DOCSLIB.ORG

Functional Evaluation of Pediatric Patients After Discharge from the Intensive Care Unit Using the Functional Status Scale

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Functional Evaluation of Pediatric Patients After Discharge from the Intensive Care Unit Using the Functional Status Scale ARTIGO ORIGINAL Gabriela Alves Pereira1,3, Camila Wohlgemuth Schaan2, Renata Salatti Ferrari2 Avaliação funcional em pacientes pediátricos após alta da unidade de terapia intensiva por meio da Functional Status Scale Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale 1. Universidade Federal de Ciências da Saúde de RESUMO 4 [1 - 4]. Os pacientes que reinternaram Porto Alegre - Porto Alegre (RS), Brasil. na unidade de terapia intensiva pediá- 2. Hospital de Clínicas de Porto Alegre, Objetivo: Avaliar a funcionalidade trica demonstraram, comparativamente Universidade Federal do Rio Grande do Sul - de pacientes pediátricos após alta da uni- Porto Alegre (RS), Brasil. aos que não reinternaram, ter pior es- 3. Hospital Moinhos de Vento - Porto Alegre dade de terapia intensiva pediátrica por core global (p = 0,01), “função motora” (RS), Brasil. meio da Functional Status Scale e compa- (p = 0,01), “alimentação” (p = 0,02), rar o tempo de ventilação mecânica in- “respiração” (p = 0,036) e maior índice vasiva, tempo de internação e o Pediatric de mortalidade pelo Pediatric Index of Index of Mortality 2 entre os indivíduos Mortality 2 (p = 0,025). com diferentes graus de comprometi- Conclusão: A avaliação da Functio- mento funcional. nal Status Scale indicou disfunção fun- Métodos: Estudo transversal, rea- cional moderada dos pacientes após a lizado com pacientes egressos de uma alta da unidade de terapia intensiva pe- unidade de terapia intensiva pediátrica. diátrica, principalmente na função mo- A avaliação funcional pela Functional tora e alimentação; pacientes que rein- Status Scale foi realizada no primeiro ternaram na unidade de terapia inten- dia após a alta da unidade, tendo sido siva pediátrica demonstraram ter piores utilizado o Pediatric Index of Mortality escore funcional global e função motora, 2 como índice preditivo de mortalidade alimentação e respiração. Indivíduos do momento da admissão na unidade. com maior comprometimento funcional Resultados: A amostra foi compos- apresentaram maior tempo de ventilação ta por 50 indivíduos, sendo 60% do mecânica invasiva e internação na unida- sexo masculino, com mediana de idade de de terapia intensiva pediátrica. de 19 meses [6 - 61]. O escore global da Functional Status Scale foi de 11,5 Descritores: Morbidade; Cuidados [7 - 15] e maiores escores nos domínios intensivos; Criança; Unidades de terapia “função motora” 3 [1 - 4] e “alimentação” intensiva pediátrica; Criança hospitalizada Conflitos de interesse: Nenhum. Submetido em 15 de fevereiro de 2017 Aceito em 22 de junho de 2017 INTRODUÇÃO Autor correspondente: Gabriela Alves Pereira Os instrumentos preditivos de mortalidade para pacientes pediátricos têm Universidade Federal de Ciências da Saúde de sido bastante estudados e utilizados em unidades de terapia intensiva (UTI) Porto Alegre (1) Rua Sarmento Leite, 245 pediátrica em diferentes partes do mundo. No entanto, a avaliação da sobre- CEP: 90050-170 - Porto Alegre (RS), Brasil vida não é mais o único desfecho de interesse, pois a mortalidade nas UTI tem E-mail: [email protected] diminuído aproximadamente 2% ao ano desde 2000.(2) Essa redução é devida principalmente a avanços tecnológicos e a melhora da assistência, como a im- Editor responsável: Jefferson Pedro Piva plementação do trabalho multidisciplinar e o desenvolvimento de rotinas e pro- DOI: 10.5935/0103-507X.20170066 tocolos próprios para cuidado e segurança dos pacientes, assim como a melhora da comunicação entre a equipe da UTI, pacientes e familiares.(2,3) Rev Bras Ter Intensiva. 