The burden of paediatric intensive care: a perspective from the UK and Ireland

2005 ◽  
Vol 6 (3) ◽  
pp. 154-159 ◽  
Author(s):  
Duncan J. Macrae
Keyword(s):  
Intensive Care ◽  
Paediatric Intensive Care ◽  
The Uk

‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals

2021 ◽  
pp. 147775092110366
Author(s):  
Harika Avula ◽  
Mariana Dittborn ◽  
Joe Brierley
Keyword(s):  
Intensive Care ◽  
Clinical Ethics ◽  
Ethical Issues ◽  
General Setting ◽  
Daily Practice ◽  
Paediatric Intensive Care ◽  
Ethical Challenges ◽  
Legal Cases ◽  
Ethics Support ◽  
The Uk

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.

scholarly journals Outcomes in Paediatric Intensive Care Units for Children with Life-Limiting Conditions: A national data linkage study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Lorna Fraser ◽  
Sarah Fleming ◽  
Roger Parslow
Keyword(s):  
Intensive Care ◽  
Demographic Data ◽  
Poor Quality ◽  
Linkage Study ◽  
Study Data ◽  
Paediatric Intensive Care ◽  
Health And Social Care ◽  
Group Sex ◽  
Limiting Condition ◽  
The Uk

ABSTRACT ObjectiveTo identify children with a Life-Limiting Condition (LLC) who have had an admission to a Paediatric Intensive Care Unit (PICU) in England and their outcomes. ApproachData for all children who had had a PICU admission in the UK between 1st Jan 2004 and 31st March 2015 were identified from the PICANet dataset. Linkage to inpatient Hospital Episode Statistics (HES) data was undertaken by the NHS Health and Social Care Information Centre for all children who had been resident in England. Their standard algorithm using NHS number, date of birth, sex and postcode was used. All inpatient HES episodes from the financial years 1997/98-2014/15 were received. Although the data quality is high in the PICANet dataset, comorbidities are variably coded therefore identifying whether a child has a LLC or not is not possible. A previously developed ICD10 coding framework was used to identify individuals with one or more of these LLC codes in the inpatient HES dataset. ResultsA total of 199,548 PICU admissions in the UK for 135,759 individuals occurred during the time period of the study. Data for 43,565 admissions (32,025 individuals) were excluded due to not having been resident in England or poor quality demographic data. Data on 103,734 individuals (155,983 admissions) were sent for linkage. Successful linkage occurred in 102,722 individuals (99.4%). Individuals who could not be linked were excluded from the analysis.51.0% of these children had a LLC and these children accounted for 62.7% of the PICU admissions. The crude PICU death rate in the children with a LLC was 5.0% (n=4826) compared to 3.1% (n=1786) in those without a LLC. The OR of death in a model adjusted for diagnostic group, sex, age, and expected risk of mortality for children with a LLC was 2.11 (95%CI 1.97-2.27). ConclusionsChildren with a LLC account for a large proportion of all PICU admissions in England. Although only one in twenty of these children die in PICU, as death may be expected in this population of children more integration of specialist palliative care with PICU services may allow more choice for children and families.

Tracheostomy in children admitted to paediatric intensive care: Table 1

2012 ◽  
Vol 97 (10) ◽  
pp. 866-869 ◽  
Author(s):  
Dora Wood ◽  
Philip McShane ◽  
Peter Davis
Keyword(s):  
Intensive Care ◽  
Death Rate ◽  
Current Practice ◽  
Paediatric Intensive Care ◽  
Invasive Ventilation ◽  
Advantages And Disadvantages ◽  
Bed Days ◽  
The Uk ◽  
Paediatric Intensive Care Units ◽  
Common Intervention

PurposeTracheostomy is a common intervention for adults admitted to intensive care; many are performed early and most are percutaneous. Our study aimed to elucidate current practice and indications for children in the UK admitted to paediatric intensive care and undergoing tracheostomy.DesignA questionnaire covering unit guidelines, practice, and the advantages and disadvantages of tracheostomy was sent to all UK paediatric intensive care units (PICUs) participating in the Paediatric Intensive Care Audit Network (PICANet). These results were combined with data from PICANet on all children in the UK reported to have had a tracheostomy performed during a PICU admission between 2005 and 2009 inclusive.ResultsOver 5 years, 1613 children had tracheostomies performed during their PICU admission (2.05% of all admissions). The death rate was 5.58% with tracheostomy versus 4.72% overall, but differences were not significant when risk-adjusted using the Paediatric Index of Mortality 2 (PIM2). All 29 units participating in PICANet responded to the survey. Prolonged invasive ventilation was an indication for tracheostomy in 25/29 units, but the definition varied between 14 and 90 days, and most respondents considered timing on an individual basis. Children undergoing tracheostomy during PICU admission account for 9% of PICU bed days in the UK.ConclusionsIn contrast with current adult UK practice, tracheostomy for children admitted to intensive care is infrequent, performed late following admission and usually surgical. Practice varies significantly. The death rate for children having a tracheostomy performed was not significantly higher than for children admitted to PICU who did not undergo tracheostomy.

