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

Abstract

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.

Slow and Steady: Optimizing Intensive Care Unit Treatment Weans for Children with Chronic Critical Illness

“…neonatal intensive care unit (NICU) beds. [2][3][4][5][6][7] Patients with PCCI are not just admitted to the intensive care units (ICUs) of the United States but ICUs around the world. [8][9][10] These ICU admissions are often triggered by an acute event, such as the birth of an extremely premature newborn who later develops PCCI or respiratory decompensation in a child with preexisting PCCI.…”

“…1 In acute-care hospitals in the United States, infants and children with PCCI are estimated to occupy 40% of general pediatric inpatient beds, 25 to 48% of pediatric intensive care unit (PICU) and cardiac intensive care unit (CICU) beds, and 34% neonatal intensive care unit (NICU) beds. 2 3 4 5 6 7 Patients with PCCI are not just admitted to the intensive care units (ICUs) of the United States but ICUs around the world. 8 9 10 These ICU admissions are often triggered by an acute event, such as the birth of an extremely premature newborn who later develops PCCI or respiratory decompensation in a child with preexisting PCCI.…”