PICU in the MICU: how adult intensive care units can support pediatric care in public health emergencies

Public health emergencies such as pandemics can put health systems in a position where they need to ration medical equipment and interventions because the resources available are not sufficient to meet demand. In public health management, the fair allocation of resources is a permanent and cross-sector issue since resources, and especially economic resources, are not infinite. During the COVID-19 pandemic resources need to be allocated under conditions of extreme urgency and uncertainty. One very problematic aspect has concerned intensive care medicine and age discrimination has been among the most hotly discussed issues, as age has been touted as a probable criterion for selection. In this paper we analyse some documents originating from scientific societies and medical associations, mainly related to EU sphere and available in English, French, Spanish and Italian (Switzerland, Spain, Belgium, France, England and Italy), concerning the criteria for admission to the intensive care units. We highlights how, in most of these documents, it is explicitly stated that “age itself” is not a criterion for patient selection. Our conclusion is that these criteria should be defined in advance of a crisis situation and be grounded in clinical indicators. Establishing “cut-off” policies with regard to criteria such as age or chronic disability is definitely an unjustifiable form of discrimination even in the context of a public health emergency.

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Impact of clinical risk management in pediatric intensive care units: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.603 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Di Pilla ◽

M L Specchia ◽

A Perilli ◽

N Tofani ◽

E Carini ◽

...

Keyword(s):

Systematic Review ◽

Risk Management ◽

Intensive Care ◽

Intensive Care Units ◽

Pediatric Intensive Care ◽

Pediatric Care ◽

Clinical Risk Management ◽

Management Tools ◽

Pediatric Intensive Care Units ◽

Clinical Risk

Abstract Background Clinical risk is the probability that a patient is the victim of an adverse event attributable to medical care, albeit unintentionally; clinical risk management is therefore a key area for the quality of healthcare, especially in care-intensive settings; even more for pediatric patients. The objective of this review is to assess the impact of the application of tools and methodologies for clinical risk management in pediatric care-intensive settings. Methods Pubmed and Web of Science were queried to carry out a systematic review, using the PICO methodology to formulate the research strategy and query (June 2019). Application experiences of clinical risk management that had quantitative and qualitative impacts in pediatric intensive care units were included. Results A total of 1178 papers were reviewed and 22 articles were included, most of them from the US (8). Out of the 22 experiences described, 11 were related to reactive management tools, 7 to proactive tools; 4 experiences reported the use of both reactive and proactive tools; 11 articles made explicit a reduction in adverse events following the intervention in the study (29.8%-78.8%, p < 0.001); 8 articles made explicit organizational changes triggered by the intervention; 2 proactive tools were also used in order to specifically assess the economical savings related to the changes that occurred as a result of the intervention; 1 article compared two reactive clinical risk management systems in the same context, underlining that a more innovative system tended to highlight more systemic errors, while a more traditional one focused on errors that were less common but potentially more dangerous; 14 studies were specifically dedicated to risk in drug management. Conclusions The application of clinical risk management tools made changes in pediatric intensive care units; the integrated use of different methodologies, both proactive and passive, for the management of clinical risk is highlighted in many studies. Key messages Methodologies for clinical risk management can have significant impacts on organizational processes and outcomes of pediatric intensive care units, improving safety of patient and operators. The simultaneous use of several clinical risk management tools, both proactive and reactive, is increasingly widespread.

