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Fennessy J, Thomas G, Waters G, Stormon M, Shun A, Cavazzoni E. Reducing Hospital Length of Stay and Hepatic Artery Thrombosis Rates for Children Receiving a Liver Transplant: A Single-Center Experience From 2000 to 2021. Pediatr Transplant 2024; 28:e14844. [PMID: 39147698 DOI: 10.1111/petr.14844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 06/01/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Pediatric liver transplantation is a very resource-intensive therapy. This study aimed to identify the changes made between two epochs of management and analyze their influence on length of stay (LOS). METHODS Data from a single center were obtained from the liver transplant and Pediatric Intensive Care Unit (PICU) databases for 336 transplants (282 children) performed between 2000 and 2021. Transplants were analyzed in two epochs, before and after July 2012, representing a change in postoperative anticoagulation management. Differences in graft recipient demographics and perioperative management factors were compared between epochs. Multivariate regression was performed to identify the complications that correlated most strongly with hospital LOS. RESULTS There was a difference in hospital LOS between Epoch 1 (Median = 31.7 days) and Epoch 2 (Median = 26.3 days) (p < 0.001), but not in PICU LOS (E1 Median = 7.3 days, E2 Median = 7.4 days; p = 0.792). Epoch 2 saw increased use of split grafts (60.6% of total), decreased pediatric end-stage liver disease (PELD) score at transplant (Average = 16.7; p < 0.001), decreased invasive ventilation time (Average = 4.48 days; p < 0.001), and decreased hepatic artery thrombosis (HAT) rates (E1 = 14.4%, E2 = 4.3%; p < 0.001) without an associated increase in bleeding rates. CONCLUSIONS Hospital LOS has reduced in Epoch 2 due to refinements in intraoperative and postoperative management. There is increased emphasis on early extubation and increased use of noninvasive ventilatory techniques in Epoch 2. Split grafts have effectively expanded our graft donor pool and reduced transplant waitlist times.
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Affiliation(s)
- Jack Fennessy
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gordon Thomas
- Department of Surgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Greer Waters
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Stormon
- Department of Gastroenterology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Albert Shun
- Department of Surgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Elena Cavazzoni
- Paediatric Intensive Care Unit, Children's Hospital at Westmead, NSW Organ and Tissue Donation Service, Sydney, New South Wales, Australia
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2
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Temsah MH, Abouammoh N, Al-Eyadhy A, AlRuthia Y, Hassounah M, Alsohime F, Alhaboob A, Almazyad M, Alabdulhafid M, Aljamaan F, Alhasan K, Jamal A. Predictors and Direct Cost Estimation of Long Stays in Pediatric Intensive Care Units in Saudi Arabia: A Mixed Methods Study. Risk Manag Healthc Policy 2021; 14:2625-2636. [PMID: 34188573 PMCID: PMC8235993 DOI: 10.2147/rmhp.s311100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Several factors influence patients’ length of stay (LOS) in pediatric intensive care units (PICUs). This study explored the factors and cost associated with long LOS among pediatric patient population across various PICUs and pediatric surgical cardiac intensive care units (SCICUs). Methods This is a multi-center concurrent mixed-methods study that was conducted in different PICUs and SCICUs in Riyadh, Saudi Arabia. The units’ leaders were qualitatively interviewed to explore the potential factors contributing to long LOSs in PICUs and SCICUs, and deductive content analysis was used. Microcosting was utilized to estimate the inpatient costs for a sample of long-stay patients (LSPs) and the potential cost savings if those patients were transferred to step-down care units (SDUs) for those who stayed ≥60 days. Results Ten (90%) leaders of PICUs and SCICUs who were invited had participated. Changing the admission criteria, patient transfer to SDUs, family engagement in the decision-making process, and adopting a national do-not-resuscitate (DNR) policy were factors contributing to short LOSs. On the other hand, administrative constraints, staff avoidance of code status decisions, lack of palliative care resources, and complex patient characteristics were factors associated with long LOSs. The mean inpatient cost per patient was SAR 3.63 million (USD 0.97 million), and the total cost for the 48 patients was SAR 172.95 million (USD 46.12 million). Conclusion If the recommendation to transfer LSPs after a 60-day PICU stay to SDUs is taken, the estimated cost savings among this sample of patients alone can be as high as SAR 109.47 million (USD 29.19 million). Therefore, future studies should examine the factors contributing to long LOSs in PICUs and SCICUs as well as the effectiveness of different policies aimed at improving the resource allocation and management using more robust study designs and diverse patient population.
