scholarly journals 3 In-Hospital Child Mortality after Consolidation of Two Pediatric Intensive Care Units

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e1-e2
Author(s):  
Sehar Parvez ◽  
Juliet Soper
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Cause Of Death ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Canadian Province ◽  
Pediatric Intensive Care Units ◽  
Hospital Deaths ◽  
Population Rate

Abstract Background While high-volume specialized Pediatric Intensive Care Units (PICUs) increase the survival of critically ill children, the benefits of consolidating PICUs to a single site may be outweighed by the need to transport critically ill children when the area serviced has a low population density and vast geography. Objectives This study seeks to describe the impact of PICU consolidation on mortality of children from the southern part of a Canadian province, after presentation to nearest hospital, following consolidation of PICUs to a single more centrally located PICU. Design/Methods We conducted a retrospective chart review of children with a primary residence in the southern part of the province, who died between January 2008 and December 2017 after presentation to the nearest hospital. Children who died prior to presentation to hospital or did not have return of spontaneous circulation at any time after presentation were excluded from analysis. Child demographics, year of death, cause of death, and Pediatric Risk of Mortality III (PRISM III) score, and duration and type of treatments provided were abstracted from health records. Population census data was obtained from the 2016 Canada Census. Deaths were grouped for analysis according to the child’s place of residence within three specific administrative areas. Nonparametric Mann Whitney U-test was used for descriptive analysis. Results Eighty-six (86) children from the southern part of the province died following presentation to the nearest hospital during the 10-year study period. The observed population rate of in-hospital deaths was 6.8 per 100,000 children per year before consolidation and 8.5 per 100,000 children per year after consolidation of PICU services. Variation in the population rate of in-hospital deaths before and after consolidation of PICUs was observed between administrative areas (p=0.016). The data did not appear to show an association with urban or non-urban areas. Children who died after consolidation were more likely to receive pain relief (p=0.013), and palliative care consultation (p=0.005) than those who died prior to consolidation. No change in acuity at presentation to hospital or cause of death was observed following PICU consolidation (p=0.3). Conclusion This study did not find evidence of a change in the rate of in-hospital child deaths per 100,000 children following consolidation of PICU services in a Canadian province.

scholarly journals Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Alberto García-Salido ◽  
◽  
Juan Carlos de Carlos Vicente ◽  
Sylvia Belda Hofheinz ◽  
Joan Balcells Ramírez ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Gastrointestinal Symptoms ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Vasoactive Drugs ◽  
Pediatric Intensive Care Units ◽  
Neutrophil Lymphocyte Ratio ◽  
Inflammatory Syndrome ◽  
To Receive

Abstract Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

scholarly journals Association of Thrombocytopenia and Mortality in Critically ill Children Admitted to PICU in Tertiary Hospital In Biratnagar

2019 ◽  
Vol 4 (1) ◽  
pp. 649-653 ◽  
Author(s):  
Vijay Kumar Sah ◽  
Arun Giri ◽  
Milan KC ◽  
Niraj Niraula
Keyword(s):  
Intensive Care ◽  
Platelet Count ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Tertiary Hospital ◽  
Critically Ill Children ◽  
Bleeding Tendency ◽  
Time Of Admission

Introduction: Thrombocytopenia is a clinical condition characterized by decrease in number of platelets below the normal range. It is associated with bleeding tendency, hemodynamic instability, impaired inflammatory process and thus affecting host defence mechanism. There has been only few studies published till date in pediatric intensive care units suggesting thrombocytopenia is associated with increased mortality. Objectives: To determine the prevalence of thrombocytopenia in the critically ill children and its relationship with mortality in Pediatric intensive care unit (PICU) admitted children. Methodology: A prospective observational study was performed over a period of 12 months on 102 critically ill children admitted in PICU who fulfilled the criteria. Two patients left the study due to financial problems and as outcome could not be assessed on them, they were excluded from the study. Platelet count was noted at the time of admission and consecutively for the initial four days at PICU. Thrombocytopenia was defined as platelet count less than 150/nL. Mortality in PICU was recorded as primary outcome. Results: The prevalence of thrombocytopenia during consecutive 4 days was 34% (n=34) and at the time of admission in PICU was 16% (n=16) among 100 children analysed in the study. The mortality in the PICU was 27% (n=27). Mortality among thrombocytopenic children was 61.7% (n=21) as compared to 7.6% (n=5) in non-thrombocytopenic children (p=<0.001). Mortality was 18 times more for those who were thrombocytopenic at the time of admission as compared to those who subsequently developed thrombocytopenia during course of stay in PICU. Conclusion: Thrombocytopenia has significant association with increased mortality. Thrombocytopenic children at the time of admission have more likelihood of mortality than nonthrombocytopenic children in intensive care units.

