Caracterização e avaliação do impacto prognóstico das intercorrências clínicas observadas duranteAos meus filhos e sobrinho.Ao meu esposo Ricardo.Aos meus pais, Norberto e Angela.Aos meus irmãos, Talita e Camilo.
AgradecimentosA Deus, fonte milagrosa de vida e amor.Ao meu marido Ricardo, pelo amor, carinho, respeito, pela paciência, motivação e pelo exemplo profissional.Aos meus pais, Norberto e Angela, pela criação, educação e pelo amor incondicional.Aos meus irmãos Talita e Camilo, fontes de inspiração e alegria, que sempre me apoiaram e estiveram juntos em todos os momentos.Aos meus cunhados, pelo apoio e pela amizade, em especial ao Lucas, por me ajudar ativamente com as intermináveis planilhas do excel.Ao meu orientador Prof. Dr. Carlos Henrique Miranda, pela confiança, amizade, pelo estímulo, ensino, exemplo profissional e pela dedicação a este estudo.Aos meus eternos professores Ana Paula, Fábio e Alessandra, por todo ensinamento no cuidado com nossas crianças, pelo tempo e pela atenção desprendidos com este estudo.Ao Davi, pela ajuda com a análise estatística dos dados coletados.
Introduction:The medical transport of critically ill children involves characteristics that increase the risk of complications, which can contribute to an increase in length of stay and mortality. Objectives: To evaluate the frequency and type of complications observed during the pre-hospital and inter-hospital transport of critically ill children, as well as the impact of these complications on mortality, length of hospital stay and hospital costs. Patients and Methods: A study carried out in two stages: the first was a cross-sectional study where through a standardized interview with the doctor who admitted the critically ill children requiring pre-hospital or inter-hospital transport identified and characterized possible complications during this transport. These data were audited by three independent doctors who defined the presence or absence of complications during transport. The second stage consists of a prospective cohort study, where patients divided into two groups (with and without complications during transportation) were followed prospectively for 60 days observing the occurrence of death or hospital discharge. Results: We included 143 children in the study. At least one complication during transportation was observed in 74 patients (52%). The most frequent complications have been associated with airway (69%), followed by metabolic disorders (47%), cardiovascular disorders (40%) and failure in the device and monitoring (37%). In the uni-variate analysis, the following predictors for the occurrence of complications during transport were observed: weight <10 kg (relative risk -RR: 1.52; 95% confidence interval -CI: 1.11-2.09); distance greater than 100 km (RR: 1.67; 95% CI: 1.16-2.40); presence of respiratory disease (RR: 1.46; 95% CI: 1.06-1.95) and associated comorbidity (RR: 1.68; 95% CI: 1.23-2.30). In the multivariate analysis, no independent predictors were observed for the occurrence of complications. The oc...