scholarly journals A UK and Irish survey of enteral nutrition practices in paediatric intensive care units

2012 ◽  
Vol 109 (7) ◽  
pp. 1304-1322 ◽  
Author(s):  
Lyvonne Tume ◽  
Bernie Carter ◽  
Lynne Latten
Keyword(s):  
Intensive Care ◽  
Enteral Nutrition ◽  
Nursing Staff ◽  
Enteral Feeding ◽  
Physician Assistants ◽  
Paediatric Intensive Care ◽  
Haemodynamic Instability ◽  
Professional Groups ◽  
Energy Delivery ◽  
The Uk

The aim of the present study was to describe the present knowledge of healthcare professionals and the practices surrounding enteral feeding in the UK and Irish paediatric intensive care unit (PICU) and propose recommendations for practice and research. A cross-sectional (thirty-four item) survey was sent to all PICU listed in the Paediatric Intensive Care Audit Network (PICANET) database (http://www.picanet.org.uk) in November 2010. The overall PICU response rate was 90 % (27/30 PICU; 108 individual responses in total). The overall breakdown of the professional groups was 59 % nursing staff (most were children's nurses), 27 % medical staff, 13 % dietitians and 1 % physician assistants. Most units (96 %) had some written guidance (although brief and generic) on enteral nutrition (EN); 85 % of staff, across all professional groups (P= 0·672), thought that guidelines helped to improve energy delivery in the PICU. Factors contributing to reduced energy delivery included: fluid-restrictive policies (60 %), the child just being ‘too ill’ to feed (17 %), surgical post-operative orders (16 %), nursing staff being too slow in starting feeds (7 %), frequent procedures requiring fasting (7 %) and haemodynamic instability (7 %). What constituted an ‘acceptable’ level of gastric residual volume (GRV) varied markedly across respondents, but GRV featured prominently in the decision to both stop EN and to determine feed tolerance and was similar for all professional groups. There was considerable variation across respondents about which procedures required fasting and the duration of this fasting. The present survey has highlighted the variability of the present enteral feeding practices across the UK and Ireland, particularly with regard to the use of GRV and fasting for procedures. The present study highlights a number of recommendations for both practice and research.

scholarly journals Sex difference in infant mortality: a study of UK Paediatric Intensive Care admissions over 11 years

2020 ◽  
Author(s):  
Ofran Almossawi ◽  
Scott O'Brien ◽  
Roger Parslow ◽  
Simon Nadel ◽  
Luigi Palla
Keyword(s):  
Intensive Care ◽  
Infant Mortality ◽  
Child Mortality ◽  
Significant Proportion ◽  
Severity Of Illness ◽  
Paediatric Intensive Care ◽  
Response To Treatment ◽  
Risk Of Death ◽  
The Uk ◽  
Male To Female

Abstract Rationale Within the UK, child mortality from all causes has declined for all ages over the last three decades. However, distinct inequality remains, as child mortality rates vary by sex and are generally found to be higher in males. A significant proportion of childhood deaths in the UK occur in Paediatric Intensive Care Units (PICU). Objectives We aimed to study the association of sex with infant mortality in PICUs. Methods We obtained data for all infant admissions to UK-PICUs from 01/01/2005 to 31/12/2015. We assessed the causal relationship between sex and mortality and selected appropriate variables for adjustment. We fitted a cause specific hazard ratio (CSHR) model, and a logistic model to estimate the adjusted effect of sex on mortality in PICU. Pre-defined subgroups were children less than 56 days old, and those with a primary diagnosis of infection. Measurements and Main Results Within the 71,243 admissions, there were 1,411/29,520 (4.8%) female deaths, and 1,809/41,723 (4.3%) male deaths. The adjusted male to female CSHR was 0.87 (95%-CI 0.81 to 0.92) representing a 13% higher risk of death for females over males. Similarly, the adjusted OR for male to female mortality is 0.87 (95%-CI, 0.81 to 0.94). Subgroup analysis yielded similar findings. Conclusions Female sex is associated with higher mortality in infants needing PICU admission, despite similar severity of illness to males. There was no effect of age or infection status. This suggests that females and males differ in the pathophysiology of critical illness and/or their response to treatment.