scholarly journals Epidemiology of Cardiopulmonary Resuscitation in Critically Ill Children Admitted to Pediatric Intensive Care Units Across England: A Multicenter Retrospective Cohort Study

2021 ◽  
Vol 10 (9) ◽  
Author(s):  
Khurram Mustafa ◽  
Hannah Buckley ◽  
Richard Feltbower ◽  
Ramesh Kumar ◽  
Barnaby R. Scholefield
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Retrospective Cohort ◽  
Pediatric Intensive Care ◽  
Paediatric Intensive Care ◽  
Critically Ill Children ◽  
Pediatric Intensive Care Units ◽  
National Quality

Background Cardiopulmonary arrests are a major contributor to mortality and morbidity in pediatric intensive care units (PICUs). Understanding the epidemiology and risk factors for CPR may inform national quality improvement initiatives. Methods and Results A retrospective cohort analysis using prospectively collected data from the Paediatric Intensive Care Audit Network database. The Paediatric Intensive Care Audit Network contains data on all PICU admissions in the United Kingdom. We identified children who received cardiopulmonary resuscitation (CPR) in 23 PICUs in England (2013–2017). Incidence rates of CPR and associated factors were analyzed. Logistic regression was used to estimate the size and precision of associations. Cumulative incidence of CPR was 2.2% for 68 114 admissions over 5 years with an incidence rate of 4.9 episodes/1000 bed days. Cardiovascular diagnosis (odds ratio [OR], 2.30; 95% CI, 2.02–2.61), age <1 year (OR, 1.84; 95% CI, 1.65–2.04), the Paediatric Index of Mortality 2 score on admission (OR, 1.045; 95% CI, 1.042–1.047) and longer length of stay (OR, 1.013; 95% CI, 1.012–1.014) were associated with increased odds of receiving CPR. We also found a higher risk of CPR associated with a history of preadmission cardiac arrest (OR, 20.69; [95% CI, 18.16–23.58) and for children with a cardiac condition admitted to a noncardiac PICU (OR, 2.75; 95% CI, 1.91–3.98). Children from Black (OR, 1.68; 95% CI, 1.36–2.07) and Asian (OR, 1.49; 95% CI, 1.28–1.74) racial/ethnic backgrounds were at higher risk of receiving CPR in PICU than White children. Conclusions Data from this first multicenter study from England provides a foundation for further research and evidence for benchmarking and quality improvement for prevention of cardiac arrests in PICU.

scholarly journals Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina

2010 ◽  
Vol 36 (6) ◽  
pp. 1015-1022 ◽  
Author(s):  
Julio A. Farias ◽  
Analía Fernández ◽  
Ezequiel Monteverde ◽  
Nilda Vidal ◽  
Pilar Arias ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Influenza A ◽  
Pediatric Intensive Care ◽  
Infants And Children ◽  
Pediatric Intensive Care Units ◽  
Influenza A H1n1

scholarly journals The Association Between Variability in Electrolytes and the In-Hospital Mortality in Critically Ill Children in Pediatric Intensive Care Units

