Causes of death in critically ill paediatric patients in Japan: a retrospective multicentre cohort study

Ishihara, Tadashi; Tanaka, Hiroshi

doi:10.1136/bmjpo-2019-000499

Cited by 10 publications

(11 citation statements)

References 35 publications

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“…Table 4 shows the categories of final diagnosis at ICUs and PICUs. The occurrence of extrinsic disease was significantly higher in the tracheostomy group (29,16.0% versus 549, 9.8%; p < 0.01). Among intrinsic disease, respiratory disease was the leading diagnosis in the tracheostomy group, and its occurrence was significantly higher than in the no-tracheostomy group (72, 39.8% versus 1029, 18.4%; p < 0.01).…”

Section: Resultsmentioning

confidence: 81%

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Factors affecting tracheostomy in critically ill paediatric patients in Japan: a data-based analysis

Ishihara

Tanaka

2020

BMC Pediatr

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Background: There has been an increasing number of children surviving with high medical needs, for whom tracheostomy and/or home ventilation is part of their chronic disease management. The purpose of this study was to describe the indications, epidemiology, frequency, and associated factors for tracheostomy in critically ill paediatric patients using the data available in the Japanese Registry of Paediatric Acute Care (JaRPAC). Methods: This multicentre epidemiologic study collected data concerning paediatric tracheostomy from the JaRPAC database. Patients were divided into two groups: those with or without tracheostomies when they were discharged from the Intensive Care Unit (ICU) or Paediatric Intensive Care Unit (PICU). Consecutive patients aged ≤16 years who did not undergo tracheostomy when admitted to ICU or PICU between April 2014 and March 2017 were included. Results: A total of 23 hospitals participated, involving 6199 paediatric patients registered in the JaRPAC database during the study period. Of the registered paediatric patients, 5769 (95%) patients were admitted to the ICUs or PICUs without tracheostomies. Among the patients, 181 patients (3.1%) had undergone tracheostomies. There were significant differences in chronic conditions (134, 74.0% versus 3096, 55.4%, p < 0.01), chromosomal anomalies (19, 10.5% versus 326, 5.8%, p < 0.01), urgent admission (151, 83.4% versus 3093, 55.4%, p < 0.01). More tracheostomies were performed on patients who were admitted for respiratory failure (61, 33.7% versus 926, 16.1%, p < 0.01) and for post-cardiac pulmonary arrest (CPA) resuscitation (40, 22.1% versus 71, 1.1%, p < 0.01). Conclusions: This is the first report to use a large-scale registry of critically ill paediatric patients in Japan to describe the interrelated factors of tracheostomies. Chronic conditions (especially for neuromuscular disease), chromosomal anomaly, admission due to respiratory failure, or treatment for post-CPA resuscitation all had the possibility to be risk factors for tracheostomy.

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Section: Resultsmentioning

confidence: 81%

“…This was an epidemiologic study based on JaRPAC data. This study was subgroup analysis, by using JaRPAC data which was published by Ishihara T, et al [16]. Data concerning patients who had not undergone tracheostomy when admitted to the ICU or PICU were extracted from the database.…”

Section: Designmentioning

confidence: 99%

Factors affecting tracheostomy in critically ill paediatric patients in Japan: a data-based analysis

Ishihara

Tanaka

2020

BMC Pediatr

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“…This was an epidemiologic study based on JaRPAC data. This study was subgroup analysis, by using JaRPAC data which was published by Ishihara T, et al [16]. study Data concerning patients who had not undergone tracheostomy when admitted to the ICU or PICU were extracted from the database.…”

Section: Designmentioning

confidence: 99%

Factors affecting tracheostomy in critically ill paediatric patients in Japan: a data-based analysis