Survey of clinical information system usage by paediatric intensive care units in the UK

2010 ◽  
Vol 36 (9) ◽  
pp. 1616-1617 ◽  
Author(s):  
Krish Thiru ◽  
Stuart Rowe ◽  
Nicola Shaw ◽  
Andrew Durward ◽  
David P. Inwald ◽  
...  
Keyword(s):  
Information System ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Information System ◽  
Clinical Information ◽  
Paediatric Intensive Care ◽  
System Usage ◽  
The Uk ◽  
Paediatric Intensive Care Units

scholarly journals Is it taking longer to die in paediatric intensive care in England and Wales?

2016 ◽  
Vol 101 (9) ◽  
pp. 798-802 ◽  
Author(s):  
Adrian Plunkett ◽  
Roger C Parslow
Keyword(s):  
Intensive Care ◽  
Severity Of Illness ◽  
Childhood Mortality ◽  
Paediatric Intensive Care ◽  
England And Wales ◽  
Factors Affecting ◽  
Prolongation Of Life ◽  
The Uk ◽  
Paediatric Critical Care ◽  
Paediatric Intensive Care Units

IntroductionAll-cause infant and childhood mortality has decreased in the UK over the last 30 years. Advances in paediatric critical care have increased survival in paediatric intensive care units (PICUs) but may have affected how and when children die in PICU. We explored factors affecting length of stay (LOS) of children who died in PICU over an 11-year period.MethodsWe analysed demographic and clinical data of 165 473 admissions to PICUs in England and Wales, from January 2003 to December 2013. We assessed time trends in LOS for survivors and non-survivors and explored the effect of demographic and clinical characteristics on LOS for non-survivors.ResultsLOS increased 0.310 days per year in non-survivors (95% CI 0.169 to 0.449) and 0.064 days per year in survivors (95% CI 0.046 to 0.083). The proportion of early deaths (<24 h of admission) fell 0.44% points per year (95% CI −0.971 to 0.094), but the proportion of late deaths (>28 days of PICU stay) increased by 0.44% points per year (95% CI 0.185 to 0.691). The paediatric index of mortality score in early deaths increased by 0.77% points per year (95% CI 0.31% to 1.23%).DiscussionIncreased LOS in children who die in PICU is driven by a decreased proportion of early deaths and an increased proportion of late deaths. This trend, combined with an increase in the severity of illness in early deaths, is consistent with a reduction in early mortality for acutely ill children, but a prolongation of life for those children admitted to PICU with life-limiting illnesses.

scholarly journals 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 ◽  
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.

scholarly journals A study of sex difference in infant mortality in UK pediatric intensive care admissions over an 11-year period

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ofran Almossawi ◽  
Scott O’Brien ◽  
Roger Parslow ◽  
Simon Nadel ◽  
Luigi Palla
Keyword(s):  
Intensive Care ◽  
Infant Mortality ◽  
Child Mortality ◽  
Significant Proportion ◽  
Pediatric Intensive Care ◽  
Primary Diagnosis ◽  
Paediatric Intensive Care ◽  
Risk Of Death ◽  
The Uk ◽  
Adjusted Association

AbstractWithin the UK, child mortality from all causes has declined for all ages over the last three decades. However, distinct inequality remains, as child mortality rates are generally found to be higher in males. A significant proportion of childhood deaths in the UK occur in Paediatric Intensive Care Units (PICU). We studied the association of sex with infant mortality in PICUs. We included all infants (0 to 12 months old) admitted to UK PICUs from 01/01/2005 to 31/12/2015 using the Paediatric Intensive Care Audit Network (PICANet) dataset. We considered first admissions to PICU and fitted a cause-specific-hazard-ratio (CSHR) model, and a logistic model to estimate the adjusted association between sex and mortality in PICU. Pre-defined subgroups were children less than 56-days old, and those with a primary diagnosis of infection. Of 71,243 cases, 1,411/29,520 (4.8%) of females, and 1,809/41,723 (4.3%) of males died. The adjusted male/female CSHR was 0.87 (95%-CI 0.81 to 0.92) representing a 13% higher risk of death for females. The adjusted OR for male to female mortality is 0.86 (95%-CI 0.80 to 0.93). Analyses in subgroups yielded similar findings. In our analysis, female infants have a higher rate of PICU mortality compared to male infants.

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