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Analyzing Mortality Trends in the UK Pediatric Critical Care Long-Stay Patient Cohort 分析英国儿科重症监护长期住院患者队列的死亡率趋势
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-05-04 DOI: 10.1055/s-0043-1770990
T. Kothari, N. Kelly, H. Kanthimathinathan
Abstract Long-stay patients in pediatric intensive care unit (PICU) are at risk of higher mortality. The long-stay PICU population is growing larger. Identification of indicators of adverse outcomes in this cohort may provide opportunities for timely counseling and support. We aim to analyze the factors associated with higher mortality in the long-stay PICU patient cohort. Retrospective single-center study of long-stay PICU admissions defined as a PICU length of stay of at least 28 days during a 3-year study period (April 1, 2017–March 31, 2020). Outcomes analyzed included in-PICU mortality and mortality within 12 months of PICU discharge. Variables analyzed for association with outcomes included primary diagnostic category, number and nature of additional comorbidities, long-term ventilation (LTV) pathway, etc. During a 3-year period, there were 2,848 unique individual patient admissions to the PICU; 165 children had 172 long-stay admissions. The overall in-PICU mortality of long-stay patient was 30.2% compared with 6.4% ( p  < 0.0001) for whole PICU population; 42% of the long-stay patients had died by 12 months postdischarge. Certain primary diagnostic groups, for example, hematology/oncology, had a statistically significant increased likelihood of death (odds ratio [OR] 8.6 [ p  = 0.004, confidence interval, CI, 2.0–39.5]). Children on an LTV pathway had relatively lower odds of death (OR 0.1 [ p  = 0.003, CI 0.01–0.34]). We described factors associated with higher and lower mortality rates in a group of long-stay PICU patients. Understanding the impact of specific combinations of factors as shown in this analysis on outcomes may be important for clinicians to help counsel families.
儿科重症监护病房(PICU)的长期住院患者存在较高的死亡率风险。长期住在重症监护病房的人数越来越多。在这个队列中,识别不良结果的指标可能提供及时咨询和支持的机会。我们的目的是分析长期PICU患者群体中与高死亡率相关的因素。在为期3年的研究期间(2017年4月1日- 2020年3月31日),对PICU住院时间至少28天的患者进行回顾性单中心研究。结果分析包括PICU内死亡率和PICU出院12个月内死亡率。分析与结果相关的变量包括主要诊断类别、附加合并症的数量和性质、长期通气(LTV)途径等。在3年的时间里,有2848名独特的个体患者入住PICU;165名儿童有172名长期住院。长期住院患者在PICU内的总死亡率为30.2%,而整个PICU人群的死亡率为6.4% (p < 0.0001);42%的长期住院患者在出院后12个月死亡。某些初级诊断组,如血液学/肿瘤学,死亡的可能性在统计学上显著增加(优势比[OR] 8.6 [p = 0.004,可信区间,CI, 2.0-39.5])。LTV通路患儿的死亡几率相对较低(OR为0.1 [p = 0.003, CI 0.01-0.34])。我们描述了一组长期PICU患者死亡率高低的相关因素。了解本分析中所显示的特定因素组合对结果的影响可能对临床医生帮助咨询家庭很重要。
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引用次数: 0
Prescription Practices and Outcome Analysis of PICU Patients at a Newly Established Tertiary Care Hospital—A Retrospective Study 某新建三级医院PICU患者的处方实践及疗效分析——回顾性研究
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-04-08 DOI: 10.1055/s-0043-1770991
Leo Francis Chalissery, Madhavi Eerike, Madhusudan Samprati, M. Reddy, Chandru Elango, Kalpana Mali Ramanna, Jhilmil Gupta
Abstract Prescription analysis studies play a crucial role in monitoring prescription patterns and establishing guidelines for effective drug delivery and health care management. Given the physiological differences between the pediatric and adult populations, it is essential to analyze the prescription records specifically for pediatric patients, considering their unique diseases, drugs, and dosages. The objectives of this study were to analyze the prescribing patterns of drugs, rationality, outcomes, and antimicrobial use and drugs from National List of Essential Medicines (NLEM) in pediatric intensive care unit (PICU) patients. A retrospective study design was employed, and data were collected from medical records, including demographic information, diagnoses, drug details, and treatment outcomes of PICU patients. The collected data were then analyzed according to the World Health Organization (WHO) indicators for rational drug use, WHO Access, Watch, and Reserve (AWaRe) guidelines for antimicrobial use, and the proportion of essential drugs prescribed. Descriptive statistics was used to express the data in this study. A total of 184 patient records were analyzed, with 57.6% were males. On average, 4.5 drugs were prescribed per prescription, with injections and syrups comprising nearly 28% each. Approximately 71.5% of prescriptions contained generic drug names. Furthermore, 49% of the prescribed drugs were listed in the NLEM. Antibiotics were present in 50% of the prescriptions, with 50% of them falling under the WHO AWaRe Watch category and 31% in Access category. Majority of the drugs being prescribed in the PICU were with generic names, and less than half the prescriptions contained antibiotics. Watch class of antibiotics was most commonly prescribed.
处方分析研究在监测处方模式、建立有效给药和卫生保健管理指南方面发挥着至关重要的作用。鉴于儿童和成人人群的生理差异,考虑到儿科患者独特的疾病、药物和剂量,有必要专门分析儿科患者的处方记录。本研究的目的是分析儿童重症监护病房(PICU)患者的药物处方模式、合理性、结局、抗菌药物的使用和国家基本药物清单(NLEM)中的药物。采用回顾性研究设计,并从医疗记录中收集数据,包括PICU患者的人口统计信息、诊断、药物细节和治疗结果。然后,根据世界卫生组织(世卫组织)合理用药指标、世卫组织获取、监测和储备抗微生物药物使用指南以及规定的基本药物比例,对收集到的数据进行分析。本研究采用描述性统计来表达数据。共分析184例病例,男性占57.6%。每份处方平均开出4.5种药物,其中注射剂和糖浆各占近28%。大约71.5%的处方包含仿制药名称。此外,49%的处方药被列在NLEM中。50%的处方中含有抗生素,其中50%属于世卫组织AWaRe Watch类别,31%属于可及性类别。PICU开出的大多数药物都是通用名称,不到一半的处方含有抗生素。观察类抗生素是最常用的处方。
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引用次数: 0
Enteral Feeding for Children on Bilevel Positive Pressure Ventilation for Status Asthmaticus. 双水平正压通气患儿肠内喂养治疗哮喘。
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-03-01 DOI: 10.1055/s-0041-1730901
Kavipriya Komeswaran, Aayush Khanal, Kimberly Powell, Giovanna Caprirolo, Ryan Majcina, Randall S Robbs, Sangita Basnet