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Affiliation(s)
- Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Noura Abouammoh
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Marwah Hassounah
- Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alsohime
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alhaboob
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Almazyad
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alabdulhafid
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alhasan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Amr Jamal
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia
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3
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Partain KN, Mpody C, Rodgers B, Kenney B, Tobias JD, Nafiu OO. Prolonged Postoperative Mechanical Ventilation (PPMV) in children undergoing abdominal operations: An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. J Pediatr Surg 2021; 56:1114-1119. [PMID: 33745739 DOI: 10.1016/j.jpedsurg.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Prolonged postoperative mechanical ventilation (PPMV) increases length of stay, hospitalization costs, and postoperative complications. Independent risk factors associated with PPMV are not well-known for children. METHOD We identified children (<18 years) in the ACS NSQIP-P database who underwent a general surgical abdominal operation. We excluded children with preoperative ventilator dependence and mortality within 48 h of surgery. PPMV was defined as cumulative postoperative mechanical ventilation exceeding 72 h. A multivariable logistic regression model identified independent predictors of PPMV. RESULTS We identified 108,392 children who underwent a general surgical abdominal operation in the ACS NSQIP-P database from 2012 to 2017. We randomly divided the population into a derivation cohort of 75,874(70%) and a validation cohort of 32,518(30%). In the derivation cohort, we identified PPMV in 1,643(2.2%). In the multivariable model, the strongest independent predictor of PPMV was neonatal age (OR:20.66; 95%CI:16.44-25.97). Other independent risk factors for PPMV were preoperative inotropic support (OR:10.56; 95%CI:7.56-14.77), an operative time longer than 150 min (OR:4.30; 95%CI:3.72-4.52), and an American Society of Anesthesiologists classification >3 (OR:12.16; 95%CI:10.75-13.75). CONCLUSION Independent preoperative risk factors for PPMV in children undergoing a general surgical operation were neonatal age, preoperative ionotropic support, duration of operation, and ASA classification >3.
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Affiliation(s)
- Kristin N Partain
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christian Mpody
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brandon Rodgers
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Kenney
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Olubukola O Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
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Temsah MHA, Al-Eyadhy AA, Al-Sohime FM, Hassounah MM, Almazyad MA, Hasan GM, Jamal AA, Alhaboob AA, Alabdulhafid MA, Abouammoh NA, Alhasan KA, Alwohaibi AA, Al Mana YT, Alturki AT. Long-stay patients in pediatric intensive care units. Five-years, 2-points, cross-sectional study. Saudi Med J 2021; 41:1187-1196. [PMID: 33130838 PMCID: PMC7804226 DOI: 10.15537/smj.2020.11.25450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: To explore the changing patterns of long-stay patients (LSP) to improve the utilization of pediatric intensive care units (PICUs) resources. Methods: This is a 2-points cross-sectional study (5 years apart; 2014-2019) conducted among PICUs and SCICUs in Riyadh, Saudi Arabia. Children who have stayed in PICU for more than 21 days were included. Results: Out of the 11 units approached, 10 (90%) agreed to participate. The prevalence of LSP in all these hospitals decreased from 32% (48/150) in 2014 to 23.4% (35/149) in 2019. The length of stay ranged from 22 days to 13.5 years. The majority of LSP had a neuromuscular or cardiac disease and were admitted with respiratory compromise. Ventilator-associated pneumonia was the most prevalent complication (37.5%). The most commonly used resources were mechanical ventilation (93.8%), antibiotics (60.4%), and blood-products transfusions (35.4%). The most common reason for the extended stay was medical reasons (51.1%), followed by a lack of family resources (26.5%) or lack of referral to long-term care facilities (22.4%). Conclusion: A long-stay is associated with significant critical care bed occupancy, complications, and utilization of resources that could be otherwise utilized as surge capacity for critical care services. Decreasing occupancy in this multicenter study deserves further engagement of the healthcare leaders and families to maximize the utilization of resources.
