Survivors of pediatric critical illnesses develop temporary or permanent functional impairments. We do not have enough data on Brazilian children, however, and the available evidence mainly shows results from high-income countries. Our objective was to assess changes in children and adolescents' functional status surviving critical illnesses in Brazil, and to identify which factors contribute to these functional changes at pediatric intensive care unit (PICU) discharge. To develop this cross-sectional study, two researchers blinded to previous patient information applied the Functional Status Scale (FSS) with patients and caregivers at two different times in a tertiary PICU. The FSS examines six function domains as follows: (1) mental status, (2) sensory functioning, (3) communication, (4) motor functioning, (5) feeding, and (6) respiratory status. The functional decline/poor outcome was defined as an increase in points sufficient to alter the FSS total scores at discharge when comparing to the total baseline score. A total of 303 patients completed the study. Of these, 199 (66%) were with previous chronic conditions. The prevalence of functional decrease was 68% at PICU discharge. Young age (<12 months) and mechanical ventilation time ≥11 days increased by 1.44 (95% confidence interval [CI]: 1.20–1.74, p < 0.001) and 1.74 (95% CI: 1.49–2.03, p < 0.001), respectively, the chances of poor functional results at PICU discharge. This study is the first in Brazil to show that during the episode of critical illness, young age (≤12 months) and duration of invasive mechanical ventilation independently increased the chances of functional impairment in children.
Objective
To evaluate the effects of critical illness on the functional status of
children aged zero to 4 years with or without a history of prematurity after
discharge from the pediatric intensive care unit.
Methods
This was a secondary cross-sectional study nested in an observational cohort
of survivors from a pediatric intensive care unit. Functional assessment was
performed using the Functional Status Scale within 48 hours after discharge
from the pediatric intensive care unit.
Results
A total of 126 patients participated in the study, 75 of whom were premature,
and 51 of whom were born at term. Comparing the baseline and functional
status at pediatric intensive care unit discharge, both groups showed
significant differences (p < 0.001). Preterm patients exhibited greater
functional decline at discharge from the pediatric intensive care unit
(61%). Among patients born at term, there was a significant correlation
between the Pediatric Index of Mortality, duration of sedation, duration of
mechanical ventilation and length of hospital stay with the functional
outcomes (p = 0.05).
Conclusion
Most patients showed a functional decline at discharge from the pediatric
intensive care unit. Although preterm patients had a greater functional
decline at discharge, sedation and mechanical ventilation duration
influenced functional status among patients born at term.
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