ESICM LIVES 2016: part three

Abstract

Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high risk for developing nutritional deficiencies and undernutrition is known to be a risk factor for morbidity and mortality. Malnutrition represents a continuous spectrum ranging from marginal nutrient status to severe metabolic and functional alterations and this in turn, affects clinical outcome. Objectives: The aim of the study was to assess nutritional status of critically ill children admitted to the PICU and its association to clinical outcomes. Methods: Critically ill children age 6 months to 18 years were prospectively enrolled on PICU admission. Nutritional status was assessed by weight for age (WFA: underweight), weight for height (WFH: wasting), height for age (HFA: stunting) z-scores and mid upper arm circumference (MUAC: wasting) according to the WHO. (1,2) Malnutrition was defined as mild, moderate, and severe if z-scores were > −1, > − 2, and > −3, respectively. Hospital and PICU length of stay (LOS), duration of mechanical ventilation (MV), and risk of mortality (ROM) by the Pediatric Index of Mortality 2 (PIM2) were obtained. Sensitivity and specificity of the MUAC to identify children with wasting (WFH) were calculated. Results: Two hundred and fifty children (136 males), aged 81 months (23-167; median (25-75 th IQR)), were prospectively included in the study. The hospital LOS was 8 (4-16) days; PICU LOS: 2 (1-4) days; duration of MV, 0 (0-1.5) days;

Adherence to guidelines is associated with improved survival following in-hospital cardiac arrest

“…To our knowledge, this has not been reported before. It has been shown previously 5 that the time intervals from collapse to 1) calling for the rescue team, 2) starting CPR and 3) defibrillation was significantly longer in general wards compared with the ICU/CCU/cath lab/OR. Surprisingly, adherence to guidelines was lower at academic hospitals compared with non-academic hospitals, perhaps reflecting logistical barriers to initiation of treatment.…”

“…Defibrillation is the appropriate treatment in patients with a shockable rhythm, but in 20% of cases there is a delay of more than 3 min. 5 A lack of AEDs at strategic locations inside the hospital and inadequate training in how to operate an AED are two possible explanations of this shortcoming.…”

“…In 2017, calling for the rescue team and CPR was performed within 1 min and defibrillation was made within 3 min in 80À90% of IHCAs in Sweden. 5 The associations between an early call for the rescue team, the swift initiation of CPR, immediate defibrillation and survival following CA are well established. 6À8 However, few studies have specifically investigated whether adherence to resuscitation guidelines is associated with increased chance of survival.…”