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Affiliation(s)
- Mohamad-Hani A Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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García Mancebo J, de la Mata Navazo S, López-Herce Arteta E, Montero Mateo R, López Esteban IM, Mazzuchelli Domínguez A, Sánchez Doutel M, López-Herce Cid J, González Cortés R. A comparative two-cohort study of pediatric patients with long term stay in ICUs. Sci Rep 2021; 11:4631. [PMID: 33633291 PMCID: PMC7907334 DOI: 10.1038/s41598-021-84248-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022] Open
Abstract
During the last decades, the number of patients with long stay admissions (LSA) in PICU has increased. The purpose of this study was to identify factors associated with PICU LSA, assessing healthcare resources use and changes in the profile of these patients. A retrospective, observational, single-center study was carried out. Characteristics of LSA were compared between two periods (2006–2010 and 2011–2015). During the earlier period there were 2,118 admissions (3.9% of them LSA), whereas during the second period, there were 1,763 (5.4% of them LSA) (p = 0.025). LSA accounted for 33.7% PICU stay days during the first period and 46.7% during the second (p < 0.001). Higher use of non-invasive ventilation (80.2% vs. 37.8%, p = 0.001) and high-flow oxygen therapy (68.8% vs. 37.8%, p = 0.005) was observed in the 2011–2015 cohort, whereas the use of arterial catheter (77.1% vs. 92.6%, p = 0.005), continuous infusion of adrenaline (55.2% vs. 75.9%, p = 0.004), and hemoderivative transfusion (74% vs. 89.2%, p = 0.010) was less frequent. In the 2006–2010 cohort, hospital-acquired infections were more common (95.2% vs. 68.8%, p < 0.001) and mortality was higher (26.8% vs. 13.8%, p = 0.026). The number of long-stay PICU admissions have increased entailing an intensive use of healthcare resources. These patients have a high risk for complications and mortality.
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Affiliation(s)
- Julia García Mancebo
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain
| | - Sara de la Mata Navazo
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain
| | - Estíbaliz López-Herce Arteta
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain
| | - Rosario Montero Mateo
- Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - Isabel María López Esteban
- Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - Adriana Mazzuchelli Domínguez
- Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - María Sánchez Doutel
- Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - Jesús López-Herce Cid
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain.,Department of Maternal and Child and Public Health, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain.,Maternal and Child Health and Development Research Network RETICS Funded By Institute of Health Carlos III (ISCIII) Ref: RD16/0022, Madrid, Spain
| | - Rafael González Cortés
- Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain. .,Maternal and Child Health and Development Research Network RETICS Funded By Institute of Health Carlos III (ISCIII) Ref: RD16/0022, Madrid, Spain.
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6
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Bargos-Munárriz M, Bermúdez-Pérez M, Martínez-Alonso AM, García-Molina P, Orts-Cortés MI. Prevention of pressure injuries in critically ill children: A preliminary evaluation. J Tissue Viability 2020; 29:310-318. [PMID: 32912759 DOI: 10.1016/j.jtv.2020.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate a prevention strategy implemented to reduce incidence and severity of positioning related pressure injuries affecting pediatric patients in a pediatric critical care unit. Secondary objective was to evaluate compliance with preventive recommendations. BACKGROUND The skin in infants or children has important physiological and anatomical differences compared with adults. Further, factors such as the immaturity of the skin and limited activity and mobility in pediatric critical care unit, along with the pressure exerted by medical devices, increases the risk of pressure ulcers in infants and children. The most effective preventive measures specific to this intensive care population need to be evaluated. MATERIAL AND METHODS Quasi-experimental before-after study with consecutive sampling. The effectiveness of the care bundle implementation was evaluated based on the latest evidence (intervention group) versus the application of non-standardized care (control group). Pediatric patients up to 14 years old at risk of suffering from pressure injuries and who were admitted more than 48 h in a pediatric intensive care unit (level III) participated. For the collection of data, two computer programs and the hospital clinical records of each participant were consulted. The data collection period was 6 months per group (pre and post intervention). RESULTS A sample of 110 patients was obtained (50 control group and 60 intervention group). The cumulative incidence in pediatric patients exposed to the risk of pressure injuries was reduced from 16% to 13.3%; and in the subgroup of patients with prolonged stay (≥28 days), the incidence was reduced from 55.55% to 20%. In the intervention group, category III and IV pressure ulcers were completely reduced. In addition, the total number of pressure injuries decreased by 21.43%. The care bandle recommendations with the highest level of adhesion recorded were: skin inspection, application of hyperoxygenated fatty acids and use of a special support surface. The main risk factor found during the study was the prone position (p < 0.05). CONCLUSIONS The application of a care bundle for prevention can be an effective solution to reduce the number and severity of LPPs in an intensive care unit. The most vulnerable subgroup of patients may benefit from the application of these resources.