A retrospective data analysis was conducted to evaluate enteral nutrition practices for children admitted with status asthmaticus in a single-center pediatric intensive care unit. Of 406 charts, 315 were analyzed (63% male); 135 on bilevel positive airway pressure ventilation (BIPAP) and 180 on simple mask. Overall median age and weight were 6.0 (interquartile range [IQR]: 6.0) years and 24.8 (IQR: 20.8) kg, respectively. All children studied were on full feeds while still on BIPAP and simple mask; 99.3 and 100% were fed per oral, respectively. Median time to initiation of feeds and full feeds was longer in the BIPAP group, 11.0 (IQR: 20) and 23.0 hours (IQR: 26), versus simple mask group, 4.3 (IQR: 7) and 12.0 hours (IQR: 15), p  = 0.001. The results remained similar after adjusting for gender, weight, clinical asthma score at admission, use of adjunct therapy, and duration of continuous albuterol. By 24 hours, 81.5% of patients on BIPAP and 96.6% on simple mask were started on feeds. Compared with simple mask, patients on BIPAP were sicker with median asthma score at admission of 4 (IQR: 2) versus 3 (IQR: 2) on simple mask, requiring more adjunct therapy (80.0 vs. 43.9%), and a longer median length of therapy of 41.0 (IQR: 41) versus 20.0 hours (IQR: 29), respectively, p  = 0.001. There were no complications such as aspiration pneumonia, and none required invasive mechanical ventilation in either group. Enteral nutrition was effectively and safely initiated and continued for children admitted with status asthmaticus, including those on noninvasive bilevel ventilation therapy.

