Pediatric Intensive Care Unit Admissions for COVID-19: Insights Using State-Level Data

Introduction. Intensive care has played a pivotal role during the COVID-19 pandemic as many patients developed severe pulmonary complications. The availability of information in pediatric intensive care units (PICUs) remains limited. The purpose of this study is to characterize COVID-19 positive admissions (CPAs) in the United States and to determine factors that may impact those admissions. Materials and Methods. This is a retrospective cohort study using data from the COVID-19 Virtual Pediatric System (VPS) dashboard containing information regarding respiratory support and comorbidities for all CPAs between March and April 2020. The state-level data contained 13 different factors from population density, comorbid conditions, and social distancing score. The absolute CPA count was converted to frequency using the state’s population. Univariate and multivariate regression analyses were performed to assess the association between CPA frequency and admission endpoints. Results. A total of 205 CPAs were reported by 167 PICUs across 48 states. The estimated CPA frequency was 2.8 per million children in a one-month period. A total of 3,235 tests were conducted of which 6.3% were positive. Children above 11 years of age comprised 69.7% of the total cohort and 35.1% had moderated or severe comorbidities. The median duration of a CPA was 4.9 days (1.25–12.00 days). Out of the 1,132 total CPA days, 592 (52.2%) involved mechanical ventilation. The inpatient mortalities were 3 (1.4%). Multivariate analyses demonstrated an association between CPAs with greater population density (beta coefficient 0.01, p < 0.01 ). Multivariate analyses also demonstrated an association between pediatric type 1 diabetes mellitus with increased CPA duration requiring advanced respiratory support (beta coefficient 5.1, p < 0.01 ) and intubation (beta coefficient 4.6, p < 0.01 ). Conclusions. Inpatient mortality during PICU CPAs is relatively low at 1.4%. CPA frequency seems to be impacted by population density. Type 1 DM appears to be associated with increased duration of HFNC and intubation. These factors should be included in future studies using patient-level data.

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Pediatric intensive care unit admissions for COVID-19: insights using state level data

10.1101/2020.07.22.20160226 ◽

2020 ◽

Author(s):

Rohit S. Loomba ◽

Enrique G. Villarreal ◽

Juan S. Farias ◽

Ronald A. Bronicki ◽

Saul Flores

Keyword(s):

Intensive Care ◽

Population Density ◽

Pediatric Intensive Care ◽

State Level ◽

The United States ◽

Pulmonary Complications ◽

Level Data ◽

Beta Coefficient ◽

Using Data

Introduction Intensive care has played a pivotal role during the COVID-19 pandemic as many patients developed severe pulmonary complications. The availability of information in pediatric intensive care (PICUs) remains limited. The purpose of this study is to characterize COVID-19 positive admissions (CPAs) in the United States and to determine factors that may impact those admissions. Materials and Methods This is a retrospective cohort study using data from the COVID-19 dashboard virtual pediatric system containing information regarding respiratory support and comorbidities for all CPAs between March and April 2020. The state level data contained 13 different factors from population density, comorbid conditions and social distancing score. The absolute CPAs count was converted to frequency using the state's population. Univariate and multivariate regression analyses were performed to assess the association between CPAs frequency and endpoints. Results A total of 205 CPAs were reported by 167 PICUs across 48 states. The estimated CPAs frequency was 2.8 per million children. A total of 3,235 tests were conducted with 6.3% positive tests. Children above 11 years of age comprised 69.7% of the total cohort and 35.1% had moderated or severe comorbidities. The median duration of a CPA was 4.9 days [1.25-12.00 days]. Out of the 1,132 total CPA days, 592 [52.2%] were for mechanical ventilation. The inpatient mortalities were 3 [1.4%]. Multivariate analyses demonstrated an association between CPA's with greater population density [beta-coefficient 0.01, p<0.01] and increased percent of children receiving the influenza vaccination [beta-coefficient 0.17, p=0.01]. Conclusions Inpatient mortality during PICU CPAs is relatively low at 1.4%. CPA frequency seems to be impacted by population density while characteristics of illness severity appear to be associated with ultraviolet index, temperature, and comorbidities such as Type 1 diabetes. These factors should be included in future studies using patient-level data.

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Disparities in Case Frequency and Mortality of Coronavirus Disease 2019 (COVID-19) Among Various States in the United States

10.1101/2020.07.28.20163931 ◽

2020 ◽

Author(s):

Rohit S. Loomba ◽

Gaurav Aggarwal ◽

Saurabh Aggarwal ◽

Saul Flores ◽

Enrique G. Villarreal ◽

...