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Affiliation(s)
- Marta Bargos-Munárriz
- Pediatric Working Group of the Commission for the Prevention and Treatment of Pressure Ulcer and Wounds. Regional University Hospital of Malaga, Spain; Pediatric Intensive Care Unit. Regional University Hospital of Malaga, Spain
| | - Montserrat Bermúdez-Pérez
- Pediatric Working Group of the Commission for the Prevention and Treatment of Pressure Ulcer and Wounds. Regional University Hospital of Malaga, Spain; Pediatric Intensive Care Unit. Regional University Hospital of Malaga, Spain
| | - Ana María Martínez-Alonso
- Pediatric Working Group of the Commission for the Prevention and Treatment of Pressure Ulcer and Wounds. Regional University Hospital of Malaga, Spain; Pediatric Intensive Care Unit. Regional University Hospital of Malaga, Spain
| | - Pablo García-Molina
- Department of Nursing. University of Valencia, Spain; Nursing Care Research Group. INCLIVA Biomedical Research Institute, Spain.
| | - María Isabel Orts-Cortés
- Department of Nursing. University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL)Alicante, Spain; Nursing and Healthcare Research Unit (Investén-isciii), CIBERFES, Instituto de Salud Carlos III, Madrid, Spain
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7
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Kanthimathinathan HK, Plunkett A, Scholefield BR, Pearson GA, Morris KP. Trends in long-stay admissions to a UK paediatric intensive care unit. Arch Dis Child 2020; 105:558-562. [PMID: 31848145 DOI: 10.1136/archdischild-2019-317797] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/22/2019] [Accepted: 12/04/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Prolonged admission to a paediatric intensive care unit (PICU) consumes significant healthcare resource. An increase in the number of long-stay admissions and bed utilisation has been reported elsewhere in the world but not in the UK. If an increasing trend of long-stay admissions is evident, this may have significant implications for provision of paediatric intensive care in the future. DESIGN/SETTING/PATIENTS We retrospectively analysed prospectively collected data from Birmingham Children's Hospital, UK, over a 20-year period from 1998 to 2017. PICU admissions, bed-days, length of stay and mortality trends were analysed and reported over four different epochs (1998-2002, 2003-2007, 2008-2012 and 2013-2017) for long-stay admissions (PICU length of stay ≥28 days) and others. Differences in patient demographics, diagnostic categorisation and hospital utilisation were also analysed. RESULTS In total, 24 203 admissions accounted for 131 553 bed-days over the 20-year period. 705 (2.9%) long-stay admissions accounted for 42 312 (32%) bed-days. Proportion of long-stay admissions and corresponding bed-days increased from 1.6% and 20.5% in 1998-2002 to 4.5% and 42.6%, respectively, in 2013-2017 (p<0.001). Long-stay patients had a significantly higher number of hospital admissions (median: 4 vs 2, p<0.001) per patient and overall hospital length of stay (median: 98 vs 15, p<0.001) bed-days compared with other patients. Long-stay admissions were associated with significantly higher crude mortality (23% vs 6%, p<0.001) compared with other admissions. CONCLUSIONS A significant increase in the proportion of prolonged PICU admissions with disproportionately high resource utilisation and mortality is evident over two decades.