回顾性数据分析评估了单中心儿科重症监护病房收治的哮喘患儿的肠内营养做法。406张图表中,315张被分析(63%为男性);双水平气道正压通气(BIPAP)为135,简易口罩为180。总体中位年龄和体重分别为6.0(四分位间距[IQR]: 6.0)岁和24.8 (IQR: 20.8) kg。所有被研究的儿童在完全喂养的同时仍然使用BIPAP和简单面罩;每口饲喂率分别为99.3%和100%。BIPAP组开始喂养和完全喂养的中位时间更长,分别为11.0 (IQR: 20)和23.0小时(IQR: 26),而简单掩膜组分别为4.3 (IQR: 7)和12.0小时(IQR: 15), p = 0.001。在调整性别、体重、入院时的临床哮喘评分、辅助治疗的使用和持续沙丁胺醇的持续时间后,结果仍然相似。24小时后,81.5%的BIPAP患者和96.6%的简单面罩患者开始进食。与简单面罩相比,BIPAP患者病情加重,入院时中位哮喘评分为4 (IQR: 2),而简单面罩的中位哮喘评分为3 (IQR: 2),需要更多的辅助治疗(80.0比43.9%),中位治疗时间更长,分别为41.0 (IQR: 41)和20.0小时(IQR: 29), p = 0.001。两组均无吸入性肺炎等并发症,均无需有创机械通气。肠内营养是有效和安全的,并继续为入院的儿童状态哮喘,包括那些无创双水平通气治疗。
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引用次数: 1
Multisystem Inflammatory Syndrome in Children Admitted to a Tertiary Pediatric Intensive Care Unit. 儿科三级重症监护病房收治儿童的多系统炎症综合征。
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-03-01 DOI: 10.1055/s-0041-1733943
Emrah Gün, Tanıl Kendirli, Edin Botan, Nazmiye Türker, Anar Gurbanov, Burak Balaban, Ali Genco Gencay, Gül Arga, Selen Karagözlü, Mehmet Gökhan Ramoglu, Halil Özdemir, Tayfun Ucar, Ercan Tutar, Ergin Ciftci

Background  Multisystem inflammatory syndrome in children (MIS-C) is characterized by persistent fever, abdominal pain, vomiting, diarrhea, rash, conjunctivitis, headaches, and mucocutaneous manifestations and it can cause circulatory dysfunction, resulting in hypotension, shock, and end-organ injury in the heart and other organs and possibly death. In this study, we aimed to analyze the clinical spectrum, treatment options and outcomes of children with MIS-C who were admitted to our pediatric intensive care (PICU). Materials and Methods  Clinical and laboratory findings and treatment of the patients admitted to the PICU with MIS-C between April 2020 and January 2021 were recorded, and their outcomes were evaluated. Results  Nineteen patients with a median age of 12.5 years (interquartile range (IQR): 5.8-14.0 years) were admitted. Eleven (57.8%) were males. The most frequent clinical and laboratory features were fever (100%), abdominal pain (94.7%), rash (63.1%), headache (68.4%), diarrhea (47.3%), seizure (10.5%), cardiac dysfunction (52.6%), acute kidney injury (26.3%), lymphopenia (84.2%), and thrombocytopenia (36.8%). However, 8 patients needed mechanical respiratory support, 11 patients needed inotropes, 2 patients needed plasma exchange, and 1 patient needed continuous renal replacement therapy. All patients received corticosteroids, 17 patients (89.2%) received intravenous immunoglobulin, 2 patients received anakinra, 10 patients received acetylsalicylic acid, and 6 patients received enoxaparin. Median PICU length of stay was 3 days (IQR: 2-5) and only one patient died. Conclusion  In conclusion, MIS-C may present with a variety of clinical manifestations, and it can lead to life-threatening critical illness. Most children need intensive care and the response to immunomodulation is usually favorable.

