Measuring the outcome of paediatric intensive care

Critical Analysis of PIM2 Score Applicability in a Tertiary Care PICU in Western India

Objective. Children have limited physiological reserve that deteriorates rapidly. Present study profiled patients admitted to PICU and determined PIM2 score applicability in Indian setting. Patients and Methods. Prospective observational study. Results. In 742 consecutive admissions, male : female ratio was 1.5 : 1, 35.6% patients were ventilated, observed mortality was 7%, and 26.4% were <1 year. The profile included septicemia and septic shock (29.6%), anemia (27.1%), pneumonia (19.6%), and meningitis and encephalitis (17.2%). For the first year, sensitivity of PIM2 was 65.8% and specificity was 71% for cutoff value at 1.9 by ROC curve analysis. The area under the curve was 0.724 (95% CI: 0.69, 0.76). This cutoff was validated for second year data yielding similar sensitivity (70.6%) and specificity (65%). Logistic regression analysis (LRA) over entire data revealed various variables independently associated with mortality along with PIM2 score. Another logistic model with same input variables except PIM2 yielded the same significant variables with Nagelkerke R square of 0.388 and correct classification of 78.5 revealing contribution of PIM2 in predicting mortality is meager. Conclusion. Infectious diseases were the commonest cause of PICU admission and mortality. PIM2 scoring did not explain the outcome adequately, suggesting need for recalibration. Following PALS/GEM guidelines was associated with better outcome.

Parents' experiences of living through their child's suffering from and surviving severe meningococcal disease

The aim of this study was to describe the lived experience of parents whose child had suffered from and survived severe meningococcal disease. A Heideggerian phenomenological approach was used within the study and data were collected from long focused interviews. In total, eight parents took part in the study; one was a woman recruited as a pilot interview and the other seven were recruited for the main study. The data were analysed using Colaizzi's (1978) method. Eleven themes emerged: (1) complications/side effects; (2) emotional turmoil; (3) child's physical appearance; (4) family disruption; (5) fear of death; (6) loss of parenting role; (7) need for support and understanding; (8) need and value of communication, information and publicity; (9) parental intuition; (10) technological interventions and (11) the impact of care delivery. A review of the literature arising out of the data was undertaken, and a final synthesis statement as perceived by the parents was achieved. Living through this experience is perceived as a major emotional stressor, and although health professionals have some insight into the experience, they are largely naive to the enormity of the situation.

Pressure area care in infants and children: Nimbus Paediatric System

Survival rates in both critically and chronically ill infants and children have improved dramatically in recent years and new challenges exist in the nursing care given to these patients. Among these is the increased risk of pressure ulcer development. Children in intensive care environments are especially at risk. Prevention and management of pressure ulceration in the paediatric population requires clinical judgement and skill. The use of pressure ulcer risk assessment tools can assist in this process; however, to date, there is a lack of research evidence and further studies are needed. The pressure relief requirements of the paediatric patient are significantly different to those of the adult patient. In children under the age of 36 months, the ears and occiput are the areas most at risk of pressure injury as a result of the fact that this area is proportionately the largest and heaviest bony prominence. Despite the abundance of specialist pressure redistributing devices for adults, there is little available specifically for the paediatric patient. This article describes a review of the literature on these subject areas and follows with a short report of the evaluation of the new Paediatric Nimbus System undertaken at the Royal Hospital for Sick Children in Edinburgh.