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 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 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 Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

2021 ◽  
Author(s):  
Zi-Hong Xiong ◽  
Xue-Mei Zheng ◽  
Guo-Ying Zhang ◽  
Meng-Jun Wu ◽  
Yi Qu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Phase Angle ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

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