儿童多系统炎症综合征(multi - system inflammatory syndrome, MIS-C)以持续发热、腹痛、呕吐、腹泻、皮疹、结膜炎、头痛和皮肤粘膜表现为特征,可引起循环功能障碍,导致低血压、休克、心脏和其他器官终末器官损伤,并可能导致死亡。在本研究中,我们旨在分析我们儿科重症监护室(PICU)收治的miss - c患儿的临床谱、治疗方案和结局。材料与方法记录2020年4月至2021年1月期间入住PICU的misc患者的临床和实验室表现及治疗情况,并对其结果进行评估。结果本组共收治19例患者,中位年龄12.5岁(四分位间距:5.8 ~ 14.0岁)。男性11例(57.8%)。最常见的临床和实验室特征是发热(100%)、腹痛(94.7%)、皮疹(63.1%)、头痛(68.4%)、腹泻(47.3%)、癫痫发作(10.5%)、心功能障碍(52.6%)、急性肾损伤(26.3%)、淋巴细胞减少(84.2%)和血小板减少(36.8%)。8例患者需要机械呼吸支持,11例患者需要肌力药物,2例患者需要血浆置换,1例患者需要持续肾脏替代治疗。所有患者均接受皮质类固醇治疗,静脉注射免疫球蛋白17例(89.2%),阿那白2例,乙酰水杨酸10例,依诺肝素6例。PICU中位住院时间为3天(IQR: 2-5),仅有1例患者死亡。综上所述,MIS-C可能表现出多种临床表现,并可导致危及生命的危重症。大多数儿童需要重症监护,对免疫调节的反应通常是有利的。
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引用次数: 0
Hyperchloremia on Admission to Pediatric Intensive Care in Mechanically Ventilated Children is Associated with Impaired Renal Function. 机械通气儿童重症监护入院时的高氯血症与肾功能受损有关。
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-03-01 DOI: 10.1055/s-0041-1728788
Rebecca B Mitting, Padmanabhan Ramnarayan, David P Inwald

Objective  There is recent interest in the association between hyperchloremic metabolic acidosis and adverse outcomes. In vitro, hyperchloremia causes renal vasoconstriction and fall in glomerular filtration rate (GFR). The objective of this retrospective, observational study is to examine associations between chloride level at admission to pediatric intensive care (PICU) and worst GFR and requirement for renal replacement therapy. Materials and Methods  All admissions to PICU between 2009 and 2019 who received invasive mechanical ventilation and had blood gas analysis performed were included. Data analyzed included patient characteristics (age, gender, diagnosis, pediatric index of mortality [PIM]-2 score); results of initial blood gas; and maximum serum creatinine (then used to calculate minimum GFR). Primary outcome measure was worst GFR during PICU stay. Secondary outcome measures were requirement for renal replacement therapy and PICU mortality. Multivariable regression analysis was used to assess if admission chloride level was independently predictive of minimum GFR during PICU stay and to examine associations between hyperchloremia (>110 mEq/L) at admission and requirement for renal replacement therapy after adjustment for confounders. Results  Data were available for 2,217 patients. Median age was 16.4 months and 39% of patients were hyperchloremic at admission to PICU. Admission chloride level was independently predictive of worst GFR during PICU stay after adjustment for known confounders. Patients with hyperchloremia were not more likely to require renal replacement therapy or die than patients with normochloremia. Conclusion  Prospective studies are necessary to determine if high chloride, specifically chloride containing resuscitation fluids, have a causal relationship with poor outcomes.

