Clinical characteristics and results of care for critically ill children in the Pediatric ICU of the Metropolitan Hospital in the period 2015-2020
DOI:
https://doi.org/10.47464/MetroCiencia/vol31/3/2023/48-56Keywords:
Critical illness, pediatric intensive care, mortalityAbstract
Introduction: The care of critically ill children in an intensive care unit allows for an improved chance of survival in life-threatening conditions. It is essential to review the actions in these units, as well as their outcomes, in search of alternatives to enhance the quality of care. Objective: To describe the clinical characteristics and outcomes of critically ill children admitted to the Pediatric ICU at Hospital Metropolitano, Quito, during the period from 2015 to 2020. Methodology: Observational study with analysis of clinical and laboratory variables collected prospectively in a database, supplemented by a retrospective review of other variables in clinical records. Results: a total of 683 children were admitted during the study period, median age of 39 months (IQR 12-89), of which 59.6% were male. The weight ranged from 3.4 to 69 kg. The length of stay ranged from 1 to 83 days, with a median of 2 days (IQR 1-5). Most frequent causes for admission were postoperative care (27.1%) and respiratory diseases (22.8%). Supportive interventions included central venous catheter placement (41.1%), arterial catheter placement (39.8%), conventional invasive mechanical ventilation (26.4%), and use of inotropes/vasoactive agents (23.3%). Ventilator-associated pneumonia occurred in 2.2% of children and catheter-related bloodstream infections in 0.9%. The overall mortality rate was 3.5%. Using PIM-3, the corrected mortality index was 0.92. Conclusion: Admission to the PICU is more frequently related to postoperative and respiratory conditions. Ventilator-associated pneumonia occurs infrequently and the overall mortality is consistent with international data.
Downloads
References
Abdelatif RG, Mohammed MM, Mahmoud RA, Bakheet MAM, Gima M, Nakagawa S. Characterization and Outcome of Two Pediatric Intensive Care Units with Different Resources. Crit Care Res Pract. 2020 Mar 17;2020:5171790. doi: 10.1155/2020/5171790. PMID: 32257435; PMCID: PMC7103036.
Ganime Ayara, Mutlu Uysal Yazicib, Sanliay Sahina, et al. Perfil de mortalidad en una Unidad de Cuidados Intensivos Pediátricos: asociación entre la mortalidad y el período fuera del horario diurno semanal. Arch Argent Pediatr 2019;117(2):120-125.DOI:10.5546/AAP-2019.120
Jiménez M, Vega D, Ortega D, Álvarez M, González C. Características Epidemiológicas en la Unidad de Cuidados Intensivos Pediátricos, Hospital General Docente de Calderón, Quito. Rev. Ecuat. Pediatr. 2020;21(1). Artículo número 8. Páginas:1-9.
De La Olivia P, Cambra F, Quintana M, Rey C, Sánchez J, Ocete E. Guías de ingreso, alta y triaje para las unidades de cuidados intensivos pediátricos en España. Anales de Pediatría de la AEP. 2018; 88(5): p. 287.e1-287.e11.
Blanch L, Francois F, Amin P, Christian M, Joynt G, Zimmerman J. Triage decisions for ICU admission: Report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine. Journal of Critical Care. 2016; 36: p. 301-305.
Nates J, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B. ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research. Critical Care Medicine. 2016; 44(8): p. 1553-1602.
Hodkinson P, Argent A, Reid S, Perea R, Harrinson S, Ward A. Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death. PLoS ONE. 2016; 11(1).
Fan YG, Wu Y, Zhang J, Zhu M, Xiong L. Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis. Crit Care. 2016; 20(1): p. 338.
Kharel S, Bist A, Kumar S. Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: A systematic review. PLoS ONE. 2021; 16(3).
CDC. Pneumonia (Ventilator-associated [VAP] and non ventilator-associated Pneumonia [PNEU]) Event. NHSN. 2021;: p. 1-12.
Nair G, Niederman M. Ventilator-associated pneumonia: present understanding and ongoing debates. Intensive Care Med. 2015; 41(1): p. 34-48.
