Mortality, length of stay, bloodstream and respiratory viral infections in a pediatric intensive care unit

Hon, Kam Lun; Luk, Man Ping; Fung, Wing Ming; Li, Cho Ying; Yeung, Hiu Lee; Liu, Pui Kwun; Li, Shun; Tsang, Kathy Yin Ching; Li, Chi Kong; Chan, Paul K.S.; Cheung, K.Y.; Leung, Ting Fan; Koh, Pei Lin

doi:10.1016/j.jcrc.2016.09.019

Cited by 20 publications

(20 citation statements)

References 35 publications

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“…If the results of these tests are positive, the patient can then be declared legally and clinically BD. [1][2][3][4] Before these examinations, conditions that may confound the clinical diagnosis of BD should be excluded. [1][2][3][4]11,12 Absence of the pupillary reflex to direct and consensual light, as well as the absence of corneal, cough, and gag reflexes, support the clinical diagnosis of BD.…”

Section: Brain Death and Evaluationmentioning

confidence: 99%

“…Despite advances in paediatric critical care medicine, death remains inevitable in some instances, due to various aetiologies. 1,2 In paediatric critical care medicine settings, patients who would have otherwise died may be kept 'alive' by advanced cardiovascular and ventilatory support. Some patients on cardiopulmonary support may experience irreversible cessation of all brain function, which is regarded as brain death (BD).…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] Because BD or cardiopulmonary death is equivalent to death, there is no obligation for the physician to provide further futile treatment. [1][2][3][4]7 Nevertheless, miraculous survivals have been reported in lay media involving patients who were previously declared BD or dead, which has created a mis-informed understanding of BD. 8 In this retrospective study, all patients who underwent BD assessment over a 16-year period were evaluated to determine whether survival occurred following BD assessment; the demographics of patients diagnosed with BD were compared with those of all other patients diagnosed with cardiopulmonary death at a paediatric intensive care unit (PICU).…”

Section: Introductionmentioning

confidence: 99%

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Brain death in children: a retrospective review of patients at a paediatric intensive care unit

Hon

Tse

Au³

et al. 2020

Hong Kong Med J

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Among patients in paediatric intensive care units (PICUs), death is sometimes inevitable despite advances in treatment. Some PICU patients may have irreversible cessation of all brain function, which is considered as brain death (BD). This study investigated demographic and clinical differences between PICU patients with BD and those with cardiopulmonary death. Methods: All children who died in the PICU at a university-affiliated trauma centre between October 2002 and October 2018 were included in this retrospective study. Demographics and clinical characteristics were compared between patients with BD and patients with cardiopulmonary death. Results: Of the 2784 patients admitted to the PICU during the study period, 127 died (4.6%). Of these 127 deaths, 22 (17.3%) were BD and 105 were cardiopulmonary death. Length of PICU stay was shorter for patients with cardiopulmonary death than for patients with BD (2 vs 8.5 days, P=0.0042). The most common mechanisms of injury in patients with BD were hypoxic-ischaemic injury (40.9%), central nervous system infection (18.2%), and traumatic brain injury (13.6%). The combined proportion of accident and trauma-related injury was greater in patients with BD than in patients with cardiopulmonary death (27.3% vs 3.8%, P<0.001). Organ donation was approved by the families of four

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Section: Brain Death and Evaluationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Brain death in children: a retrospective review of patients at a paediatric intensive care unit

Hon

Tse

Au³

et al. 2020

Hong Kong Med J

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“…This approach has been used successfully in other complex patient populations, including kidney transplant recipients, 27 patients receiving extended deep vein thrombosis (DVT) prophylaxis following hip fracture surgery, 28 and pediatric intensive care unit (ICU) patients. 29 Based on the hypothesis that biomarkers of multiple physiological systems will provide improved diagnostic and prognostic relevance over individual biomarkers or biomarkers of a single system, levels of biomarkers representative of multiple physiological systems were measured in plasma from a cohort of 103 adult ICU patients with sepsis. Biomarkers were selected to represent several different physiological categories, namely hemostasis, inflammation, infection, endothelial function, and platelet function.…”

Section: Introductionmentioning

confidence: 99%

Development of an Algorithm to Predict Mortality in Patients With Sepsis and Coagulopathy

