The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational study

IntroductionIn the general population, female children have been reported to have a survival advantage. For children admitted to paediatric intensive care units (PICUs), mortality has been reported to be lower in males despite the higher admission rates for males into intensive care. This apparent sex reversal in PICU mortality is not well studied. To address this, we propose to conduct a systematic literature review to summarise the available evidence. Our review will study the reported differences in mortality between males and females aged 0–17, who died in a PICU, to examine if there is a difference between the two sexes in PICU mortality, and if so, to describe the magnitude and direction of this difference.Methods and analysisStudies that directly or indirectly addressed the association between sex and mortality in children admitted to intensive care will be eligible for inclusion. Studies that directly address the association will be eligible for data extraction. The search strings were based on terms related to the population (children in intensive care), the exposure (sex) and the outcome (mortality). We used the databases MEDLINE (1946–2020), Embase (1980–2020) and Web of Science (1985–2020) as these cover relevant clinical publications. We will assess the reliability of included studies using the risk of bias in observational studies of exposures tool. We will consider a pooled effect if we have at least three studies with similar periods of follow up and adjustment variables.Ethics and disseminationEthical approval is not required for this review as it will synthesise data from existing studies. This manuscript is a part of a larger data linkage study, for which Ethical approval was granted. Dissemination will be via peer-reviewed journals and via public and patient groups.PROSPERO registration numberCRD42020203009.

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Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320962 ◽

2021 ◽

pp. archdischild-2020-320962

Author(s):

Ruchi Sinha ◽

Angela Aramburo ◽

Akash Deep ◽

Emma-Jane Bould ◽

Hannah L Buckley ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Clinical Care ◽

Adult Patients ◽

Paediatric Intensive Care ◽

Critically Ill Adults ◽

Care Capacity ◽

Ill Adults ◽

Paediatric Intensive Care Units

ObjectiveTo describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic.DesignDescriptive study.SettingSeven PICUs in England.Main outcome measures(1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs.ResultsSeven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280–307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50–62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%).ConclusionIn a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.

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Measuring efficiency in Australian and New Zealand paediatric intensive care units

Intensive Care Medicine ◽

10.1007/s00134-010-1916-3 ◽

2010 ◽

Vol 36 (8) ◽

pp. 1410-1416 ◽

Cited By ~ 6

Author(s):

Lahn D. Straney ◽

Archie Clements ◽

Jan Alexander ◽

Anthony Slater

Keyword(s):

Intensive Care ◽

New Zealand ◽

Intensive Care Units ◽

Paediatric Intensive Care ◽

Measuring Efficiency ◽

Paediatric Intensive Care Units

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Factors influencing plasma transfusion practices in paediatric intensive care units around the world

Vox Sanguinis ◽

10.1111/vox.12490 ◽

2017 ◽

Vol 112 (2) ◽

pp. 140-149 ◽

Cited By ~ 1

Author(s):

O. Karam ◽

P. Demaret ◽

A. Duhamel ◽

A. Shefler ◽

P. C. Spinella ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Paediatric Intensive Care ◽

Plasma Transfusion ◽

Factors Influencing ◽

The World ◽

Paediatric Intensive Care Units

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Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

Cardiology in the Young ◽

10.1017/s1047951107001229 ◽

2007 ◽

Vol 17 (S4) ◽

pp. 116-126 ◽

Cited By ~ 26

Author(s):

Stacie B. Peddy ◽

Mary Fran Hazinski ◽

Peter C. Laussen ◽

Ravi R. Thiagarajan ◽

George M. Hoffman ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Cardiopulmonary Resuscitation ◽

Intensive Care Units ◽

Cardiac Disease ◽

Paediatric Intensive Care ◽

Cardiac Intensive Care Unit ◽

Cardiac Intensive Care ◽

Paediatric Intensive Care Units

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

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