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Affiliation(s)
- Hari Krishnan Kanthimathinathan
- Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK .,Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Adrian Plunkett
- Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Barnaby R Scholefield
- Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gale A Pearson
- Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Kevin P Morris
- Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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8
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Miura S, Fukushima M, Kurosawa H, Kimura S. Epidemiology of long-stay patients in the pediatric intensive care unit: prevalence, characteristics, resource consumption and complications. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2020; 30:111-119. [PMID: 32421088 PMCID: PMC7223791 DOI: 10.1007/s10389-020-01282-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/01/2020] [Indexed: 11/03/2022]
Abstract
Background The impact of pediatric intensive care unit (PICU) utilization and resource consumption among long-stay patients has not been characterized recently. This study aimed to describe the resource consumption and characteristics of long-stay patients in a PICU. Methods This was a single-center descriptive cohort study of 1309 patients admitted to a PICU in 2017. The main outcome was ICU length of stay (LOS). Patients were divided into prolonged LOS (PLS) and non-PLS groups if they had an LOS of ≥ 28 or < 28 days, respectively. Two groups were compared to characterize PLS. Results Thirty-two (2.4%) patients had a PLS and utilized 33% of PICU bed days. Factors associated with PLS with odds ratio [95% confidence interval (CI)] were being a neonate (7.8 [2.5-25.4], p = <0.001), being an infant (2.9 [1.0-9.0], p = 0.04), admission for a respiratory ailment (7.3 [1.6-44.2], p = 0.003), cardiovascular dysfunction (24.1 [4.8-152.1], p = <0.001), post-cardiac operation (8.0 [1.7-50.1], p = 0.003), post-cardiopulmonary arrest (22.8 [1.7-211.9], p = 0.01), and transfer from another facility (4.2 [1.8-10.7], p = 0.001). PLS patients developed more nosocomial infections and disproportionately received monitoring and therapeutic resources. Conclusions A PLS was associated with substantial PICU utilization and complication rates. Future studies should aim to alleviate both institutional and patient-related issues in the affected population harboring possible risk factors for PLS.
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Affiliation(s)
- S Miura
- Department of Pediatric Intensive Care, Saitama Children's Medical Center, 1-2, Shintoshin, Saitama, Chuou-ku 330-8777 Japan
| | - M Fukushima
- Department of Pediatric Intensive Care, Saitama Children's Medical Center, 1-2, Shintoshin, Saitama, Chuou-ku 330-8777 Japan
| | - H Kurosawa
- Department of Pediatric Intensive Care, Saitama Children's Medical Center, 1-2, Shintoshin, Saitama, Chuou-ku 330-8777 Japan
| | - S Kimura
- Department of Pediatric Intensive Care, Saitama Children's Medical Center, 1-2, Shintoshin, Saitama, Chuou-ku 330-8777 Japan
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9
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Affiliation(s)
- Rafael González
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria, Pediatric Intensive Care Unit, Madrid, Spain; Maternal and Child Health and Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), Madrid, Spain
| | - Jesús López-Herce
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria, Pediatric Intensive Care Unit, Madrid, Spain; Maternal and Child Health and Development Network, RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), Madrid, Spain; Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Salud Pública y Maternoinfantil, Madrid, Spain.
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10
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Mortality of patients with chronic disease: an increasing problem. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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11
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Song Y, Gao S, Tan W, Qiu Z, Zhou H, Zhao Y. Dexmedetomidine versus midazolam and propofol for sedation in critically ill patients: Mining the Medical Information Mart for Intensive Care data. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:197. [PMID: 31205915 DOI: 10.21037/atm.2019.04.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The benefits of dexmedetomidine on reducing mortality and length of intensive care unit (ICU) stay are still controversial. We aimed to evaluate the superiority of dexmedetomidine by comparing it with midazolam and propofol. Methods Subjects who were given dexmedetomidine, midazolam and propofol exclusively as sedatives in the Beth Israel Deaconess Medical Center between 2001 and 2012 were identified from the Medical Information Mart for Intensive Care (MIMIC) III database. Univariate, multivariate and stratified analysis was performed to compare the mortality and length of ICU stay between the dexmedetomidine, midazolam and propofol groups. To compare the depth of sedation between the midazolam and propofol group, we used propensity score matching (PSM) to create comparable units and their Richmond Agitation Sedation Score (RASS) were analyzed. Results A total of 1,542 unique ICU records were identified in the MIMIC-III database, among which 163 belonged to the dexmedetomidine group and 531 belonged to the midazolam group and 848 belonged to the propofol group. Mortality was decreased in dexmedetomidine group compared with midazolam group (OR 15.25; 95% CI, 5.29-64.80, P<0.001) and propofol group (OR 5.51; 95% CI, 1.91-23.45, P=0.006). In patients with high Simplified Acute Physiologic Score (SAPS) II (>52), midazolam was related to a higher mortality (~50%). But competing risk analysis revealed that dexmedetomidine was associated with longer ICU stay (P<0.001). There was no significant difference in the RASS between propofol and midazolam group (P=0.300). Conclusions Dexmedetomidine was significantly related to lower mortality when compared with midazolam and propofol. Midazolam had a comparably higher mortality than propofol and dexmedetomidine in patients with high SAPS II. Propofol and midazolam were equivalent in sedative efficacy. Further evaluation is needed.