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Precautionary behaviours of individuals with multimorbidity during the COVID-19 pandemic

European Journal of Ageing ◽

10.1007/s10433-021-00632-8 ◽

2022 ◽

Author(s):

Alice Delerue Matos ◽

Andreia Fonseca de Paiva ◽

Cláudia Cunha ◽

Gina Voss

Keyword(s):

Public Health ◽

Intensive Care ◽

Intensive Care Units ◽

Financial Distress ◽

Severe Case ◽

European Countries ◽

Older Individuals ◽

Awareness Campaigns ◽

Preventive Actions ◽

Protective Behaviours

AbstractStudies show that older individuals with multimorbidity are more susceptible to develop a more severe case of COVID-19 when infected by the virus. These individuals are more likely to be admitted to Intensive Care Units and to die from COVID-19-related conditions than younger individuals or those without multimorbidity. This research aimed to assess whether there are differences in terms of precautionary behaviours between individuals aged 50 + with multimorbidity and their counterparts without multimorbidity residing in 25 European countries plus Israel. We used data from the SHARE-COVID19 questionnaire on the socio-demographic and economic characteristics, multimorbidity, and precautionary behaviours of individuals. SHARE wave 8 and 7 databases were also used to fully identify individuals with multimorbidity. Our results showed that individuals with multimorbidity were more likely to exhibit precautionary behaviours than their counterparts without multimorbidity when gender, age, education, financial distress and countries were included as controls. Additionally, we found that women, more educated individuals and those experiencing more financial distress adopt more protective behaviours than their counterparts. Our results also indicate that the prevalence of precautionary behaviours is higher in Spain and Italy and lower in Denmark, Finland and Sweden. To guarantee the adoption of preventive actions against COVID-19, public health messaging and actions must continue to be disseminated among middle and older aged persons with multimorbidity, and more awareness campaigns should be targeted at men and less educated individuals but also at persons experiencing less financial distress, particularly in countries where people engaged in fewer precautionary behaviours.

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Klebsiella pneumoniae acquisition in ICUs: patient-based and laboratory-based surveillance

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.714 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Barchitta ◽

A Maugeri ◽

C La Mastra ◽

MC La Rosa ◽

L Sessa ◽

...

Keyword(s):

Public Health ◽

Intensive Care ◽

High Risk ◽

Klebsiella Pneumoniae ◽

Intensive Care Units ◽

Multidrug Resistant ◽

Trauma Patients ◽

Healthcare Associated Infections ◽

Global Threat ◽

Healthcare Associated

Abstract Klebsiella pneumoniae - and especially multidrug-resistant K. pneumoniae - represents a global threat for Public Health, due to its high dissemination in Intensive Care Units (ICUs) and its association with mortality. Here, we investigated the molecular epidemiology of multidrug-resistant K. pneumoniae strains in ICUs from Catania, Italy. We used data and samples from the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project, which has been surveying the epidemiology and the risk of Healthcare-associated infections (HAIs) in Italian ICUs. The SPIN-UTI network adopted the ECDC protocols for patient-based HAI surveillance. In a sample of ICUs the patient-based surveillance was integrated with a laboratory-based surveillance of MDR K. pneumoniae isolates. K. pneumoniae isolates were genotyped by multilocus sequence typing (MLST), and patterns of K. pneumoniae acquisition (i.e. carriage, colonization and infection) were identified using standard definitions. Our analysis included 155 patients who stayed in two ICUs for a total of 2254 days, from October 2016 to March 2017. Trauma patients were more likely to be infected with K. pneumoniae than other patients (OR = 5.9; 95%CI=2.4-14.8; p = 0.004). A total of 109 K. pneumoniae strains were isolated from different sites of 39 patients, which in turn were defined as 45.2% colonization, 25.8% infection, and 29% carriage. 79.3% K. pneumoniae isolates resistant to carbapenems and 100% resistant to penicillins and cephalosporins. The MLST identified two major clonal groups: the ST395 and the ST37, which represented respectively the 65.6% and the 21.3% of typed isolates. Surveillance of colonization and infection by high-risk clones might help in implementing appropriate strategies, which are crucial to reduce the spread of K. pneumoniae in ICUs. *Study Group AOU 'Policlinico-Vittorio Emanuele', Catania, Italy: Patrizia Bellocchi, Giacomo Castiglione, Alida Imbriani, Marinella Astuto, Giuseppa La Camera, Agata Sciacca Key messages Multidrug-resistant K. pneumoniae still represents a threat for Public Health in Italy and globally, due to its high dissemination in intensive care units. Surveillance of colonization and infection by high-risk clones might help in reducing the spread of Klebsiella pneumoniae.