2017;29(4):460-465 Avaliação funcional em pacientes pediátricos após alta da unidade de terapia intensiva 461 Com o aumento da sobrevida, os pacientes críticos per- cirúrgicos, exceto as situações de trauma e cirurgia cardí- manecem por períodos mais longos no ambiente hospita- aca.(5) A amostra foi composta por pacientes egressos des- lar, criando uma população de pacientes doentes crônicos ta UTI pediátrica, sendo incluídos no estudo indivíduos após a alta das UTI.(3) A internação hospitalar prolongada de ambos os sexos, com idade superior a 1 mês de vida e comumente leva à redução da independência funcional, inferior a 18 anos completos, com permanência na UTI decorrente do uso de bloqueadores neuromusculares e de pediátrica por um período ≥ 24 horas. Foram excluídos do medicações como corticosteroides e, principalmente, por estudo indivíduos dependentes de tecnologia ventilatória conta do tempo de ventilação mecânica invasiva (VMI) a previamente à internação na UTI pediátrica, prematuros que são submetidos.(3) (idade gestacional ≤ 37 semanas) com idade ≤ 12 meses no Dentre os sintomas apresentados pelos sobreviventes, momento da admissão no estudo e pacientes readmitidos destacam-se problemas psicológicos (ansiedade e depres- na UTI pediátrica em um período ≤ 24 horas após a alta são), disfunção cognitiva, piora da função pulmonar e de- da unidade. senvolvimento de complicações neuromusculares periféri- A avaliação da funcionalidade foi realizada pela FSS cas.(2) Tais limitações e incapacidades apresentadas após a (Apêndice 1), aplicada a todos os participantes do estu- alta afetam o desempenho e o desenvolvimento global da do no primeiro dia após a alta da UTI pediátrica, sempre criança nas dimensões de saúde física, cognitiva, emocio- pelo mesmo avaliador. Esta escala já foi validada para a po- nal e/ou social,(1) e estão relacionadas à morbidade destes pulação pediátrica na língua inglesa,(7) e os pesquisadores pacientes, desfecho ainda com resultados escassos na lite- obtiveram autorização do autor responsável para sua utili- ratura ou avaliados de forma pouco adequada à faixa etária zação neste estudo. A escala de funcionalidade é composta pediátrica e suas especificidades.(4-6) por seis domínios: estado mental, sensório, comunicação, A Functional Status Scale (FSS) foi desenvolvida e fun- função motora, alimentação e respiração. Cada domínio é damentada nos conceitos de Atividades de Vida Diária categorizado de normal (1) a disfunção muito severa (5) e (AVD) e de comportamento adaptativo,(7) tratando-se de seu escore total varia de 6 a 30. uma escala de avaliação do escore funcional nos domínios As pontuações da FSS global são categorizadas em: 6 - motor e cognitivo, especificamente desenvolvida para pa- 7 para adequada; 8 - 9, disfunção leve; 10 - 15, disfunção cientes pediátricos hospitalizados.(7) Destaca-se por ser um moderada; 16 - 21, disfunção severa; e mais de 21 pontos, método quantitativo, rápido e confiável, independente de disfunção muito severa.(8) A escala PIM2 é preditiva de avaliações subjetivas e aplicável a uma ampla faixa etária, mortalidade específica para utilização em UTI pediátrica. desde recém-nascidos a termo até adolescentes, sendo des- Para seu preenchimento é registrado o primeiro valor de crito como o instrumento mais completo para avaliação cada variável clínica medida a partir do momento da ad- destes pacientes.(6,7) Com base no exposto, o presente estu- missão até 1 hora após a chegada na UTI pediátrica.