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Affiliation(s)
- Yiyan Song
- Department of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Department of General Surgery, Guangdong Second Provincial General Hospital, Guangzhou 510310, China
| | - Shaowei Gao
- Department of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Wulin Tan
- Department of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Zeting Qiu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Huaqiang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yue Zhao
- Department of General Surgery, Guangdong Second Provincial General Hospital, Guangzhou 510310, China
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Woodger O, Menon K, Yazbeck M, Acharya A. A Pragmatic Method for Identification of Long-Stay Patients in the PICU. Hosp Pediatr 2018; 8:636-642. [PMID: 30190266 DOI: 10.1542/hpeds.2018-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop a pragmatic method of identifying long-stay patients (LSPs) in the PICU. METHODS We surveyed 40 expert stakeholders in 14 Canadian PICUs between February 2015 and March 2015 to identify key factors to use for defining LSPs in the PICU. We then describe a pragmatic method using these factors to analyze 523 admissions to an academic, tertiary-care PICU from February 1, 2015, to January 31, 2016. RESULTS The overall response rate was 70% (28 of 40). Of respondents, 75% (21of 28) stated that it was important to define LSPs and identified present and future resource consumption (18 of 21 [86%] and 16 of 21 [76%], respectively) as the key reasons for defining LSPs. Respondents valued a definition that was consistent and ranked a percentile cutoff as the preferred analytic method for defining LSPs. Of respondents, 86% (24 of 28) though the LSP definition should include factors other than length of stay. We developed a surrogate marker for LSPs using mechanical ventilation and presence of a central venous catheter in our sample population to compare to varying percentile cutoffs. We identified 108 patients at the 80th percentile as LSPs who used 67% of total bed days and had a median length of stay of 11.3 days. CONCLUSIONS We present a pragmatic method for the retrospective identification of LSPs in the PICU that incorporates unit- and/or patient-specific characteristics. The next steps would be to validate this method using other patient and/or unit characteristics in different PICUs and over time.
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Affiliation(s)
- Owen Woodger
- Department of Economics, Carleton University, Ottawa, Ontario, Canada
| | - Kusum Menon
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and .,Departments of Pediatrics and
| | - Myra Yazbeck
- Economics, University of Ottawa, Ottawa, Ontario, Canada
| | - Anand Acharya
- Department of Economics, Carleton University, Ottawa, Ontario, Canada
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13
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Hamshary AAEE, Sherbini SAE, Elgebaly HF, Amin SA. Prevalence of multiple organ dysfunction in the pediatric intensive care unit: Pediatric Risk of Mortality III versus Pediatric Logistic Organ Dysfunction scores for mortality prediction. Rev Bras Ter Intensiva 2018; 29:206-212. [PMID: 28977260 PMCID: PMC5496755 DOI: 10.5935/0103-507x.20170029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/21/2016] [Indexed: 11/20/2022] Open
Abstract
Objectives To assess the frequency of primary multiple organ failure and the role of
sepsis as a causative agent in critically ill pediatric patients; and
calculate and evaluate the accuracy of the Pediatric Risk of Mortality III
(PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores to
predict the outcomes of critically ill children. Methods Retrospective study, which evaluated data from patients admitted from January
to December 2011 in the pediatric intensive care unit of the Children's
Hospital of the University of Cairo. Results Out of 237 patients in the study, 72% had multiple organ dysfunctions, and
45% had sepsis with multiple organ dysfunctions. The mortality rate in
patients with multiple organ dysfunction was 73%. Independent risk factors
for death were mechanical ventilation and neurological failure [OR: 36 and
3.3, respectively]. The PRISM III score was more accurate than the PELOD
score in predicting death, with a Hosmer-Lemeshow X2 (Chi-square
value) of 7.3 (df = 8, p = 0.5). The area under the curve was 0.723 for
PRISM III and 0.78 for PELOD. Conclusion A multiple organ dysfunctions was associated with high mortality. Sepsis was
the major cause. Pneumonia, diarrhea and central nervous system infections
were the major causes of sepsis. PRISM III had a better calibration than the
PELOD for prognosis of the patients, despite the high frequency of the
multiple organ dysfunction syndrome.