Keyword(s):

Population Density ◽

State Level ◽

The United States ◽

Testing Frequency ◽

Level Data ◽

The Us ◽

Mortality Case ◽

Percent Mortality ◽

Beta Coefficient ◽

Reported Data

Objective: To utilize publicly reported, state-level data to identify factors associated with the frequency of cases, tests, and mortality in the US. Materials & Methods: Retrospective study using publicly reported data collected included the number of COVID-19 cases, tests, and mortality from March 14th through April 30th, 2020. Publicly available state-level data was collected which included: demographics comorbidities, state characteristics and environmental factors. Univariate and multivariate regression analyses were performed to identify the significantly associated factors with percent mortality, case and testing frequency. All analyses were state-level analyses and not patient-level analyses. Results: A total of 1,090,500 COVID-19 cases were reported during the study period. The calculated case and testing frequency were 3,332 and 19,193 per 1,000,000 patients. There were 63,642 deaths during this period which resulted in a mortality of 5.8%. Factors including to but not limited to population density (beta coefficient 7.5, p< 0.01), transportation volume (beta coefficient 0.1, p< 0.01), tourism index (beta coefficient -0.1, p=0.02) and older age (beta coefficient 0.2, p=0.01) are associated with case frequency and percent mortality. Conclusions: There were wide variations in testing and case frequencies of COVID-19 among different states in the US. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality.

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Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

Global Pediatric Health ◽

10.1177/2333794x21991531 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2199153

Author(s):

Ameer Al-Hadidi ◽

Morta Lapkus ◽

Patrick Karabon ◽

Begum Akay ◽

Paras Khandhar

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Noninvasive Positive Pressure Ventilation ◽

Pediatric Intensive Care ◽

Nasal Cannula ◽

Respiratory Support ◽

Positive Pressure ◽

P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

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High Flow Nasal Cannula Therapy as a Primary Mode of Respiratory Support in a Pediatric Intensive Care Unit

Indian Pediatrics ◽

10.1007/s13312-021-2095-8 ◽

2020 ◽

Vol 58 (1) ◽

pp. 41-43

Author(s):

Sachin Shah ◽

Amita Kaul ◽

Rupesh Bhosale ◽

Ganesh Shiwarkar

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

High Flow ◽

Nasal Cannula ◽

Respiratory Support ◽

High Flow Nasal Cannula ◽

Primary Mode

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On the Link between Policy Uncertainty and House Prices: Asymmetric Evidence from State-Level Data in the United States

Journal of Real Estate Portfolio Management ◽

10.1080/10835547.2021.1986348 ◽

2021 ◽

pp. 1-20

Author(s):

Mohsen Bahmani-Oskooee ◽

Radames Azaryan ◽

Seyed Hesam Ghodsi

Keyword(s):

United States ◽

House Prices ◽

State Level ◽

The United States ◽

Policy Uncertainty ◽

Level Data

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Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

Children ◽

10.3390/children8111035 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1035

Author(s):

Rachel K. Marlow ◽

Sydney Brouillette ◽

Vannessa Williams ◽

Ariann Lenihan ◽

Nichole Nemec ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Medical Center ◽

Invasive Mechanical Ventilation ◽

Severity Of Illness ◽

Pediatric Intensive Care ◽

Respiratory Support ◽

Non Invasive ◽

Lengths Of Stay

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.

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Sedation in the Pediatric Intensive Care Unit: Challenges, Outcomes, and Future Strategies in the United States

Pediatric Sedation Outside of the Operating Room ◽

10.1007/978-1-4939-1390-9_16 ◽

2014 ◽

pp. 275-328

Author(s):

Joseph D. Tobias

Keyword(s):

United States ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

The United States

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The prevalence and characteristics of rapid response systems in hospitals with pediatric intensive care units in Japan and barriers to their use

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa040 ◽

2020 ◽

Vol 32 (5) ◽

pp. 325-331

Author(s):

Taiki Haga ◽

Hiroshi Kurosawa ◽

Junji Maruyama ◽

Katsuko Sakamoto ◽

Ryo Ikebe ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Pediatric Intensive Care ◽

The United States ◽

Rapid Response ◽

Full Time ◽

Pediatric Intensive Care Units ◽

Rapid Response Systems ◽

Significant Difference ◽

Response Systems

Abstract Objective The use of pediatric rapid response systems (RRSs) to improve the safety of hospitalized children has spread in various western countries including the United States and the United Kingdom. We aimed to determine the prevalence and characteristics of pediatric RRSs and barriers to use in Japan, where epidemiological information is limited. Design A cross-sectional online survey. Setting All 34 hospitals in Japan with pediatric intensive care units (PICUs) in 2019. Participants One PICU physician per hospital responded to the questionnaire as a delegate. Main outcome measures Prevalence of pediatric RRSs in Japan and barriers to their use. Results The survey response rate was 100%. Pediatric RRSs had been introduced in 14 (41.2%) institutions, and response teams comprised a median of 6 core members. Most response teams employed no full-time members and largely comprised members from multiple disciplines and departments who served in addition to their main duties. Of 20 institutions without pediatric RRSs, 11 (55%) hoped to introduce them, 14 (70%) had insufficient knowledge concerning them and 11 (55%) considered that their introduction might be difficult. The main barrier to adopting RRSs was a perceived personnel and/or funding shortage. There was no significant difference in hospital beds (mean, 472 vs. 524, P = 0.86) and PICU beds (mean, 10 vs. 8, P = 0.34) between institutions with/without pediatric RRSs. Conclusions Fewer than half of Japanese institutions with PICUs had pediatric RRSs. Operating methods for and obstructions to RRSs were diverse. Our findings may help to popularize pediatric RRSs.

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