(9,10) do teve o objetivo de avaliar a funcionalidade global de pa- Esse instrumento é aplicado de rotina pela equipe médica cientes pediátricos após a alta da UTI pediátrica por meio da UTI pediátrica do HCPA em todos os pacientes ad- da escala FSS, comparar os escores funcionais e o Pediatric mitidos nesta unidade, e seu escore final é registrado no Index of Mortality 2 (PIM2) em relação à ocorrência de prontuário eletrônico. reinternação na UTI pediátrica, e comparar o tempo de As informações clínicas e demográficas dos pacientes, VMI, tempo de internação e PIM2 entre os indivíduos como idade, sexo, diagnóstico de base, motivo da interna- com diferentes graus de comprometimento no escore FSS ção, tipo de internação, procedência, tempo de internação global. na UTI pediátrica e tempo de permanência em VMI, fo- ram coletadas a partir do prontuário eletrônico dos parti- MÉTODOS cipantes. A ocorrência de óbito e reinternações foi avaliada Trata-se de um estudo transversal, desenvolvido na no mês de outubro de 2015 por meio do livro de registro UTI pediátrica e na unidade de internação pediátrica do da UTI pediátrica e prontuário eletrônico. Hospital de Clínicas de Porto Alegre (HCPA) entre os me- O tamanho de amostra estimado foi de 47 indivídu- ses de março a agosto de 2015. O projeto foi aprovado os, considerando um poder estatístico de 80%, nível de pela Comissão de Pesquisa e Ética do HCPA sob pare- significância de 5%, ajustados para uma margem de erro cer 966.513 e foi obtido o Termo de Consentimento Li- de 2 pontos na escala FSS e desvio padrão de 4,4, como (7) vre e Esclarecido (TCLE) dos pais/responsáveis. A UTI apresentado no estudo original; para verificar correlações pediátrica do HCPA é composta por 13 leitos e admite de, no mínimo, 0,4 entre as variáveis de escore funcional pacientes com distúrbios clínicos ou após procedimentos e tempo de internação, tempo de ventilação mecânica e Rev Bras Ter Intensiva. 2017;29(4):460-465 462 Pereira GA, Schaan CW, Ferrari RS PIM2, foi utilizado o software WinPEPI, versão 11.43. As Tabela 1 - Características clínicas e demográficas da amostra (n=50) variáveis quantitativas foram descritas por média e desvio Variáveis padrão quando a distribuição era simétrica, e mediana e Sexo masculino 30 (60) amplitude interquartil quando distribuição assimétrica, Idade (meses) 19 [6 - 61] conforme teste de normalidade de Shapiro-Wilk. Para fins Procedência da análise comparativa
Load more

Recommended publications
  • Application of Different Scoring Systems and Their Value in Pediatric
    Egyptian Pediatric Association Gazette (2014) 62,59–64 HOSTED BY Contents lists available at ScienceDirect Egyptian Pediatric Association Gazette journal homepage: http://www.elsevier.com/locate/epag Application of different scoring systems and their value in pediatric intensive care unit Hanaa I. Rady *, Shereen A. Mohamed, Nabil A. Mohssen, Mohamed ElBaz Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt Received 4 September 2014; accepted 28 October 2014 Available online 17 November 2014 KEYWORDS Abstract Background: Little is known on the impact of risk factors that may complicate the Scoring systems; course of critical illness. Scoring systems in ICUs allow assessment of the severity of diseases and Pediatric intensive care unit; predicting mortality. Mortality rate; Objectives: Apply commonly used scores for assessment of illness severity and identify the combi- Critical care; nation of factors predicting patient’s outcome. Illness severity; Methods: We included 231 patients admitted to PICU of Cairo University, Pediatric Hospital. Multiple organ dysfunction PRISM III, PIM2, PEMOD, PELOD, TISS and SOFA scores were applied on the day of admis- sion. Follow up was done using SOFA score and TISS. Results: There were positive correlations between PRISM III, PIM2, PELOD, PEMOD, SOFA and TISS on the day of admission, and the mortality rate (p < 0.0001). TISS and SOFA score had the highest discrimination ability (AUC: 0.81, 0.765, respectively). Significant positive correla- tions were found between SOFA score and TISS scores on days 1, 3 and 7 and PICU mortality rate (p < 0.0001). TISS had more ability of discrimination than SOFA score on day 1 (AUC: 0.843, 0.787, respectively).