目的研究高氯血症代谢性酸中毒与不良预后的关系。在体外,高氯血症引起肾血管收缩和肾小球滤过率(GFR)下降。这项回顾性观察性研究的目的是研究儿科重症监护(PICU)入院时氯化物水平与最坏GFR和肾脏替代治疗需求之间的关系。材料与方法纳入2009年至2019年PICU收治的所有接受有创机械通气并进行血气分析的患者。数据分析包括患者特征(年龄、性别、诊断、儿童死亡率指数[PIM]-2评分);初始血气结果;和最大血清肌酐(然后用于计算最小GFR)。主要结局指标为PICU期间最差GFR。次要结局指标是肾脏替代治疗和PICU死亡率的要求。多变量回归分析用于评估入院时氯化物水平是否能独立预测PICU住院期间的最低GFR,并检查入院时高氯血症(>110 mEq/L)与调整混杂因素后肾脏替代治疗需求之间的关系。结果2217例患者获得资料。中位年龄为16.4个月,39%的患者在入PICU时患有高氯血症。在对已知混杂因素进行校正后,入院氯化物水平可独立预测PICU期间最差GFR。高氯血症患者并不比正常氯血症患者更有可能需要肾脏替代治疗或死亡。结论:有必要进行前瞻性研究,以确定高氯化物,特别是含氯化物的复苏液,是否与不良预后有因果关系。
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引用次数: 1
Increase in Pediatric Intensive Care Unit Hospitalizations Due to Toxic Ingestions during the COVID-19 Pandemic. COVID-19大流行期间因有毒摄入而住院的儿科重症监护病房增加。
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-03-01 DOI: 10.1055/s-0041-1727249
Jennifer L van Helmond, Brittany Fitts, Jigar C Chauhan

The coronavirus disease 2019 (COVID-19) pandemic and related community mitigation measures had a significant psychosocial impact. We suspected that more patients were admitted to our pediatric intensive care unit (PICU) for toxic ingestions since the start of the pandemic. We therefore investigated if PICU admissions related to toxic ingestions were higher in 2020 as a result of COVID-19 compared with previous years. We completed a cross-sectional study at a tertiary children's hospital comparing admissions to our PICU between April 2020 and October 2020, during which COVID-19 and community mitigation measures were in place, to those during the same 7-month period in the previous 3 years. Total PICU admissions, admissions for all toxic ingestions (intentional ingestions and accidental ingestions), and demographic and clinical characteristics of patients were compared. Total PICU admissions in 2020 during COVID-19 pandemic months were lower compared with the same months in the preceding 3 years (-16%, p < 0.001), however, admissions for toxic ingestions were higher during COVID-19 (+64%, p < 0.001). When separated by type, intentional (+55%, p  = 0.012) and accidental ingestions (+94%, p  = 0.021) were higher during COVID-19. COVID-19 with community mitigation measures has led to an increase in PICU admissions for intentional and accidental ingestions, indicating an increase in severity of toxic ingestions in children associated with the pandemic. Mental health of adolescents, and safety of infants and toddlers in their home environment, should be targeted with specific interventions in the ongoing COVID-19 pandemic.

2019冠状病毒病(COVID-19)大流行和相关社区缓解措施产生了重大的社会心理影响。我们怀疑,自大流行开始以来,我们的儿科重症监护病房(PICU)收治了更多因中毒摄入的患者。因此,我们调查了与前几年相比,2019冠状病毒病在2020年与有毒物质摄入相关的PICU入院是否更高。我们在一家三级儿童医院完成了一项横断面研究,比较了2020年4月至2020年10月期间我们PICU的入院情况,在此期间采取了COVID-19和社区缓解措施,与前3年相同的7个月期间的入院情况。比较PICU总入院人数、所有毒性摄入(故意摄入和意外摄入)入院人数以及患者的人口学和临床特征。与前3年同期相比,2020年COVID-19大流行月份PICU总入院率较低(-16%,p < 0.001),但COVID-19期间因毒物摄入入院率较高(+64%,p < 0.001)。当按类型分开时,故意摄入(+55%,p = 0.012)和意外摄入(+94%,p = 0.021)在COVID-19期间更高。采取社区缓解措施的COVID-19导致故意和意外摄入的PICU入院人数增加,这表明与大流行相关的儿童毒性摄入的严重程度有所增加。在当前的COVID-19大流行中,应针对青少年的心理健康以及婴幼儿在家庭环境中的安全采取具体干预措施。
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引用次数: 0
Environment and Culture, a Cross-Sectional Survey on Drivers of Burnout in Pediatric Intensive Care. 环境与文化:儿童重症监护倦怠驱动因素的横断面调查。
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-03-01 DOI: 10.1055/s-0041-1730917
Nupur N Dalal, Laura M Gaydos, Scott E Gillespie, Christina J Calamaro, Rajit K Basu

