Nurses Week 2022: Patients at high risk for adverse events related to sepsis

Boston Children’s commitment to exceptional patient care and the best possible outcomes inspires innovation and growth. Both the hospital and its nursing leadership encourage professional development of employees through a variety of research and educational programs.

The professional practice of Katie Roy, DNP, RN, CPNP-AC, FNP-BC, nurse practitioner, Medical-Surgical Intensive Care Unit (MSICU), provides a noteworthy example of an advanced practice registered nurse (APRN) blending both nursing science and innovation to improve patient outcomes. As a nurse practitioner in the MSICU, Dr. Roy has seen firsthand the devastating effects that sepsis can have on the lives of children. Sepsis is a leading cause of pediatric morbidity and mortality, with an estimated 1.2 million cases of pediatric sepsis per year globally. In a study of nearly 400 critically ill children with community-acquired septic shock, 35 percent of survivors had not regained their baseline health-related quality of life after one year.

These stark statistics, coupled with her professional experience, spurred Dr. Roy to explore innovative ways to approach sepsis. She applied to Boston Children’s prestigious Nursing Science Fellowship, which is designed to advance nursing practice and associated patient care outcomes. She is now a Nursing Science Fellowship graduate and a recipient of an Inquiry Investment Drives Evidence into Action (IDEA) Grant through Boston Children’s, which helped fund her research.

Relationship between the inadequate oxygen delivery index and sepsis outcomes in critically ill children

The inadequate oxygen delivery (IDO2) index is a risk-analysis algorithm that estimates the probability that a patient is experiencing insufficient systemic oxygen delivery.

When Dr. Roy learned about the IDO2 index through research, she immediately thought it could be a valuable tool in caring for critically ill children with sepsis. She discovered that in this population, the IDO2 index was never studied. Dr. Roy committed herself to investigating this novel application of the IDO2 index through further research.

By reviewing past charts (retrospective chart review), Dr. Roy’s research applied the IDO2 index to critically ill patients with sepsis to look for associations between IDO2 index values and major adverse events, illness severity metrics, and outcomes.

• Adverse events: Cardiac arrest requiring chest compressions, ECMO cannulation, and mortality
• Illness severity metrics: Vasoactive-inotropic score and pediatric logistic organ dysfunction scores
• Outcomes: ICU length of stay and invasive ventilator days

Dr. Roy’s study found that the IDO2 index might be helpful in determining if a patient with sepsis is at higher risk of an adverse event. Specifically, her results showed significant associations between IDO2 values and major adverse events, illness severity metrics, and outcomes.

Improving patient outcomes through innovation

The results of this study suggest that routine IDO2 monitoring of critically ill children with sepsis, particularly during the first 12 hours of PICU admission, may help identify those at highest risk. Clinicians can use this information to optimize interventions and implement indicated treatment modifications. Amid increasing availability of analytic tools to support clinicians in all realms of healthcare, it is essential to continue to explore how integration of these tools into practice can maximize outcomes for patients.

Dissemination of the results is the next step. Dr. Roy shares, “My research will be published in the American Journal of Critical Care this spring, which is very exciting, as it will be my first publication.”

Dr. Roy believes additional research will help determine the benefits of real-time IDO2 monitoring at the bedside. “My hope is that this study will motivate APRNs and clinicians, both at Boston Children’s and other pediatric institutions, to consider IDO2 monitoring as a potential tool in the management of pediatric sepsis,” she says.

Learn more about the Medical-Surgical Intensive Care Unit (MSICU).