    [Show full text]
  • Regional Variability of Admission Prevalence and Mortality of Pediatric Critical Illness in Latvia
    Anesth Crit Care 2019; 1 (1): 015-022 DOI: 10.26502/acc.003 Research Article Regional Variability of Admission Prevalence and Mortality of Pediatric Critical Illness in Latvia Linda Setlere1,2, Ivars Vegeris2,3, Margita Stale4, Reinis Balmaks1,2 1Faculty of Medicine, Riga Stradins University, Latvia 2Intensive Care Unit, Children’s Clinical University Hospital, Riga, Latvia 3Department of Doctoral Studies, Riga Stradins University, Latvia 4The Centre for Disease Prevention and Control of Latvia, Riga *Corresponding Author: Dr. Reinis Balmaks, Departments of Clinical Skills and Medical Technologies and Pediatrics, Riga Stradins University, 26a Anninmuizas Blvd, Riga, LV-1067, Latvia, Tel: +37167061579; E-mail: [email protected] Received: 03 May 2019; Accepted: 09 May 2019; Published: 17 May 2019 Abstract Objectives: There is only one pediatric intensive care unit (PICU) in Latvia, where all critically ill children <18 years are admitted from all regions of Latvia. The aim of this study is to ascertain regional differences in mortality and morbidity of critically ill children over a 5-year period. Materials and Methods: Descriptive retrospective study of children who were admitted to the PICU in Latvia from January 2012 to December 2016. Data on episodes were obtained from the Children's Clinical University Hospital electronic health records. Pediatric Index of Mortality (PIM2) was used for risk adjustment and calculation of standardized mortality ratio (SMR). The data were compared among the six regions of Latvia - Kurzeme, Latgale, Pieriga, Riga, Vidzeme, and Zemgale. Results: The analysis included 3651 intensive care episodes. The highest PICU admission prevalence was in Riga and the lowest in Latgale - 2.3 and 1.7 admissions per 1000 children per year, respectively.
    [Show full text]
  • Predictive Value of Scoring System in Severe Pediatric Head Injury
    Medicina (Kaunas) 2007; 43(11) 861 Predictive value of scoring system in severe pediatric head injury Dovilė Evalda Grinkevičiūtė, Rimantas Kėvalas, Viktoras Šaferis1, Algimantas Matukevičius1, Vytautas Ragaišis2, Arimantas Tamašauskas1 Department of Children’s Diseases, 1Institute for Biomedical Research, 2Department of Neurosurgery, Kaunas University of Medicine, Lithuania Key words: pediatric head trauma; Glasgow Coma Scale, Pediatric Trauma Score; Glasgow Outcome Scale, Pediatric Index of Mortality 2. Summary. Objectives. To determine the threshold values of Pediatric Index of Mortality 2 (PIM 2) score, Pediatric Trauma Score (PTS), and Glasgow Coma Scale (GCS) score for mortality in children after severe head injury and to evaluate changes in outcomes of children after severe head injury on discharge and after 6 months. Material and methods. All children with severe head injury admitted to the Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital, Lithuania, from January 2004 to June 2006 were prospectively included in the study. The severity of head injury was categorized according to the GCS score ≤8. As initial assessment tools, the PTS, postresuscitation GCS, and PIM 2 scores were calculated for each patient. Outcome was assessed according to Glasgow Outcome Scale on discharge and after 6 months. Results. The study population consisted of 59 children with severe head injury. The group consisted of 37 (62.7%) boys and 22(37.3%) girls; the mean age was 10.6±6.02. The mean GCS, PTS, and PIM 2 scores were 5.9±1.8, 4.8±2.7, and 14.0±19.5, respectively. In terms of overall outcome, 46 (78.0%) patients survived and 13 (22.0%) died.
