scholarly journals Asthma in Paediatric Intensive Care in England Residents: Observational Study

2021 ◽  
Author(s):  
Mome Mukherjee ◽  
Steve Cunningham ◽  
Mohammad Romel Bhuia ◽  
Tsz-Yan Milly Lo ◽  
Jasper V Been ◽  
...  
Keyword(s):  
Intensive Care ◽  
Paediatric Intensive Care ◽  
Primary Reason ◽  
Invasive Ventilation ◽  
Deprived Neighbourhoods ◽  
High Prevalence ◽  
Asthma In Children ◽  
The Uk ◽  
Reason For Admission ◽  
Paediatric Intensive Care Units

Abstract Purpose Despite high prevalence of asthma in children in the UK, there are no prior report on asthma admissions in paediatric intensive care units (PICU). Methods PICANet, a UK national PICU database, was queried for asthma as the primary reason for admission, of children resident in England from April 2006 till March 2013. Results There were 2,195 admissions to PICU for a median stay of 1.4 days. 59% were males and 51% aged 0-4 years. The fourth and fifth deprivation quintiles represented 61% (1,329) admissions and 73% (11) of the 15 deaths. Deaths were most frequent in 10-14 years age (n=11, 73%), with no deaths in less than 5 years age. 38% of admissions (828/2193) received invasive ventilation, which was more frequent with increasing deprivation (13% (108/828) in least deprived to 31% (260/828) in most deprived) and decreasing age (0-4-year-olds: 49%, 409/828). Conclusions This first multi-centre PICU study in England found that children from more deprived neighbourhoods represented the majority of asthma admissions, invasive ventilation and deaths in PICU. Children experiencing socioeconomic deprivation could benefit from enhanced asthma support in the community.

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.

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 Characteristics of adolescents requiring intensive care in the United Kingdom: A retrospective cohort study

2018 ◽  
Vol 19 (3) ◽  
pp. 209-213 ◽  
Author(s):  
Dora Wood ◽  
Sarah Goodwin ◽  
John Pappachan ◽  
Peter Davis ◽  
Roger Parslow ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Intensive Care Unit Mortality ◽  
Elective Surgery ◽  
Paediatric Intensive Care ◽  
Adult Intensive Care Unit ◽  
The United Kingdom ◽  
The Uk ◽  
Paediatric Intensive Care Units

Objectives To describe the case mix, resource use and outcomes for adolescents admitted to intensive care units in the UK. Methods Analysis of national prospectively collected data for all adolescents aged 12–19 years admitted to UK adult or paediatric intensive care units. Results There were 37,320 admissions of adolescents during the eight–year study period. Excluding elective surgery, respiratory diagnoses were the most common reason for paediatric intensive care unit (PICU) admission, with trauma and intoxication the most common reasons for adult intensive care unit (AICU) admission. Intensive care unit mortality was 6.0% and 5.7% for those admitted to PICUs and AICUs, respectively. Conclusions Mortality is similar among adolescents admitted to AICUs and PICUs; however, these rates have not been corrected for severity of acute illness or underlying burden of chronic illness, which may be different between AICUs and PICUs. Services planned for the majority of AICU and PICU patients may not be optimal for critically ill adolescents treated in UK intensive care units, who may need special consideration.

scholarly journals Is there a sex difference in mortality rates for deaths occurring in paediatric intensive care units? Systematic literature review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e046794
Author(s):  
Ofran Almossawi ◽  
Amanda Friend ◽  
Luigi Palla ◽  
Richard Feltbower ◽  
Bianca De Stavola
Keyword(s):  
Intensive Care ◽  
Literature Review ◽  
Intensive Care Units ◽  
Systematic Literature Review ◽  
Data Extraction ◽  
Linkage Study ◽  
Paediatric Intensive Care ◽  
Admission Rates ◽  
Ethical Approval ◽  
Paediatric Intensive Care Units

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.

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

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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