Home extubation by a pediatric critical care team: Providing a compassionate death outside the pediatric intensive care unit*

Abstract Background Pediatric intensive care unit (PICU) tremendously improves the success of saving patients having potentially life-threatening illness. An accurate estimate of lives saved through pediatric critical care intervention is important to evaluate the quality of the health care system. Data on pediatric critical care in developing countries remain scarce yet is much needed to improve clinical practices and outcomes. This study aimed to determine the incidence and predictors of mortality in the pediatric intensive care unit in the study setting.Method An institution based prospective cohort study was conducted from February 2018 to July 2019. We collected data by interview, chart and registration book review. Life table was used to estimate the cumulative survival of patients and Log rank test was used to compare survival curves between different categories of the explanatory variables. Survival trend over the follow up time was described using the Kaplan Meier graph. Bivariate and multivariate Cox proportional hazard model were used to identify predictors.Result Based on the 10 th version of international classifications of disease (ICD) of WHO, neurologic disorders (22.7%) infectious disease (18.8%) and environmental hazards (11.8%) account for the top three diagnoses. The median observation time was 3 days with IQR of 1 to 6 days. Of the total of 313 participants, 102 (32.6%) died during the follow-up time. This gives the incidence of mortality of 6.9 deaths per 100 person day observation. Caregivers’ occupation of government-employed (AHR=0.35, 95%CI: 0.14, 0.89), weekend admission (AHR=1.63, 95%CI: 1.02, 2.62), critical illness (AHR=1.79, 95%CI: 1.13, 2.85) Mechanical ventilation AHR=2.36,95%CI: 1.39, 4.01)and PIM2 score (AHR=1.53, 95%CI: 1.36, 1.72) were predictors of mortality in the pediatric ICU.Conclusion Neurologic disorder was the leading causes of admission followed by infectious diseases, and environmental hazards. Rate of mortality was high and admission over weekends, caregivers' occupation, mechanical ventilation, critical illness diagnosis, and higher PIM2 scores were found to be significant and independent predictors of mortality at the PICU. This suggests that ICU medical equipment, diagnostics, and interventions should be available up to the standard. Intensivist and full staffing around the clock has to be available in the PICU.

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Guidelines and Levels of Care for Pediatric Intensive Care Units

PEDIATRICS ◽

10.1542/peds.92.1.166 ◽

1993 ◽

Vol 92 (1) ◽

pp. 166-175 ◽

Cited By ~ 2

Author(s):

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

American Academy ◽

Pediatric Intensive Care Unit ◽

Hospital Care ◽

Pediatric Intensive Care ◽

Critical Care Medicine ◽

Pediatric Critical Care ◽

American Academy Of Pediatrics

Pediatric critical care medicine has matured dramatically during the past two decades. Knowledge of the pathophysiology of life-threatening processes and the technologic capacity to monitor and treat pediatric patients suffering from them have advanced rapidly during this period. Along with the scientific and technical advances has been the evolution of the pediatric intensive care unt (PICU), where the special needs of critically ill or injured children can be met by pediatric specialists. In 1985, the American Board of Pediatrics recognized the new subspecialty of Pediatric Critical Care Medicine and established criteria for subspecialty certification. The American Boards of Medicine, Surgery, and Anesthesiology gave similar recognition to the subspecialty. In 1990, the Residency Review Committee of the Accreditation Council for Graduate Medical Education completed its first accreditation of Pediatric Critical Care Medicine Training Programs. In view of these developments, the Pediatric Section of the Society of Critical Care Medicine and the American Academy of Pediatrics Section on Critical Care Medicine and Committee on Hospital Care believe that existing published1 guidelines should now be revised for the pediatric intensive care unit. This policy represents the consensus of the three above-mentioned groups who believe the recommendations that follow are current, necessary, and attainable in 1993. The guidelines are not intended as a statement of the ideal or ultimate requirements for PICUs. We expect standards for PICUs to rise as critical care medicine continues to develop and appropriately trained providers become more readily available. In view of these developments, the Pediatric Section of the Society of Critical Care Medicine and the American Academy of Pediatrics Section on Critical Care Medicine and Committee on Hospital Care believe that existing published1 guidelines should now be revised for the pediatric intensive care unit.

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The Utility of Point-of-Care Ultrasound in the Pediatric Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/08850666211047824 ◽

2021 ◽

pp. 088506662110478

Author(s):

Laura A. Watkins ◽

Sharon P. Dial ◽

Seth J. Koenig ◽

Dalibor N. Kurepa ◽

Paul H. Mayo

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Point Of Care ◽

Pediatric Intensive Care ◽

Pediatric Care ◽

Point Of Care Ultrasound ◽

Pediatric Critical Care ◽

New Therapy

Objectives: Point of care ultrasound (POCUS) in adult critical care environments has become the standard of care in many hospitals. A robust literature shows its benefits for both diagnosis and delivery of care. The utility of POCUS in the pediatric intensive care unit (PICU), however, is understudied. This study describes in a series of PICU patients the clinical indications, protocols, findings and impact of pediatric POCUS on clinical management. Design: Retrospective analysis of 200 consecutive POCUS scans performed by a PICU physician. Patients: Pediatric critical care patients who required POCUS scans over a 15-month period. Setting: The pediatric and cardiac ICUs at a tertiary pediatric care center. Interventions: Performance of a POCUS scan by a pediatric critical care attending with advanced training in ultrasonography. Measurement and Main Results: A total of 200 POCUS scans comprised of one or more protocols (lung and pleura, cardiac, abdominal, or vascular diagnostic protocols) were performed on 155 patients over a 15-month period. The protocols used for each scan reflected the clinical question to be answered. These 200 scans included 133 thoracic protocols, 110 cardiac protocols, 77 abdominal protocols, and 4 vascular protocols. In this series, 42% of scans identified pathology that required a change in therapy, 26% confirmed pathology consistent with the ongoing plans for new therapy, and 32% identified pathology that did not result in initiation of a new therapy. Conclusions: POCUS performed by a trained pediatric intensivist provided useful clinical information to guide patient management.