    [Show full text]
  • PIM2) in Argentina: a Prospective, Multicenter, Observational Study
    Original article Validation of the Pediatric Index of Mortality 2 (PIM2) in Argentina: a prospective, multicenter, observational study Ariel L. Fernández, M.Sc.,a María P. Arias López, M.D.,b María E. Ratto, M.D.,c Liliana Saligari, M.D.,d Alejandro Siaba Serrate, M.D.,e Marcela de la Rosa, M.D.,f Norma Raúl, M.D.,g Nancy Boada, M.D.,h Paola Gallardo, M.D.,i InjaKo, M.D.,b and Eduardo Schnitzler, M.D.e ABSTRACT and the different investments made Introduction. The Pediatric Index of Mortality 2 by each region in their healthcare (PIM2) is one of the most commonly used scoring systems to predict mortality in patients systems. Critical care distribution and admitted to pediatric intensive care units (PICU) quality are not homogeneous within in Argentina. The objective of this study was to each country either, which leads to validate the PIM2 score in PICUs participating differences in results and a likely in the Quality of Care Program promoted by the Argentine Society of Intensive Care. impact on overall health indicators, Population and Methods. Multicenter, such as child mortality rates.1 prospective, observational, cross-sectional study. In order to implement any quality All patients between 1 month and 16 years old improvement initiative, results should a. FUNDASAMIN admitted to participating PICUs between January (Fundación para 1st, 2009 and December 31st, 2009 were included. be objectively measured. Prognostic la Salud Materno The discrimination and calibration of the PIM2 scores of mortality in intensive care Infantil). score were assessed in the entire population and units (ICU) have been developed to b.
    [Show full text]
  • Abstracts Months) and (6.31±1.75 Kg) Respectively
    Arch Dis Child: first published as 10.1136/archdischild-2012-302724.0804 on 1 October 2012. Downloaded from Abstracts months) and (6.31±1.75 kg) respectively. The age and weight in Results Total number of CVC days (for 227 CVC) was 960 days. group B was (7.6±3.9 months) and (4.84±1.12) kg respectively. Complications during insertion were multiple attempts(4.84%), There were no significant differences between the 2 groups in term bleeding(0.88%) and haemothorax(0.44%). of post operative mortality or morbidity. Conclusion Failure to thrive can complicate congenital heart dis- Abstract 805 Table 1 Central venous catheter complication rates eases (CHD) associated with significant left to right shunt and heart failure. FTT was not associated with increase in ICU morbidity or Type of complication Infection Thrombosis Leakage mortality. Attempt to optimize the body weight for age in children with CHD may not add any beneficial advantages in term of surgi- Complication rates 22.91 per 1000 4.16 per 1000 catheter 18.75 per 1000 cal risk or postoperative ICU outcome. catheter days days catheter days 804 OUTCOMES OF PEDIATRIC TETANUS IN WESTERN INDIA Abstract 805 Table 2 Complication in relation to duration of CVC doi:10.1136/archdischild-2012-302724.0804 Number of Total catheter Average duration of one CVC 1 1 1,2 1 VV Shukla, AS Nimbalkar, SM Nimbalkar. Department of Pediatrics, Pramukhswami Type of complication catheters days in-situ in days Medical College; 2Central Research Services, Charutar Arogya Mandal, Anand, India Infection 22 188 8.54 Background Despite being easily preventable with a highly effec- Leakage 17 129 7.5 tive vaccine, tetanus remains a significant source of morbidity and Thrombosis 4 14 3.5 mortality.