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Affiliation(s)
| | - Seham Awad El Sherbini
- Department of Pediatric Intensive Care, Faculty of Medicine, Cairo University - Cairo, Egypt
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14
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Ping Kirk AH, Sng QW, Zhang LQ, Ming Wong JJ, Puthucheary J, Lee JH. Characteristics and Outcomes of Long-Stay Patients in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2018; 7:1-6. [PMID: 31073460 PMCID: PMC6260322 DOI: 10.1055/s-0037-1601337] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/18/2017] [Indexed: 10/19/2022] Open
Abstract
Long-stay patients in the PICU have a higher risk of mortality as compared with non-long-stay patients. We aim to describe mortality and characteristics of long-stay patients and to determine the risk factors for mortality in these children. Total 241 (4.8%) long-stay admissions were identified. Mortality of long-stayers was 48/241 (20%). Higher severity-of-illness score at admission, need for organ support therapies, number of nosocomial infections, and bloodstream nosocomial infection were associated with a higher mortality in long-stay patients in the PICU. Based on multivariate analysis, oncologic diagnosis as a preexisting comorbidity is a strong independent predictor of mortality for long-stay patients.
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Affiliation(s)
| | - Qian Wen Sng
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Lu Qin Zhang
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Judith Ju Ming Wong
- Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Janil Puthucheary
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
- Office of Clinical Sciences, Duke-NUS School of Medicine, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
- Office of Clinical Sciences, Duke-NUS School of Medicine, Singapore
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15
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Guidelines of admission, discharge and organization of the pediatric intensive care. Med Intensiva 2018; 42:203-204. [PMID: 29463425 DOI: 10.1016/j.medin.2017.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 12/25/2017] [Indexed: 11/23/2022]
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16
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Hassan RH, Eldegla H, Elmorsy F, Eldars WM. Clinical and microbiological characteristics of healthcare-associated infections in a tertiary care pediatric hospital. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2017. [DOI: 10.1016/j.epag.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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17
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Wang D, Lai X, Liu C, Xiong Y, Zhang X. Influence of supplemental parenteral nutrition approach on nosocomial infection in pediatric intensive care unit of Emergency Department: a retrospective study. Nutr J 2015; 14:103. [PMID: 26443996 PMCID: PMC4596468 DOI: 10.1186/s12937-015-0094-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/26/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND & AIMS Nutritional support for patients in the intensive-care unit (ICU) is a part of standard care which promotes medical quality and decreases nosocomial infection. Supplemental parenteral nutrition (SPN) approach (enteral nutrition (EN) combined with parenteral nutrition (PN) when EN alone is insufficient) has become one major concern in nutrition research field. This research aims to explore the following relationships: (i) the relationship between SPN and nosocomial infection, (ii) the relationship between early and late SPN initiation and the development of nosocomial infection. METHODS A retrospective study was conducted in patients who met the inclusion criteria from February 2012 to February 2015 in Pediatric ICU (PICU). Patients were classified into two groups according to nutrition delivery approach-SPN group and EN alone group. Then SPN group were further divided into two subgroups by initiation timing, which were defined as early-initiation SPN and late-initiation SPN group respectively. Age, gender, serum albumin at admission, severity of disease, length of stay in PICU, nutrition delivery approach, amounts of delivered caloric intake and occurence of nosocomial infection were recorded. Univariate analysis and binary logistic regression analysis were performed to identify the risk factors and assess the independent effect of SPN approach on nosocomial infection in PICU of Emergency Department. RESULTS 204 patients were included in our study. Compared with EN alone group, patients delivered by SPN approach had a higher nosocomial infection rate (34.0 vs.10.9%, p < 0.001). The late-initiation subgroup of SPN approach was found to be an independent predictor of nosocomial infection in the logistic regression analysis model (OR = 3.40; 95% CI, 1.13 ~ 10.19; p = 0.029). Serum albumin at admission (OR = 0.91; 95% CI, 0.84 ~ 0.97; p = 0.008), mechanical ventilation (OR = 3.85; 95% CI, 1.43 ~ 10.39; p = 0.008), severity of disease (OR = 3.79; 95% CI, 1.03 ~ 13.99; p = 0.045) and PICU length of stay (OR = 1.23; 95% CI, 1.11 ~ 1.35; p < 0.001) were also identified as significant risk factors for nosocomial infection. CONCLUSIONS Our study shows late-initiation SPN approach increases the incidence of nosocomial infection compared with early-initiation approach in critically ill children in PICU of Emergency Department. Compared with EN alone group, patients delivered by SPN approach had a higher nosocomial infection rate.
