in hospital. (NICE guideline [NG29]). Source[Quality Measures,Clinical Practice Guidelines]
    • National Institute for Health and Care Excellence. (2016). Sepsis: Recognition, diagnosis and early management. (NICE guideline [NG51]). Source[Quality Measures,Clinical Practice Guidelines]
    • Rewa, O.; Bagshaw, S. M. Principles of fluid management. Critical Care Clinics. 2015;31(4), 785-801. doi:https://doi.org/10.1016/j.ccc.2015.06.012 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Rothrock, S. G.; Cassidy, D. D.; Barneck, M.; Schinkel, M.; Guetschow, B.; Myburgh, C.; Nguyen, L.; Earwood, R.; Nanayakkara, P. W. B.; Nannan Panday, R. S.; Briscoe, J. G. Outcome of Immediate Versus Early Antibiotics in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. Annals of Emergency Medicine. 2020, Oct;76(4), 427-441. doi:10.1016/j.annemergmed.2020.04.042 Source[Meta-analysis,Systematic Review]
    • Schmidt, G. L. (2015). In Fluids and electrolytes. Corkins, M. R (Eds.), The ASPEN pediatric nutrition support core curriculum. Silver Spring, MD: American Society of Parenteral and Enteral Nutrition. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Siegel, J. D.; Rhinehart, E.; Jackson, M.; Chiarello, L.; Healthcare Infection Control Practices Advisory Committee. Guideline for isolation precautions:  Preventing transmission of infectious agents in healthcare settings. American Journal of Infection Control. 2007, June;35, S64-S164. [Quality Measures,Clinical Practice Guidelines]
    • Smith, M. J.; Gerber, J. S.; Hersh, A. L. Inpatient antimicrobial stewardship in pediatrics:  A systematic review. Journal of the Pediatric Infectious Diseases Society. 2015;4(4), 43109. doi:10.1093/jpids/piu141 [Metasynthesis,Meta-analysis,Systematic Review]
    • Stern, A.; Skalsky, K.; Avni, T.; Carrara, E.; Leibovici, L.; Paul, M. Corticosteroids for pneumonia. Cochrane Database of Systematic Reviews. 2017;(12) doi:10.1002/14651858.CD007720.pub3 [Metasynthesis,Meta-analysis,Systematic Review]
    • Stern, A.; Skalsky, K.; Avni, T.; Carrara, E.; Leibovici, L.; Paul, M. Corticosteroids for pneumonia. Cochrane Database of Systematic Reviews. 2017;(12) doi:10.1002/14651858.CD007720.pub3 [Metasynthesis,Meta-analysis,Systematic Review]
    • Strickland, S. L.; Rubin, B. K.; Drescher, G. S.; Haas, C. F.; O'Malley, C. A.; Volsko, T. A.; Branson, R. D.; Hess, D. R. AARC clinical practice guideline:  Effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients. Respiratory Care. 2013;58(12), 2187-2193. doi:10.4187/respcare.02925 [Quality Measures,Clinical Practice Guidelines]
    • Strickland, S. L.; Rubin, B. K.; Haas, C. F.; Volsko, T. A.; Drescher, G. S.; O'Malley, C. A. AARC clinical practice guideline: Effectiveness of pharmacologic airway clearance therapies in hospitalized patients. Respiratory Care. 2015;60(7), 1071-1077. [Quality Measures,Clinical Practice Guidelines]
    • The Joint Commission. Approved: new antimicrobial stewardship standard. Joint Commission Perspectives. 2016;36(7), 1-8. [Regulatory/Accreditation Standards]
    • Ticona, J. H.; Zaccone, V. M.; McFarlane, I. M. Community-acquired pneumonia: a focused review. American Journal of Medical Case Reports. 2021;9(1), 45-52. doi:10.12691/ajmcr-9-1-12 [Review Articles,Expert/Committee Opinion]
    • Ticona, J. H.; Zaccone, V. M.; McFarlane, I. M. Community-acquired pneumonia: a focused review. American Journal of Medical Case Reports. 2021;9(1), 45-52. doi:10.12691/ajmcr-9-1-12 [Review Articles,Expert/Committee Opinion]
    • Ticona, J. H.; Zaccone, V. M.; McFarlane, I. M. Community-acquired pneumonia: a focused review. American Journal of Medical Case Reports. 2021;9(1), 45-52. doi:10.12691/ajmcr-9-1-12 [Review Articles,Expert/Committee Opinion]
    • Ticona, J. H.; Zaccone, V. M.; McFarlane, I. M. Community-acquired pneumonia: a focused review. American Journal of Medical Case Reports. 2021;9(1), 45-52. doi:10.12691/ajmcr-9-1-12 [Review Articles,Expert/Committee Opinion]
    • Warnapura, C.; Peiris, M. Intravenous fluid therapy in adults and children. Sri Lankan Journal of Anaesthesiology. 2017;25(1) doi:10.4038/slja.v25i1.8202 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Weiss, S. L.; Peters, M. J.; Alhazzani, W.; Agus, M. S.; Flori, H. R.; Inwald, D. P.; Nadel, S.; Schlapbach, L. J.; Tasker, R. C.; Argent, A. C.; Brierley, J.; et. al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Medicine. 2020;46(1), 10-67. doi:10.1097/PCC.0000000000002198 Source[Clinical Practice Guidelines]
    • Yan, J. H.; Yu, N.; Want, Y. H.; Gao, Y. B.; Pan, L. Lung ultrasound vs chest radiography in the diagnosis of children pneumonia: systematic evidence. Medicine. 2020;99(50), e23671. doi:10.1097/MD.0000000000023671 [Systematic Review]
    • Yan, J. H.; Yu, N.; Want, Y. H.; Gao, Y. B.; Pan, L. Lung ultrasound vs chest radiography in the diagnosis of children pneumonia: systematic evidence. Medicine. 2020;99(50), e23671. doi:10.1097/MD.0000000000023671 [Systematic Review]

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