    [Show full text]
  • 0663 Pediatric MODS Topic Brief 2.2.17
    Pediatric Multiple Organ Dysfunction Syndrome Results of Topic Selection Process & Next Steps The nominator, the Pediatric Organ Dysfunction Information Update Mandate (PODIUM), is interested in a new AHRQ systematic review examining the performance characteristics of both clinical assessments and scoring tools in predicting outcomes among children with individual and multiple organ dysfunction. Due to limited program resources, the program will not develop a review at this time. No further activity on this topic will be undertaken by the Effective Health Care (EHC) Program. Topic Brief Topic Name: Pediatric Multiple Organ Dysfunction Syndrome (MODS) Topic #: 0663 Nomination Date: April 18, 2016 Topic Brief Date: January 30, 2017 Authors: Stephanie Veazie Kara Winchell Rose Relevo Karli Kondo Mark Helfand Conflict of Interest: None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Summary of Key Findings: • Appropriateness and importance: The nomination is both appropriate and important. • Duplication: A new review on this topic would not duplicate existing efforts. We identified no completed or in-process reviews on the performance characteristics of scoring tools or clinical assessments for single organ dysfunction (KQ1) or scoring tools for multiple organ dysfunction (KQ2) in pediatric populations. • Impact: A new evidence review has high impact potential, as the standard for care for assessing children with single and multiple organ dysfunction is unclear. • Feasibility : A new review on this topic is feasible. o Size/scope of review: We identified a total of 65 studies pertaining to the key questions: 43 studies on the performance characteristics of clinical assessments and scoring tools for individual organ dysfunction (KQ1) and 22 studies on scoring tools for multiple organ dysfunction (KQ2).
    [Show full text]
  • Characteristics, Course and Outcomes of Children Admitted to a Paediatric Intensive Care Unit After Cardiac Arrest
    This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. RESEARCH Characteristics, course and outcomes of children admitted to a paediatric intensive care unit after cardiac arrest J Appiah,1,2,3 MB ChB, MWACP, MPhil, Cert Crit Care (Paed); S Salie,1,2 MB ChB, DCH, FCPaed, Cert Crit Care (Paed); A Argent,1,2 MB ChB, MMed(Paed), MD(Paed), DCH (SA), FCPaed (SA); B Morrow,2 PhD, BSc (Physiotherapy) 1 Paediatric Intensive Care Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa 2 Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa 3 Paediatric Intensive Care Unit, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana Corresponding author: J Appiah ([email protected]) Background. Cardiac arrest is a potentially devastating event, associated with death or severe neurological complications in survivors. There is little evidence on paediatric cardiac arrest prevalence, characteristics and outcomes in South Africa (SA). Objective. To describe the characteristics, course and outcomes of children admitted to an SA paediatric intensive care unit (PICU) following cardiac arrest. Methods. Retrospective descriptive study of routinely collected data (January 2010 - December 2011). Results. Of 2 501 PICU admissions, 110 (4.4%) had preceding cardiac arrest. The median (interquartile range (IQR)) age of children was 7.2 (2.5 - 21.6) months. In-hospital arrests accounted for 80.6% of the events. The most common primary diagnostic categories were respiratory (29.1%), cardiovascular (21.4%) and gastrointestinal (21.4%). Twenty-four patients (23.3%) arrested during endotracheal intubation.
    [Show full text]
  • Viewed Publications
    Knaup et al. Journal of Intensive Care (2019) 7:38 https://doi.org/10.1186/s40560-019-0392-2 RESEARCH Open Access Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score Emily Knaup1,2, Nobuyuki Nosaka1,2,3* , Takashi Yorifuji4, Kohei Tsukahara1,2, Hiromichi Naito1,HirokazuTsukahara2, and Atsunori Nakao1 for the JaRPAC Study Group Abstract Background: The length of stay (LOS) in intensive care units (ICUs) has been used as a good indicator not only for resource consumption but also for health outcomes of patients. However, data regarding pediatric LOS in Japanese ICUs are limited. The primary aim of this study was to characterize the Japanese pediatric ICU patients based on their LOS. Second, we aimed to develop a simple scoring system to predict long-stay pediatric ICU patients on admission. Methods: We performed a retrospective cohort study using consecutive pediatric data (aged < 16 years) registered in the Japanese Registry of Pediatric Acute Care (JaRPAC) from October 2013 to September 2016, which consisted of descriptive and diagnostic information. The factors for long-stay patients (LSPs; LOS > 14 days) were identified using multiple regression analysis, and subsequently, a simple predictive scoring system was developed based on the results. The validity of the score was prospectively tested using data from the JaRPAC registration from October 2016 to September 2017. Results: Overall, 4107 patients were included. Although LSPs were few (8.0% [n = 330]), they consumed 38.0% of ICU bed days (9750 for LSPs versus 25,659 overall). Mortality was seven times higher in LSPs than in short-stay patients (9.1% versus 1.3%).
