Impacto da internação em unidade de terapia intensiva pediátrica: avaliação por meio de escalas de desempenho cognitivo e global

Abstract

Objective: To assess the impact of admission to the pediatric intensive care unit (ICU) at the Hospital de Clínicas de Porto Alegre, RS, Brazil on children's cognitive and global performance.Methods: An observational, longitudinal study of a sequential sample of critically ill children. The following indicators were used: the Pediatric Index of Mortality (PIM), for severity and risk of death at admission, the Pediatric Cerebral Performance Category (PCPC), for cognitive morbidity and the Pediatric Overall Performance Category (POPC), for global morbidity, at admission and at discharge. Morbidity related to the ICU was measured according to the difference between classifications at discharge and at admission (delta scores). The Kruskal-Wallis test was applied.Results: A total of 443 patients were assessed, 54% of whom were male, with a median age of 12 months (IQ 4-45), and a median ICU stay of 4.24 days (IQ 2.4-8). The mortality rate was 6.3%. The median PIM score was 2.36% (IQ 1-7). On admission, 46% of the patients had some degree of cognitive morbidity and 66% had some degree of global morbidity. At discharge there was 60% cognitive morbidity and 86% global morbidity. The assessment of ICUrelated morbidity revealed that 25% of the patients had undergone cognitive changes while 41% had undergone global variations, at discharge compared with admission. Conclusions:Although affected by the elevated degree of morbidity at admission, the impact of the ICU stay was more significant in the global than in the cognitive domain. In the same manner, both risk of death at admission and length of stay had a significant effect on the morbidity of severely ill patients.J Pediatr (Rio J). 2007;83(6): 505-511:Outcome, critical care, pediatric cerebral performance category, pediatric overall performance category, morbidity.

Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale

“…In contrast to other studies that indicate a relationship between functional status at discharge, assessed by the Pediatric Cerebral Performance Category (PCPC) and the Pediatric Outcome Performance Category (POPC), and predictive mortality rates at admission, ( 5 , 14 , 15 ) in this study, we did not observe a significant difference in admission PIM2 values, according to the impairment in the overall FSS score presented by individuals at discharge from the PICU . This can be explained by Fonseca et al, ( 16 ) who verified that the PIM2 proved to be an inadequate measure to predict the mortality of patients with chronic conditions, which seems to be the case of the population in our study, in which only 16% individuals did not present any health condition prior to hospitalization in the PICU.…”

“…The median overall functional score and the percentage of individuals with normal FSS scores and overall FSS scores ≥ 20 found in our population were similar to the results of the original instrument study. ( 7 ) The main causes of admission to the PICU, such as respiratory failure, postoperative recovery, sepsis and shock, and liver failure, were similar to those of another study conducted in the PICU of HCPA, ( 5 ) likely due to the profile of the patients admitted in this unit.…”

“…The PICU of the HCPA has 13 beds and admits patients with clinical disorders or after surgical procedures, except trauma situations and cardiac surgery. ( 5 ) Patients of both sexes who were discharged from this PICU, over 1 month of age and younger than 18 years old, with a stay in the PICU for a period of ≥ 24 hours were included in the study. Patients dependent on ventilatory technology prior to admission to the PICU, those who were premature (gestational age ≤ 37 weeks) aged ≤ 12 months upon admission to the study and patients readmitted to the PICU within a period of ≤ 24 hours after discharge from the unit were excluded from the study.…”

Characterization and Outcome of Two Pediatric Intensive Care Units with Different Resources

“…is was similar to a reference range of 54% to 84.3% [26,27]. However, the percentage of survivors with normal PCPC was lower for those admitted to the SUH PICU.…”

Transforming PICU Culture to Facilitate Early Rehabilitation

“…32 Other studies have reported the rate of new functional disability to be higher in PICU survivors (32%) compared with children with normal cognitive function (20%). 33 Knoester et al reported that an alarming 69% of children suffer physical and neurocognitive sequelae 3 months after PICU discharge, half of whom acquired these morbidities as a direct result of their critical illness. 34 …”