Ishihara

Tanaka

2020

Preprint

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BACKGROUND: There has been an increasing number of children surviving with high medical needs, for whom tracheostomy and/or home ventilation is part of their chronic disease management. The purpose of this study was to describe the indications, epidemiology, frequency, and associated factors for tracheostomy in critically ill paediatric patients using the data available in the Japanese Registry of Paediatric Acute Care (JaRPAC).METHODS: This multicentre epidemiologic study collected data concerning paediatric tracheostomy from the JaRPAC database. Patients were divided into two groups: those with or without tracheostomies when they were discharged from the ICU or PICU. Consecutive patients aged ≤ 16 years who did not undergo tracheostomy when admitted to ICU or PICU between April 2014 and March 2017 were included.RESULTS: A total of 23 hospitals participated, involving 6,199 paediatric patients registered in the JaRPAC database during the study period. Of the registered paediatric patients, 5,769 (95%) patients were admitted to the ICUs or PICUs without tracheostomies. Among the patients, 181 patients (3.1%) had undergone tracheostomies. There were significant differences in chronic conditions (134, 74.0% versus 3096, 55.4%, p < 0.01), chromosomal anomalies (19, 10.5% versus 326, 5.8%, p < 0.01), urgent admission (151, 83.4% versus 3093, 55.4%, p < 0.01). More tracheostomies were performed on patients who were admitted for respiratory failure (61, 33.7% versus 926, 16.1%, p < 0.01) and for post-cardiac pulmonary arrest (CPA) resuscitation (40, 22.1% versus 71, 1.1%, p < 0.01).CONCLUSIONS: This is the first report to use a large-scale registry of critically ill paediatric patients in Japan to describe the interrelated factors of tracheostomies. Chronic conditions (especially for neuromuscular disease), chromosomal anomaly, urgent admission, admission due to respiratory failure, or treatment for post-CPA resuscitation all had the possibility to be risk factors for tracheostomy.

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“…In our study, 11.14% of the patients who applied to the PICU met the definition for CCI. Ishihara et al [ 18 ] determined CCI at a rate of 58.15% in their study considering the broad-framed chronic condition. Similarly, Walter et al [ 20 ] found the CCI rate to be 51%.…”

Section: Discussionmentioning

confidence: 99%

“…Prematurity and prolonged mechanical ventilation seem to be acceptable indicators of significant health complications as well as healthcare costs. In previous studies, cardiovascular and neuromuscular diseases have been reported as the most common cause of death in the critically ill pediatric patients [ 18 , 23 – 25 ]. Namachivayam et al [ 19 ] observed that children who died in PICU were ventilated longer than survivors (34 days [25–50] versus 31 days [20–47]; p = 0.014).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the incidence, characteristics, and outcomes of pediatric chronic critical illness

Demirkıran

Kılıç²,

Tomak

et al. 2021

PLoS ONE

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Our aim was to determine characteristics of children with chronic critical illness (CCI) admitted to the pediatric intensive care unit (PICU) of a tertiary care children’s hospital in Turkey. The current study was a multicenter retrospective cohort study that was done from 2014 to 2017. It involved three university hospitals PICUs in which multiple criteria were set to identify pediatric CCIs. Pediatric patients staying in the ICU for at least 14 days and having at least one additional criterion, including prolonged mechanical ventilation, tracheostomy, sepsis, severe wound (burn) or trauma, encephalopathy, traumatic brain injury, status epilepticus, being postoperative, and neuromuscular disease, was accepted as CCI. In order to identify the newborn as a chronic critical patient, a stay in the intensive care unit for at least 30 days in addition to prematurity was required. Eight hundred eighty seven (11.14%) of the patients who were admitted to the PICU met the definition of CCI and 775 of them (87.3%) were discharged to their home. Of CCI patients, 289 (32.6%) were premature and 678 (76.4%) had prolonged mechanical ventilation. The total cost values for 2017 were statistically higher than the other years. As the length of ICU stay increased, the costs also increased. Interestingly, high incidence rates were observed for PCCI in our hospitals and these patients occupied 38.01% of the intensive care bed capacity. In conclusion, we observed that prematurity and prolonged mechanical ventilation increase the length of ICU stay, which also increased the costs. More work is needed to better understand PCCI.

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Causes of death in critically ill paediatric patients in Japan: a retrospective multicentre cohort study

Cited by 10 publications

References 35 publications

Factors affecting tracheostomy in critically ill paediatric patients in Japan: a data-based analysis

Factors affecting tracheostomy in critically ill paediatric patients in Japan: a data-based analysis

Factors affecting tracheostomy in critically ill paediatric patients in Japan: a data-based analysis

Evaluation of the incidence, characteristics, and outcomes of pediatric chronic critical illness

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