Walborn

Rondina

Fareed

2020

Clin Appl Thromb Hemost

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Sepsis is a systemic response to infection with a high rate of mortality and complex pathophysiology involving inflammation, infection response, hemostasis, endothelium, and platelets. The purpose of this study was to develop an equation incorporating biomarker levels at intensive care unit (ICU) admission to predict mortality in patients with sepsis, based on the hypothesis that a combination of biomarkers representative of multiple physiological systems would provide improved predictive value. Plasma samples and clinical data were collected from 103 adult patients with sepsis at the time of ICU admission. Biomarker levels were measured using commercially available methods. A 28-day mortality was used as the primary end point. Stepwise linear regression modeling was performed to generate a predictive equation for mortality. Differences in biomarker levels between survivors were quantified using the Mann-Whitney test and the area under the receiver operating curve (AUC) was used to describe predictive ability. Significant differences (P < .05) were observed between survivors and nonsurvivors for plasminogen activator inhibitor 1 (AUC ¼ 0.70), procalcitonin (AUC ¼ 0.77), high mobility group box 1 (AUC ¼ 0.67), interleukin (IL) 6 (AUC ¼ 0.70), IL-8 (AUC ¼ 0.70), protein C (AUC ¼ 0.71), angiopoietin-2 (AUC ¼ 0.76), endocan (AUC ¼ 0.58), and platelet factor 4 (AUC ¼ 0.70). A predictive equation for mortality was generated using stepwise linear regression modeling, which incorporated procalcitonin, vascular endothelial growth factor, the IL-6:IL-10 ratio, endocan, and platelet factor 4, and demonstrated a better predictive value for patient outcome than any individual biomarker (AUC ¼ 0.87). The use of mathematical modeling resulted in the development of a predictive equation for sepsis-associated mortality with performance than any individual biomarker or clinical scoring system which incorporated biomarkers representative of multiple systems.

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“…Observa-se elevada taxa de mortalidade nesse ambiente, variando de acordo com os artigos internacionais entre 5,4 e 33%. 7,8,9,10 . Porém, na realidade brasileira, encontra-se uma taxa de óbitos acima da internacional, variando de 36,9 a 50,74%, não se sabendo se isso é devido ao sistema público brasileiro ou a falhas de registro 11,12,13 .…”

Section: Introductionunclassified

Características de óbitos dos pacientes internados em uma unidade de terapia intensiva de hospital terciário

et al. 2018

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Introdução: Estudos comparam taxa de óbitos de Unidade de Terapia Intensiva (UTI) no Brasil que se encontra acima da internacional, não se sabendo se isso é devido ao sistema público brasileiro ou a falhas de registro. Objetivo: Traçar uma relação entre mortalidade prevista e características dos pacientes internados na UTI de hospital terciário de grande porte do município de Fortaleza, Ceará. Métodos: Trata-se de um estudo retrospectivo, analítico e transversal sobre pacientes internados na UTI do Hospital Geral de Fortaleza de janeiro a novembro de 2016. Resultados: No período da pesquisa, foram estudados 137 pacientes; desse total vieram a óbito 31 pacientes (24,48%). De acordo com a prioridade estabelecida pela Society Critical Care Medicine para Unidade de Terapia Intensiva, tivemos 53,3% na prioridade I, 10,0% na prioridade II, 30,0% na prioridade III, 3,3% na prioridade IVA e 3,3% na prioridade IVB, resultados estatisticamente significantes (p=0,012). Constatou-se neste trabalho que 80,6% dos óbitos haviam desenvolvido sepse durante o internamento na UTI (p<0,001). Aplicando-se os escores de mortalidade APACHE-II e SOFA, observa-se que o APACHE-II com escore médio de 22 pontos e com mortalidade prevista média de 55,7 (p<0,001), enquanto, o SOFA teve média no primeiro dia de 7 pontos (p<0,001), no quinto dia de 5 pontos (p=0,004) e no décimo dia de 5 pontos (p=0,004). Conclusão: Observou-se a importância da análise epidemiológica em relação aos óbitos ocorridos em Unidades de Terapia Intensiva, visando demonstrar a necessidade de se conhecer melhor a aplicabilidade dos escores SOFA e APACHE II e as medidas que devem ser adotadas.

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Mortality, length of stay, bloodstream and respiratory viral infections in a pediatric intensive care unit

Cited by 20 publications

References 35 publications

Brain death in children: a retrospective review of patients at a paediatric intensive care unit

Brain death in children: a retrospective review of patients at a paediatric intensive care unit

Development of an Algorithm to Predict Mortality in Patients With Sepsis and Coagulopathy

Características de óbitos dos pacientes internados em uma unidade de terapia intensiva de hospital terciário

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