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Physico-chemical incompatibilities

Batna Journal of Medical Sciences (BJMS) ◽

10.48087/bjmstf.2014.1212 ◽

2014 ◽

Vol 1 (2) ◽

pp. 107-110

Author(s):

Manel Chaabna ◽

◽

Lina Aissa ◽

Fadhila Debbah ◽

Nassima Taleb

Keyword(s):

Public Health ◽

Intensive Care ◽

Intensive Care Units ◽

Active Ingredient ◽

Health Concern ◽

Public Health Concern ◽

Physico Chemical ◽

Different Origins ◽

Chemical Problem

Compatibility problems are frequently encountered in hospitals, particularly in intensive care units. Physico-chemical incompatibilities (PCI) may have different origins and several types. The result is inactivation of the active ingredient reacted training or derivative(s) more or less toxic. The issue of PCI is made complex, moreover, by the fact that the reactions involved may be influenced by many factors. This chemical problem becomes a public health concern because it poses a risk to the patient.

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Determinants of Fatal Outcome in Patients Admitted to Intensive Care Units With Influenza, European Union 2009–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz462 ◽

2019 ◽

Vol 6 (11) ◽

Cited By ~ 3

Author(s):

Cornelia Adlhoch ◽

Joana Gomes Dias ◽

Isabelle Bonmarin ◽

Bruno Hubert ◽

Amparo Larrauri ◽

...

Keyword(s):

Public Health ◽

European Union ◽

Intensive Care ◽

Intensive Care Units ◽

Influenza A ◽

Medical Condition ◽

Fatal Outcome ◽

Health Concern ◽

Medical Conditions ◽

Risk Of Death

Abstract Background Morbidity, severity, and mortality associated with annual influenza epidemics are of public health concern. We analyzed surveillance data on hospitalized laboratory-confirmed influenza cases admitted to intensive care units to identify common determinants for fatal outcome and inform and target public health prevention strategies, including risk communication. Methods We performed a descriptive analysis and used Poisson regression models with robust variance to estimate the association of age, sex, virus (sub)type, and underlying medical condition with fatal outcome using European Union data from 2009 to 2017. Results Of 13 368 cases included in the basic dataset, 2806 (21%) were fatal. Age ≥40 years and infection with influenza A virus were associated with fatal outcome. Of 5886 cases with known underlying medical conditions and virus A subtype included in a more detailed analysis, 1349 (23%) were fatal. Influenza virus A(H1N1)pdm09 or A(H3N2) infection, age ≥60 years, cancer, human immunodeficiency virus infection and/or other immune deficiency, and heart, kidney, and liver disease were associated with fatal outcome; the risk of death was lower for patients with chronic lung disease and for pregnant women. Conclusions This study re-emphasises the importance of preventing influenza in the elderly and tailoring strategies to risk groups with underlying medical conditions.

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In the eye of the storm: impact of COVID-19 pandemic on admission patterns to paediatric intensive care units in the UK and Eire

Critical Care ◽

10.1186/s13054-021-03779-z ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Hari Krishnan Kanthimathinathan ◽

Hannah Buckley ◽

Peter J. Davis ◽

Richard G. Feltbower ◽

Caroline Lamming ◽

...