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End-of-life care in the pediatric intensive care unit: Attitudes and practices of pediatric critical care physicians and nurses

Critical Care Medicine ◽

10.1097/00003246-200103000-00036 ◽

2001 ◽

Vol 29 (3) ◽

pp. 658-664 ◽

Cited By ~ 90

Author(s):

Jeffrey P. Burns ◽

Christine Mitchell ◽

John L. Griffith ◽

Robert D. Truog

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

End Of Life ◽

Pediatric Intensive Care Unit ◽

End Of Life Care ◽

Pediatric Intensive Care ◽

Life Care ◽

Pediatric Critical Care ◽

Attitudes And Practices

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The Pediatric Intensive Care Unit of the Future:Technological Advances in Pediatric Critical Care Medicine

Science and Practice of Pediatric Critical Care Medicine ◽

10.1007/978-1-84800-921-9_14 ◽

2008 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Kenneth Tegtmeyer

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Critical Care Medicine ◽

Pediatric Critical Care

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Incidence and predictors of mortality among children admitted to the pediatric intensive care unit at the University of Gondar comprehensive specialized hospital, northwest Ethiopia: A prospective observational cohort study

10.21203/rs.2.19878/v2 ◽

2020 ◽

Author(s):

Nahom Worku Teshager ◽

Ashenafi Tazebew Amare ◽

koku Tamirat

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Critical Care ◽

Cohort Study ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Pediatric Critical Care ◽

Predictors Of Mortality

Abstract Background Pediatric intensive care unit (PICU) tremendously improves the success of saving patients having potentially life-threatening illness. An accurate estimate of lives saved through pediatric critical care intervention is important to evaluate the quality of the health care system. Data on pediatric critical care in developing countries remain scarce yet is much needed to improve clinical practices and outcomes. This study aimed to determine the incidence and predictors of mortality in the pediatric intensive care unit in the study setting.Method An institution based prospective cohort study was conducted from February 2018 to July 2019. We collected data by interview, chart and registration book review. Life table was used to estimate the cumulative survival of patients and Log rank test was used to compare survival curves between different categories of the explanatory variables. Survival trend over the follow up time was described using the Kaplan Meier graph. Bivariate and multivariate Cox proportional hazard model were used to identify predictors.Result Based on the 10 th version of international classifications of disease (ICD) of WHO, neurologic disorders (22.7%) infectious disease (18.8%) and environmental hazards (11.8%) account for the top three diagnoses. The median observation time was 3 days with IQR of 1 to 6 days. Of the total of 313 participants, 102 (32.6%) died during the follow-up time. This gives the incidence of mortality of 6.9 deaths per 100 person day observation. Caregivers’ occupation of government-employed (AHR=0.35, 95%CI: 0.14, 0.89), weekend admission (AHR=1.63, 95%CI: 1.02, 2.62), critical illness (AHR=1.79, 95%CI: 1.13, 2.85) Mechanical ventilation AHR=2.36,95%CI: 1.39, 4.01)and PIM2 score (AHR=1.53, 95%CI: 1.36, 1.72) were predictors of mortality in the pediatric ICU.Conclusion Neurologic disorder was the leading causes of admission followed by infectious diseases, and environmental hazards. Rate of mortality was high and admission over weekends, caregivers' occupation, mechanical ventilation, critical illness diagnosis, and higher PIM2 scores were found to be significant and independent predictors of mortality at the PICU. This suggests that ICU medical equipment, diagnostics, and interventions should be available up to the standard. Intensivist and full staffing around the clock has to be available in the PICU.

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Development and Evaluation of a Guideline for Monitoring Propylene Glycol Toxicity in Pediatric Intensive Care Unit Patients Receiving Continuous Infusion Lorazepam

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-20.5.367 ◽

2015 ◽

Vol 20 (5) ◽

pp. 367-372

Author(s):

Lizbeth Hansen ◽

Rebecca Lange ◽

Sameer Gupta

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Continuous Infusion ◽

Propylene Glycol ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Pediatric Critical Care ◽

Clinical Toxicity ◽

Critical Care Patients

OBJECTIVES: To develop and determine the safety of a guideline, by using osmol gap as an indicator of propylene glycol toxicity for pediatric patients receiving continuous infusion lorazepam. METHODS: From existing adult data, a guideline was developed for the use of continuous infusion lorazepam in pediatric critical care patients with recommendations for using osmol gap as an indicator of propylene glycol toxicity. A retrospective medical chart review was performed of patients receiving continuous infusion lorazepam from February 2012 to September 2012 for whom the guideline was used. RESULTS: Twenty-one patients received continuous infusion lorazepam for sedation in the pediatric intensive care unit during the 9-month study period for a total of 23 infusions. Eight patients (34.8%) had an osmol gap of ≥ 12 mOsm/kg during lorazepam infusion, and 7 patients (30.4%) did not have an elevated osmol gap at any point during the infusion. Two patients (8.6%) had clinical toxicity as indicated by elevated anion gap or lactate in addition to an osmol gap ≥ 12 mOsm/kg, while no patients experienced clinical toxicity with an osmol gap < 12 mOsm/kg. CONCLUSIONS: A guideline for the use of lorazepam infusion in pediatric critical care patients was developed and evaluated for safety. Lorazepam continuous infusions appeared to be associated with minimal toxicity in pediatric intensive care unit patients when the osmol gap monitoring guideline was used.

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