    [Show full text]
  • Association Between Off-Hour Admission of Critically Ill Children To
    www.nature.com/scientificreports OPEN Association between of‑hour admission of critically ill children to intensive care units and mortality in a Japanese registry Takahiro Kido1,2, Masao Iwagami 2,3*, Toshikazu Abe2,3,4, Yuki Enomoto1,5, Hidetoshi Takada1,6 & Nanako Tamiya2,3 Limited information exists regarding the efect of of‑hour admission among critically ill children. To evaluate whether children admitted to intensive care units (ICUs) in of‑hour have worse outcomes, we conducted a cohort study in 2013–2018 in a multicenter registry in Japan. Pediatric (age < 16 years) unplanned ICU admissions were divided into regular‑hour (daytime on business days) or of‑hour (others). Mortality and changes in the functional score at discharge from the unit were compared between the two groups. We established multivariate logistic regression models to examine the independent association between of‑hour admission and outcomes. Due to the small number of outcomes, two diferent models were used. There were 2512 admissions, including 757 for regular‑ hour and 1745 for of‑hour. Mortality rates were 2.4% (18/757) and 1.9% (34/1745) in regular‑hour and of‑hour admissions, respectively. There was no signifcant association between of‑hour admission and mortality both in model 1 adjusting for age, sex, and Pediatric Index of Mortality 2 (adjusted odds ratio [aOR] 0.89, 95% confdence interval [CI] 0.46–1.72) and in model 2 adjusting for propensity score predicting of‑hour admission (aOR 1.05, 95% CI 0.57–1.91). In addition, of‑hour admission did not show an independent association with deterioration of functional score.
    [Show full text]
  • Predictive Value of the Physiological Deadspace/Tidal Volume Ratio in The
    0021-7557/12/88-03/217 Jornal de Pediatria Copyright © by Sociedade Brasileira de Pediatria ARTIGO ORIGIN A L Predictive value of the physiological deadspace/tidal volume ratio in the weaning process of mechanical ventilation in children Valor preditivo da razão entre espaço morto e volume corrente fisiológicos no processo de desmame da ventilação mecânica em crianças Yvon Riou1, Wissem Chaari2, Stéphane Leteurtre1, Francis Leclerc1 Resumo Abstract Objetivo: Avaliar a razão entre espaço morto e volume corrente Objective: To evaluate the physiological deadspace/tidal volume fisiológicos (VD/VT) como preditor do fracasso na extubação em 42 ratio (VD/VT) as a predictor of extubation failure in 42 ventilated children crianças ventiladas (idade média: 4,75 anos). (median age: 4.75 years). Método: Prontidão para extubação foi determinada usando os Method: Extubation readiness was determined using the criteria critérios propostos pela 6a Conferência Internacional de Consenso em proposed by the 6th International Consensus Conference on Intensive Medicina Intensiva adaptados a crianças. Care Medicine adapted to children. Resultados: A ventilação não invasiva (VNI) foi usada em quatro Results: Non-invasive ventilation (NIV) was used in four patients pacientes que desenvolveram insuficiência respiratória após a extubação; who developed respiratory failure after extubation; none was reintubated. nenhum foi reintubado. Crianças que precisaram de VNI para evitar a Children who needed NIV to avoid reintubation had a significantly higher reintubação tiveram razão VD/VT significativamente maior do que as que VD/VT ratio than those who were extubated without NIV (p < 0.001). The foram extubadas sem VNI (p < 0,001). O valor de corte da razão VD/VT cut-off value of VD/VT ratio was 0.55 and the area under the receiver foi 0,55, e a área sob a curva ROC foi 0,86.