Keyword(s):

Public Health ◽

Intensive Care ◽

Intensive Care Units ◽

Health Interventions ◽

Paediatric Intensive Care ◽

Public Health Interventions ◽

The Uk ◽

Unplanned Admissions ◽

The Impact ◽

Paediatric Intensive Care Units

Abstract Background The coronavirus disease-19 (COVID-19) pandemic had a relatively minimal direct impact on critical illness in children compared to adults. However, children and paediatric intensive care units (PICUs) were affected indirectly. We analysed the impact of the pandemic on PICU admission patterns and patient characteristics in the UK and Ireland. Methods We performed a retrospective cohort study of all admissions to PICUs in children < 18 years during Jan–Dec 2020, using data collected from 32 PICUs via a central database (PICANet). Admission patterns, case-mix, resource use, and outcomes were compared with the four preceding years (2016–2019) based on the date of admission. Results There were 16,941 admissions in 2020 compared to an annual average of 20,643 (range 20,340–20,868) from 2016 to 2019. During 2020, there was a reduction in all PICU admissions (18%), unplanned admissions (20%), planned admissions (15%), and bed days (25%). There was a 41% reduction in respiratory admissions, and a 60% reduction in children admitted with bronchiolitis but an 84% increase in admissions for diabetic ketoacidosis during 2020 compared to the previous years. There were 420 admissions (2.4%) with either PIMS-TS or COVID-19 during 2020. Age and sex adjusted prevalence of unplanned PICU admission reduced from 79.7 (2016–2019) to 63.1 per 100,000 in 2020. Median probability of death [1.2 (0.5–3.4) vs. 1.2 (0.5–3.4) %], length of stay [2.3 (1.0–5.5) vs. 2.4 (1.0–5.7) days] and mortality rates [3.4 vs. 3.6%, (risk-adjusted OR 1.00 [0.91–1.11, p = 0.93])] were similar between 2016–2019 and 2020. There were 106 fewer in-PICU deaths in 2020 (n = 605) compared with 2016–2019 (n = 711). Conclusions The use of a high-quality international database allowed robust comparisons between admission data prior to and during the COVID-19 pandemic. A significant reduction in prevalence of unplanned admissions, respiratory diseases, and fewer child deaths in PICU observed may be related to the targeted COVID-19 public health interventions during the pandemic. However, analysis of wider and longer-term societal impact of the pandemic and public health interventions on physical and mental health of children is required.

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Tracheostomy in a tertiary care hospital: epidemiology, indications and complications

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201532 ◽

2020 ◽

Vol 6 (5) ◽

pp. 826

Author(s):

Anchal Gupta ◽

Palak Gupta ◽

Vikrant Mahajan ◽

Padam Singh Jamwal

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Tertiary Care ◽

Upper Airway ◽

Neck Surgery ◽

Pediatric Care ◽

Care Hospital ◽

Surgical Intensive Care ◽

Female Ratio ◽

Male Female Ratio

Background: Tracheostomy is one of the most frequently performed surgeries in the emergency department, Intensive care units and at bedside in the present scenario. The aim of our study is to outline the frequent indications, to analyse various complications and to evaluate the outcomes of tracheostomy in our setting in our Institution.Methods: This retrospective study was conducted in the Department of ENT and Head & Neck Surgery, SMGS Hospital, Jammu from January 2018 to January 2020. The cases were recorded from ENT Department and also intensive medical care, intensive neonatal and pediatric care, intensive respiratory care, surgical intensive care units of our institution. We included all the emergency, elective and prophylactic tracheostomies in this group. Results: Out of 100 patients included in our study, male: female ratio was 2.7:1. 61 (61%) patients were in the age group of 41 to 60 years. The mean age was 43 years. In our study 58 (58%) tracheostomies were done on emergency. 38 (38%) were done electively whereas rest 4 (4%) were done prophylactically. 37 (37%) tracheostomies were done for upper airway obstruction, followed by artificial ventilation done in 36 (36%) patients. The most indication was carcinoma seen in 17 (17%) patient followed by head injury seen in 16 (16%) patients. The most common complication was surgical emphysema seen in 8(8%) tracheostomies followed by haemorrhage in 6 (6%) tracheostomies.Conclusions: Tracheostomy still remains a life saving procedure in the surgical management of airway if performed timely despite its few complications.

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