Children admitted to the PICU following emergency transfers by the specialist paediatric transport team were younger, sicker, received more PICU-specific therapies and had longer PICU LOS than other acutely admitted critically ill patients. This indicates that these transfers were appropriate.

Objective/aim The aim of the study was to quantify excess mortality in children after admission to a Pediatric Intensive Care Unit (PICU), compared to the age and sex matched general Swedish population. Design Single-center, retrospective cohort study. Setting Registry study of hospital registers, a national population register and Statistics Sweden. Patients Children admitted to a tertiary PICU in Sweden in 2008–2016. Interventions None. Main results In total, 6,487 admissions (4,682 patients) were included in the study. During the study period 444 patients died. Median follow-up time for the entire PICU cohort was 7.2 years (IQR 5.0–9.9 years). Patients were divided into four different age groups (0–28 d, > 28 d -1 yr, > 1–4 yr, and > 4 yr) and four different risk stratification groups [Predicted Death Rate (PDR) intervals: 0–10%, > 10–25%, > 25–50%, and > 50%] at admission. Readmission was seen in 929 (19.8%) patients. The Standardized Mortality Ratios (SMRs) were calculated using the matched Swedish population as a reference group. The SMR for the entire study group was 49.8 (95% CI: 44.8–55.4). For patients with repeated PICU admissions SMR was 108.0 (95% CI: 91.9–126.9), and after four years 33.9 (95% CI: 23.9–48.0). Patients with a single admission had a SMR of 35.2 (95% CI: 30.5–40.6), and after four years 11.0 (95% CI: 7.0–17.6). The highest SMRs were seen in readmitted children with oncology/hematology (SMR = 358) and neurologic (SMR = 192) diagnosis. Children aged >1–4 years showed the highest SMR (325). In PDR group 0–10% children with repeated PICU admissions (n = 798), had a SMR of 100. Conclusion Compared to the matched Swedish population, SMRs were greatly elevated up to four years after PICU admission, declining from over 100 to 33 for patients with repeated PICU admissions, and from 35 to 11 for patients with a single PICU admission.

The aim of the present study was to evaluate the performance of regional oxygen saturation (rSO2) monitoring with near infrared spectroscopy (NIRS) during pediatric inter-hospital transports and to optimize processing of the electronically stored data. Cerebral (rSO2-C) and abdominal (rSO2-A) NIRS sensors were used during transport in air ambulance and connecting ground ambulance. Data were electronically stored by the monitor during transport, extracted and analyzed off-line after the transport. After removal of all zero and floor effect values, the Savitzky–Golay algorithm of data smoothing was applied on the NIRS-signal. The second order of smoothing polynomial was used and the optimal number of neighboring points for the smoothing procedure was evaluated. NIRS-data from 38 pediatric patients was examined. Reliability, defined as measurements without values of 0 or 15%, was acceptable during transport (> 90% of all measurements). There were, however, individual patients with < 90% reliable measurements during transport, while no patient was found to have < 90% reliable measurements in hospital. Satisfactory noise reduction of the signal, without distortion of the underlying information, was achieved when 20–50 neighbors (“window-size”) were used. The use of NIRS for measuring rSO2 in clinical studies during pediatric transport in ground and air-ambulance is feasible but hampered by unreliable values and signal interference. By applying the Savitzky–Golay algorithm, the signal-to-noise ratio was improved and enabled better post-hoc signal evaluation.

Objectives: Data on long-term survival in children after interhospital transport to a PICU are scarce. The main objective was to investigate short- and long-term outcome after acute interhospital transport to a PICU for different age and risk stratification groups. Secondary aims were to investigate whether neonatal patients would have higher mortality and be more resource demanding than older patients. Design: Single-center, retrospective cohort study. Setting: Specialist pediatric transport team and a tertiary PICU in Sweden. Patients: Critically ill children 0–18 years old, acutely transported by a specialist pediatric transport team to a PICU in Sweden (January 1, 2008, to December 31, 2016). Interventions: None. Measurements and Main Results: A total of 401 acute transport events were included. Overall mortality was 15.7% with a median follow-up time of 3.4 years (range, 0–10.2 yr). Median predicted death rate was 4.9%. There was no mortality during transport. Cumulative mortality almost doubled within the first 6 months after PICU discharge, from 6.5% to 12.0%. Of late deaths, 66.7% occurred in the risk stratification group predicted death rate 0–10%, and 95% suffered from severe comorbidity. There were no deaths after PICU discharge in the neonatal group. Cumulative mortality in multiple transported patients was 36.4%. Conclusions: This is the first report on long-term survival after acute pediatric interhospital transport. For the entire cohort, there was significant mortality after PICU discharge, especially in multiple transported patients. In contrast, survival in the subgroup of neonatal patients was high after PICU discharge.

The aim of the current study was to investigate how cerebral and splanchnic oxygen saturation (rSO 2-C and rSO 2-A) in critically ill children transported in air ambulance was affected by flight with cabin pressurization corresponding to � 5000 feet. A second aim was to investigate any differences between cyanotic and non-cyanotic children in relation to cerebral and splanchnic oxygen saturation during flight � 5000 feet. The variability of the cerebral and splanchnic Near Infrared Spectroscopy (NIRS) sensors was evaluated. Design NIRS was used to measure rSO 2-C and rSO 2-A during transport of critically ill children in air ambulance. rSO 2 data was collected and stored by the NIRS monitor and extracted and analyzed off-line after the transport. Prior to evaluation of the NIRS signals all zero and floor-effect values were removed.

Objective/Aim: The aim of the study was to investigate the mortality rate in children after admission to a Pediatric Intensive Care Unit (PICU), compared to the matched general Swedish population. Design: Single-center, retrospective cohort study. Setting: Registry study of hospital registers, a national population register and Statistics Sweden. Patients: Children admitted to a tertiary PICU in Sweden in 2008-2016. Interventions: None Main Results: In total, 6,487 admissions (4,682 patients) were included in the study. During the study period 444 patients died. Median follow-up time for the entire PICU cohort was 7.2 years (IQR 5.0-9.9 years). Patients were divided into four different age groups (0–28 d, > 28 d -1 yr, > 1–4 yr, and > 4 yr) and four different risk stratification groups [Predicted Death Rate (PDR) intervals: 0–10%, > 10–25%, > 25–50%, and > 50%] at admission. Readmission was seen in 929 (19.8%) patients. The Standardized Mortality Ratios (SMRs) were calculated using the matched Swedish population as a reference group. The SMR for the entire study group was 49.8 (95% CI: 44.8-55.4). For patients with repeated PICU admissions SMR was 108.0 (95% CI: 91.9-126.9), and after four years 33.9 (95% CI: 23.9-48.0). Patients with a single admission had a SMR of 35.2 (95% CI: 30.5-40.6), and after four years 11.0 (95% CI: 7.0-17.6). The highest SMRs were seen in readmitted children with oncology/hematology (SMR=358) and neurologic (SMR=192) diagnosis. Children aged >1-4 years showed the highest SMR (325). In PDR group 0-10% children with repeated PICU admissions (n=798), had a SMR of 100. Conclusion : SMRs were greatly elevated up to four years after PICU admission, declining from over 100 to 33 for patients with repeated PICU admissions, and from 35 to 11 for patients with a single PICU admission, compared to the matched Swedish population.

To avoid unnecessary harm to children admitted to PICU, an arterial blood gas analysis should only be performed if clinically indicated or if the child has a respiratory admission diagnosis. Estimation of the PIM2 score and PDR will not be less accurate by this approach.