    [Show full text]
  • Clinical Characteristics and Mortality Risk Prediction in Critically Ill Children in Malaysian Borneo
    Singapore Med J 2014; 55(5): 261-265 O riginal A rticle doi:10.11622/smedj.2014069 Clinical characteristics and mortality risk prediction in critically ill children in Malaysian Borneo Indra Ganesan1,2, MD, MRCPCH, Terrence Thomas1,2, MD, MRCPCH, Fon En Ng2, MBBS, Thian Lian Soo2, MBBS, FRCP INTRODUCTION Mortality risk prediction scores are important for benchmarking quality of care in paediatric intensive care units (PICUs). We aimed to benchmark PICU outcomes at our hospital against the Pediatric Index of Mortality 2 (PIM2) mortality risk prediction score, and evaluate differences in diagnosis on admission and outcomes between Malaysian and immigrant children. METHODS We prospectively collected demographic and clinical data on paediatric medical patients admitted to the PICU of Sabah Women’s and Children’s Hospital in Kota Kinabalu, Sabah, Malaysia. The PIM2 risk score for mortality was tabulated. RESULTS Of the 131 patients who met the inclusion criteria, data was available for 115 patients. The mean age of the patients was 2.6 ± 3.8 years, with 79% of the cohort aged less than five years. Patients were mainly of Kadazan (38%) and Bajau (30%) descent, and 26% of patients were non-citizens. Leading diagnoses on admission were respiratory (37%), neurological (18%) and infectious (17%) disorders. Out of the 29 patients who died, 23 (79%) were Malaysians and the main mortality diagnostic categories were respiratory disorder (22%), septicaemia (22%), haemato-oncological disease (17%) and neurological disorder (13%). Calculated standardised mortality ratios (SMRs) were not significantly > 1 for any patient category for variables such as age and admission diagnosis. However, infants less than two years old with comorbidities were significantly worse (SMR 2.61, 95% confidence interval 1.02–6.66).
    [Show full text]
  • PIM2: a Revised Version of the Paediatric Index of Mortality
    Intensive Care Med (2003) 29:278–285 DOI 10.1007/s00134-002-1601-2 NEONATAL AND PEDIATRIC INTENSIVE CARE Anthony Slater PIM2: a revised version of the Paediatric Index Frank Shann Gale Pearson of Mortality for the PIM Study Group Received: 11 January 2002 Abstract Objective: To revise the units were used to derive a learning Accepted: 15 November 2002 Paediatric Index of Mortality (PIM) model that was tested using data Published online: 23 January 2003 to adjust for improvement in the out- from seven other units. The model © Springer-Verlag 2003 come of paediatric intensive care. fitted the test data well (deciles of Design: International, multi-centre, risk goodness-of-fit χ2 8.14, p=0.42) This paper was written on behalf of the prospective, observational study. and discriminated between death PIM Study Group. Setting: Twelve specialist paediatric and survival well [area under the re- intensive care units and two com- ceiver operating characteristic bined adult and paediatric units in (ROC) plot 0.90 (0.89–0.92)]. The Australia, New Zealand and the final PIM2 model, derived from the United Kingdom. Patients: All chil- entire sample of 19,638 survivors dren admitted during the study period. and 1,104 children who died, also In the analysis, 20,787 patient ad- fitted and discriminated well [χ2 11.56, missions of children less than p=0.17; area 0.90 (0.89–0.91)]. 16 years were included after 220 pa- Conclusions: PIM2 has been re-cali- A. Slater (✉) tients transferred to other ICUs and brated to reflect the improvement Women’s and Children’s Hospital, 72 King William Road, one patient still in ICU had been that has occurred in intensive care North Adelaide, SA 5006 Australia excluded.
    [Show full text]