Very little data is available to understand the drivers of burnout amongst health care workers in the pediatric intensive care unit. This is a survey-based, cross-sectional, point-prevalence analysis within a single children's health system with two free-standing hospitals (one academic and one private) to characterize the relationship of demographics, organizational support, organizational culture, relationship quality, conflict and work schedules with self-reported burnout. Burnout was identified in 152 (39.7%) of the 383 (38.7%) respondents. No significant relationship was identified between burnout and demographic factors or work schedule. A more constructive culture (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.77-0.90; p  < 0.001), more organizational support (OR, 0.94; 95% CI, 0.92-0.96; p <0 0.001), and better staff relationships (OR, 0.54, 95% CI, 0.43-0.69; p  < 0.001) reduced odds of burnout. More conflict increased odds (OR, 1.25; 95% CI, 1.12-1.39; p  < 0.001). Less organizational support ( Z β  = 0.425) was the most important factor associated with burnout overall. A work environment where staff experience defensive cultures, poor relationships, more frequent conflict, and feel unsupported by the organization is associated with significantly higher odds of burnout in pediatric critical care. The effect of targeted interventions to promote constructive cultures, collegiality, and organizational support on burnout in pediatric intensive care should be studied.

很少有数据可用于了解在儿科重症监护病房的卫生保健工作者倦怠的驱动因素。这是一项基于调查的、横断面的、点流行分析,在一个有两家独立医院(一所学术医院和一所私立医院)的单一儿童卫生系统中,以表征人口统计学、组织支持、组织文化、关系质量、冲突和工作时间表与自我报告的倦怠之间的关系。在383名(38.7%)受访者中,有152名(39.7%)被认为倦怠。职业倦怠与人口学因素或工作时间无显著关系。更具建设性的文化(优势比[OR], 0.84;95%置信区间[CI], 0.77-0.90;p p p p Z β = 0.425)是影响倦怠的最重要因素。在一个工作环境中,员工经历防御性文化、糟糕的人际关系、更频繁的冲突,并感到得不到组织的支持,这与儿科重症护理中出现倦怠的几率显著增加有关。有针对性的干预措施,以促进建设性的文化,合作和组织支持对倦怠儿科重症监护的影响应进行研究。
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引用次数: 1
Clinical Factors of High-Flow Nasal Cannula Oxygen Success in Children. 儿童高流量鼻插管输氧成功的临床因素。
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-03-01 DOI: 10.1055/s-0041-1730915
Gokce Iplik, Dincer Yildizdas, Ahmet Yontem

This study was aimed to evaluate the success rate of high-flow nasal cannula (HFNC) oxygen therapy and factors causing therapy failure. This prospective observational study included 131 children who received HFNC oxygen and followed-up in the pediatric emergency department, pediatric clinics, and pediatric intensive care unit between March 2018 and December 2019. The median age was 23.0 months (interquartile range [IQR]: 9.0-92.0) and 65 patients were male (49.6%). The most common reason for requiring HFNC oxygen therapy was pneumonia ( n  = 75, 57.3%). A complex chronic condition was present in 112 (85.5%) patients. Therapy success was achieved in 116 patients (88.5%). The reason for requiring treatment and the patients' complex chronic condition did not affect the success of the therapy ( p  = 0.294 and 0.091, respectively). In the first 24 hours of treatment, a significant improvement in pulse rate, respiratory rate, pH, and lactate level were observed in successful HFNC oxygen patients ( p  < 0.05). In addition, these patients showed a significant improvement in SpO 2 and SpO 2 /FiO 2 ratio, and a significant decrease in FiO 2 and flow rate ( p  < 0.05). HFNC oxygen success rate was 95.6% in patients with SpO 2 /FiO 2 ≥ 150 at the 24th hour; it was 58.0% in those with SpO 2 /FiO 2  < 150 ( p  < 0.001). Caution should be exercised in terms of HFNC oxygen failure in patients with no significant improvement in vital signs and with SpO 2 /FiO 2  < 150 during treatment.