Vizmanos G, Martín C. Neumonía adquirida en el hospital. Protoc diagn ter pediatr. 2017; 1: p. 147-156.
Cabrales M, Au O. Neumonía asociada al ventilador en una unidad de cuidados intensivos. Revista Cubana de Medicina Intensiva y Emergencias. 2017; 16(4).
Vijay G, Mandal A, Sankar J, Kapil A, Lodha R, Kabra S. Ventilator Associated Pneumonia in Pediatric Intensive Care Unit: Incidence, Risk Factors and Etiological Agents. Indian J Pediatr. 2018; 85(10): p. 861-866.
Cieza L, Coila E. Neumonía asociada a ventilación mecánica en la Unidad de Cuidados Intensivos Pediátricos de un Hospital Terciario 2015-2018. Rev. Fac. Med. Hum. 2019; 19(3): p. 19-26.
Asensio M, Hernández M, Yus S, Minvielle A. Infecciones en el paciente crítico. Medicine (Madr). 2018; 12(52): p. 3085-3096.
Malhotra D, Nour N, El Halik M, Zidan M. Performance and Analysis of Pediatric Index of Mortality 3 Score in a Pediatric ICU in Latifa Hospital, Dubai, UAE. Dubai Medical Journal. 2020; 3: p. 19-25.
Moldes M, Prado L, González M, Sánchez N, Díaz Y, Fuentes M. Comportamiento de la ventilación mecánica en una terapia intensiva pediátrica. Revista Cubana de Medicina Intensiva y Emergencia. Volumen. 2017; 16(1).
Coletti KD, Bagdure DN, Walker LK, Remy KE, Custer JW. High-flow nasal cannula utilization in pediatric critical care. Respir Care [Internet]. 2017 [citado el 29 de junio de 2023];62(8):1023–9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28588119/
Munaico Abanto ME, Paredes Zevallos P, Quispe Flores GA, Manchego Rosado LM, Galarza Robles Ángel R, Palma Monserrate V, Ortiz Chicchon M, Quiñones García GJ. MIS-C y COVID-19: características clínicas y epidemiológicas de los pacientes de una unidad de cuidados críticos pediátricos. MetroCiencia [Internet]. 5 de octubre de 2021 [citado 13 de octubre de 2023];29(3):5-10. Disponible en: https://revistametrociencia.com.ec/index.php/revista/article/view/187
Cruz-Rodarte P, Rincón-Zuno J, Mendieta-Alcántara GG. Factores de riesgo asociados a infección de catéter venoso central. [Internet]. Arch Invest Materno Inf. 2015;7(3):107-15. SU: medigraphic/67731.
Castillo A. Ventilación mecánica invasiva en el paciente pediátrico. Neumol Pediatr. 2017; 12 (1):15-22.
García-Torres A, Moreira-Bermúdez ME. Comparación entre una unidad de cuidados intensivos pediátrica de puertas abiertas y una con horarios de visita establecidos, en cuanto a tiempo de hospitalización, uso de analgésicos, percepción y relación de los familiares y personal de salud, durante el periodo de abril a mayo de 2019. [Internet]. Tesis de Especialización. Pontificia Universidad Católica del Ecuador. 2019. SU: Despace/puce/16758
Campos-Miño S, Sasbón JS, von Dessauer B. Cuidados intensivos pediátricos en Latinoamérica. Med Intensiva. 2012; 36(1): 3-10. DOI: 10.1016/j.medin.2011.07.004
Witt N, Rezende M, Trugilho S, Pinasco G, Sousa E, Silva V. Clinical-epidemiological profile of hospitalised patients in paediatric intensive care unit. Journal of Human Growth and Development. 2015; 25(2): 187-193. Disponible en: http://pepsic.bvsalud.org/scielo.php?pid=S0104-12822015000200009&scrip-t=sci_abstract
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Patricia Acosta, Rocío Yerovi, Rodrigo Sempértegui-Moscoso, Andrea Vásconez-Montalvo, Julissa González-Cedeño, Martha Cuñas Quishpe
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