2021 ◽  
Vol 9 ◽  
Author(s):  
Jilei Lin ◽  
Yin Zhang ◽  
Meng Chen ◽  
Jihong Dai ◽  
Anchao Song ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
High Variability ◽  
Critically Ill Children ◽  
Retrospective Case ◽  
Potassium Sodium ◽  
The Mean

Objective: This study aimed to explore the association between the variability in electrolytes and the in-hospital mortality in critically ill children admitted into intensive care units (ICUs).Design: This is a retrospective case–control study.Setting and Participants: Total of 11,245 children have been admitted to ICUs of Children's Hospital of Zhejiang University from 2010 to 2018.Methods: The coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM) were calculated as variability indices. High variability was defined as having values in the highest quartile for each parameter. Age, sex, diagnoses of disease, and surgical treatment were adjusted in the multivariable-adjusted logistic regression model.Results: A total of 11,245 children were included, and 660 patients died in the hospital. The median (P25, P75) potassium, sodium, and chloride of all patients were 3.8 (3.58, 4.09), 136.83 (135.11, 138.60), and 108.67 (105.71, 111.17), respectively. U-shaped relationships between the mean, lowest, and highest levels of potassium, sodium, and chloride and the in-hospital mortality were observed. The lowest mortality was noted when serum potassium, sodium, and chloride were between ~3.5 and 5.0, 135 and 145, and 105 and 115 mmol/l, respectively. The areas under the curve (AUCs) of three indices of variability in electrolytes were larger than those of the mean and lowest levels of electrolytes in predicting the in-hospital mortality. In the multivariable-adjusted model, the odds ratios and 95% confidence interval (CI) of the in-hospital mortality were 3.14 (2.44–4.04) for one parameter, 5.85 (4.54–7.53) for two parameters, and 10.32 (7.81–13.64) for three parameters compared with subjects having no parameters of high variability measured as the CV. The results were consistent when the variability was determined using the SD and VIM (all P for trend &lt;0.001). Consistent results were noted in various subgroup analyses.Conclusions: This study showed that individuals with higher variability of each parameter were related with higher risk of in-hospital mortality. There was a linear association between the number of high variability parameters and the in-hospital mortality. The variability of electrolytes might be a good predictor for in-hospital mortality of children in ICUs.

scholarly journals Where Should Critically Ill Adolescents Receive Care? A Qualitative Interview-Based Study of Perspectives of Staff Working in Adult and Pediatric Intensive Care Units

2019 ◽  
Vol 35 (11) ◽  
pp. 1271-1277
Author(s):  
Dora Wood ◽  
Sophie Geoghegan ◽  
Padmanabhan Ramnarayan ◽  
Peter J. Davis ◽  
Lyvonne Tume ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Medical Condition ◽  
Pediatric Intensive Care ◽  
Emotional Impact ◽  
Framework Analysis ◽  
Pediatric Intensive Care Units ◽  
Medical Needs ◽  
The Impact

Purpose: In the United Kingdom, critically ill adolescents are treated in either adult or pediatric intensive care units (AICUs or PICUs). This study explores staff perspectives on where and how best to care for this distinct group. Materials and Methods: Semistructured interviews were conducted with 12 members of staff (3 medical, 6 nursing, and 3 allied health professionals) working in 4 ICUs; 2 general hospital AICUs and 2 tertiary centre–based PICUs in England. Interviews were audio-recorded, transcribed, and analyzed using framework analysis. Findings: One overarching theme was identified, reflecting staff understanding of the term “adolescent,” and this was linked to 2 further themes, each of which had several subthemes. “Needs of the critically ill adolescent” included medical needs, dignity and privacy, issues around consent, and the impact of intensive care admission. “Implications for staff” included managing parental presence and lack of familiarity, and emotional impact, of dealing with this patient group. Some of these factors are currently better accommodated in adult settings. Conclusions: Decision-making about the place of care should take into account the individual circumstances of the patient (e.g., nature of their medical condition and previous experiences, maturity, family preference) and not be based only on age at admission. We should work across disciplines to ensure we can discover, and consistently deliver, best practice to meet the needs of critically ill adolescents.

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