本研究旨在评价高流量鼻插管(HFNC)氧疗的成功率及导致治疗失败的因素。这项前瞻性观察性研究包括2018年3月至2019年12月期间在儿科急诊科、儿科诊所和儿科重症监护病房接受HFNC吸氧并随访的131名儿童。中位年龄为23.0个月(四分位间距[IQR]: 9.0 ~ 92.0),男性65例(49.6%)。需要HFNC氧疗的最常见原因是肺炎(n = 75, 57.3%)。112例(85.5%)患者存在复杂的慢性疾病。治疗成功116例(88.5%)。需要治疗的原因和患者复杂的慢性疾病不影响治疗的成功(p分别= 0.294和0.091)。治疗前24小时,成功的HFNC吸氧患者的脉搏率、呼吸率、pH值和乳酸水平均有显著改善(p 2和SpO 2 /FiO 2比),第24小时FiO 2和血流率(p 2 /FiO 2≥150;SpO 2 /FiO 2 p 2 /FiO 2组为58.0%
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引用次数: 0
Performance of Cornell Assessment of Pediatric Delirium Scale in Mechanically Ventilated Children. 康奈尔儿童谵妄量表评估在机械通气儿童中的表现。
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-03-01 DOI: 10.1055/s-0041-1728784
Neha Gupta, Saurabh Talathi, Allison Woolley, Stephanie Wilson, Mildred Franklin, Johanna Robbins, Candice Colston, Leslie Hayes

Accuracy of delirium diagnosis in mechanically ventilated children is often limited by their varying developmental abilities. The purpose of this study was to examine the performance of the Cornell Assessment of Pediatric Delirium (CAPD) scale in these patients. This is a single-center, prospective, observational study of patients requiring sedation and mechanical ventilation for 2 days or more. CAPD scale was implemented in our unit for delirium screening. Each CAPD assessment was accompanied by a physician assessment using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Sensitivity analysis was performed to determine the best cut-off score in our target population. We also evaluated ways to improve the accuracy of this scale in patients with and without developmental delay. A total of 837 paired assessments were performed. Prevalence of delirium was 19%. Overall, CAPD score ≥ 9 had sensitivity of 81.8% and specificity of 44.8%. Among typically developed patients, the sensitivity and specificity were 76.7 and 65.4%, respectively, whereas specificity was only 16.5% for developmentally delayed patients. The best cut-off value for CAPD was 9 for typically developed children and 17 for those with developmental delay (sensitivity 74.4%, specificity 63.2%). Some CAPD questions do not apply to patients with sensory and neurocognitive deficits; upon excluding those questions, the best cut-off values were 5 for typically developed and 6 for developmentally delayed children. In mechanically ventilated patients with developmental delay, CAPD ≥ 9 led to a high false-positive rate. This emphasizes the need for either a different cut-off score or development of a delirium scale specific to this patient population.