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Affiliation(s)
- Dan Wang
- School of Medical Management and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
| | - Xiaoquan Lai
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
| | - Chenxi Liu
- School of Medical Management and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
| | - Yuqi Xiong
- School of Medical Management and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
| | - Xinping Zhang
- School of Medical Management and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
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Morillo-García Á, Aldana-Espinal JM, Olry de Labry-Lima A, Valencia-Martín R, López-Márquez R, Loscertales-Abril M, Conde-Herrera M. Hospital costs associated with nosocomial infections in a pediatric intensive care unit. GACETA SANITARIA 2015; 29:282-7. [DOI: 10.1016/j.gaceta.2015.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/16/2022]
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Jurasinski P, Schindler CA. An emerging population: the chronically critically ill. J Pediatr Health Care 2014; 28:550-4. [PMID: 24929844 DOI: 10.1016/j.pedhc.2014.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 04/09/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
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Powers MA, Mudd P, Gralla J, McNair B, Kelley PE. Sedation-related outcomes in postoperative management of pediatric laryngotracheal reconstruction. Int J Pediatr Otorhinolaryngol 2013; 77:1567-74. [PMID: 23932833 DOI: 10.1016/j.ijporl.2013.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/10/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Examine outcomes of varied postoperative sedation management in pediatric patients recovering from single stage laryngotracheal reconstruction. DESIGN Retrospective review of 34 patients treated with single stage laryngotracheal reconstruction from 2001 through 2011. SETTING Tertiary children's hospital. METHODS Patients were divided into 2 groups: those managed postoperatively with sedation, with or without paralysis (group 1), and those managed awake with narcotic pain medication as needed for primary management (group 2). Outcomes were measured as a function of sedation management. Outcomes investigated focused on those related to the success of the airway reconstruction, and those related to sedation management. RESULTS Out of 68 cases of laryngotracheal reconstruction reviewed from 2001 to 2011, 34 were single stage reconstructions. Nineteen patients were sedated postoperatively (group 1) and fifteen patients were left awake (group 2). There were no significant differences between groups in airway-related outcomes, including risk of accidental decannulation, revision rates, and need for secondary airway procedures such as balloon dilation. Sedation-related outcomes, specifically focusing on differences in medical management, showed significant increases in rates of withdrawal (p<0.0001), nursing concerns of withdrawal (p<0.0001) and sedation level (p<0.0001), pulmonary complications (OR 7.7, p=0.008), and prolonged hospital stay due to withdrawal (p=0.0005) in patients managed with sedation with or without paralysis. Multivariable regression analysis revealed that duration of sedation was the primary risk factor for increased postoperative morbidity, while younger age, lower weight, and use of a posterior graft were also significant variables assessed. CONCLUSION Avoiding sedation as the standard for postoperative management of single stage laryngotracheal reconstruction airway patients leads to an overall decreased risk of morbidity without increasing risk of airway-specific morbidity. This is specifically as related to withdrawal, pulmonary complications, concerns about sedation level and prolonged hospital course, all of which increase significantly with increased level and duration of sedation.
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Affiliation(s)
- Matthew A Powers
- University of Colorado School of Medicine, Department of Otolaryngology & Children's Hospital Colorado, 13120 E. 19th Avenue, Mail Stop C292, Aurora, CO 80045, United States
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