Poor Functional Outcomes in Pediatric Intensive Care Survivors in Brazil: Prevalence and Associated Factors

Abstract

Survivors of pediatric critical illnesses develop temporary or permanent functional impairments. We do not have enough data on Brazilian children, however, and the available evidence mainly shows results from high-income countries. Our objective was to assess changes in children and adolescents' functional status surviving critical illnesses in Brazil, and to identify which factors contribute to these functional changes at pediatric intensive care unit (PICU) discharge. To develop this cross-sectional study, two researchers blinded to previous patient information applied the Functional Status Scale (FSS) with patients and caregivers at two different times in a tertiary PICU. The FSS examines six function domains as follows: (1) mental status, (2) sensory functioning, (3) communication, (4) motor functioning, (5) feeding, and (6) respiratory status. The functional decline/poor outcome was defined as an increase in points sufficient to alter the FSS total scores at discharge when comparing to the total baseline score. A total of 303 patients completed the study. Of these, 199 (66%) were with previous chronic conditions. The prevalence of functional decrease was 68% at PICU discharge. Young age (<12 months) and mechanical ventilation time ≥11 days increased by 1.44 (95% confidence interval [CI]: 1.20–1.74, p < 0.001) and 1.74 (95% CI: 1.49–2.03, p < 0.001), respectively, the chances of poor functional results at PICU discharge. This study is the first in Brazil to show that during the episode of critical illness, young age (≤12 months) and duration of invasive mechanical ventilation independently increased the chances of functional impairment in children.

Effects of critical illness on the functional status of children with a history of prematurity

“…Previous studies conducted in the same pediatric ICU also reported respiratory illnesses (40% and 43%) as the most frequent causes of admission. ( 5 , 7 )…”

“…However, there are only two Brazilian studies investigating the functional status of patients after discharge from the pediatric ICU and considering baseline functional status measurements. ( 5 . 7 )…”

“…All clinical and surgical patients, except those with trauma and cardiac surgery, up to 4 years of age, were selected from the original study sample. ( 5 ) Therefore, the present study had a sample of 126 patients: 75 with a history of prematurity and 51 full-term. Children with a hospitalization time < 24 hours, readmissions to the pediatric ICU for <48 hours, children in palliative care, children born at term with previous chronic conditions, patients transferred from the neonatal ICU and patients with a corrected age below 1 month of life were excluded from the study.…”

Out of the PICU and Beyond!

“…Young age (< 12 months) and MV time ≥ 11 days increased by 1.44 and 1.74, respectively, the chances of poor functional results at PICU discharge. 11 Similarly, for the oncology patients of the study of Santos et al, acute respiratory failure requiring invasive MV, plus higher PRISM IV, age < 5 years and CNS tumors were independent predictors of new morbidity. Unfortunately, the authors of the present study did not quantify ventilation days and their correlation with such findings; one assumes that the majority of intubated patients post-surgery for brain tumors got extubated within 24 hrs, and only the most severe cases required prolonged ventilation courses, hence the increased probability of respiratory dysfunction.…”