机械通气儿童谵妄诊断的准确性往往受到其不同发育能力的限制。本研究的目的是检查康奈尔儿童谵妄评估(CAPD)量表在这些患者中的表现。这是一项单中心、前瞻性、观察性研究,研究对象是需要镇静和机械通气2天或更长时间的患者。本单位采用CAPD量表进行谵妄筛查。每个CAPD评估都伴随着医生评估,使用精神障碍诊断与统计手册第五版(DSM-V)标准。进行敏感性分析以确定目标人群的最佳临界值。我们还评估了在有或没有发育迟缓的患者中提高该量表准确性的方法。共进行了837次成对评估。谵妄的患病率为19%。总体而言,CAPD评分≥9的敏感性为81.8%,特异性为44.8%。在典型发育患者中,敏感性和特异性分别为76.7%和65.4%,而在发育迟缓患者中,特异性仅为16.5%。典型发育儿童CAPD的最佳临界值为9,发育迟缓儿童CAPD的最佳临界值为17(敏感性74.4%,特异性63.2%)。一些CAPD问题不适用于感觉和神经认知缺陷的患者;排除这些问题后,典型发育儿童的最佳临界值为5,发育迟缓儿童的最佳临界值为6。在发育迟缓的机械通气患者中,CAPD≥9导致假阳性率较高。这就强调了需要一个不同的分界点或针对这一患者群体制定谵妄量表。
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引用次数: 1
Timing of Pediatric Palliative Care Consults in Hospitalized Patients with Heart Disease. 住院心脏病患者儿科姑息治疗咨询的时机
IF 0.7 Q4 PEDIATRICS Pub Date : 2023-03-01 DOI: 10.1055/s-0041-1730916
Danielle J Green, Erin Bennett, Lenora M Olson, Sarah Wawrzynski, Stephanie Bodily, Dominic Moore, Kelly J Mansfield, Victoria Wilkins, Lawrence Cook, Claudia Delgado-Corcoran

Pediatric palliative care (PPC) provides an extra layer of support for families caring for a child with complex heart disease as these patients often experience lifelong morbidities with frequent hospitalizations and risk of early mortality. PPC referral at the time of heart disease diagnosis provides early involvement in the disease trajectory, allowing PPC teams to longitudinally support patients and families with symptom management, complex medical decision-making, and advanced care planning. We analyzed 113 hospitalized pediatric patients with a primary diagnosis of heart disease and a PPC consult to identify timing of first PPC consultation in relation to diagnosis, complex chronic conditions (CCC), and death. The median age of heart disease diagnosis was 0 days with a median of two CCCs while PPC consultation did not occur until a median age of 77 days with a median of four CCCs. Median time between PPC consult and death was 33 days (interquartile range: 7-128). Death often occurred in the intensive care unit ( n  = 36, 67%), and the most common mode was withdrawal of life-sustaining therapies ( n  = 31, 57%). PPC referral often occurred in the context of medical complexity and prolonged hospitalization. Referral close to the time of heart disease diagnosis would allow patients and families to fully utilize PPC benefits that exist outside of end-of-life care and may influence the mode and location of death. PPC consultation should be considered at the time of heart disease diagnosis, especially in neonates and infants with CCCs.

儿科姑息治疗(PPC)为照顾患有复杂心脏病的儿童的家庭提供了额外的支持,因为这些患者经常经历终身发病率,经常住院治疗,并有早期死亡的风险。心脏病诊断时的PPC转诊提供了疾病轨迹的早期参与,使PPC团队能够长期支持患者和家属进行症状管理、复杂的医疗决策和高级护理计划。我们分析了113例初诊为心脏病和PPC会诊的住院儿科患者,以确定首次PPC会诊的时间与诊断、复杂慢性疾病(CCC)和死亡的关系。心脏病诊断的中位年龄为0天,中位数为2次CCCs,而PPC咨询直到中位年龄为77天,中位数为4次CCCs才发生。PPC会诊至死亡的中位时间为33天(四分位数范围:7-128)。死亡常发生在重症监护室(n = 36, 67%),最常见的模式是停止维持生命的治疗(n = 31, 57%)。PPC转诊通常发生在医疗复杂和长期住院的情况下。在接近心脏病诊断的时间转诊将使患者和家属充分利用PPC的好处,这些好处存在于临终关怀之外,并可能影响死亡的方式和地点。在心脏病诊断时应考虑PPC咨询,特别是在患有CCCs的新生儿和婴儿中。
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引用次数: 0
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Journal of Pediatric Intensive Care
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