Prevalência das síndromes inflamatórias sistêmicas em uma unidade de tratamento intensivo pediátrica terciária

Abstract

Objective: To assess the prevalence of systemic inflammatory syndromes on admission to a tertiary-care university pediatric intensive care unit (ICU), and relate this to length of hospital stay, risk of death and mortality rate.Methods: Cross-sectional, prospective, observational study, including all patients admitted to the Hospital de Clínicas de Porto Alegre (HCPA) ICU between August 1 st 1999 and July 31 st 2000. Patient demographic variables were considered together with the risk of mortality on admission, co-morbidities, length of hospital stay and ICU outcome, in addition to variables that characterize the systemic inflammatory syndromes (systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock).Results: We studied 447 admissions of 388 patients; 54% were male, with a median age of 20 months. The prevalence of systemic inflammatory response syndrome (SIRS) was 68%: 2/3 infectious (sepsis, severe sepsis or septic shock) and 1/3 non-infectious. Risk of mortality scores for patients with infectious SIRS were higher than for those with non-infectious SIRS (6.75% [P25=2.25 -P75=21.3] vs. 2.35% [P25=1.1 -P75=6.7]; p=0) and increased according to SIRS severity (2.9; 10.85, 43.9%; p<0.05). The observed mortality was 12% for patients with SIRS and 5.8% for those without SIRS (p=0.057); the observed mortality for infectious SIRS was 14.9% and for non-infectious 6.3% (p=0.041). The period spent in ICU for infectious SIRS was longer than for non-infectious cases: 3 days (P25=2 -P75=7) vs. 2 days (P25=1.5 -P75=4); p=0.006. Conclusions:The prevalence rate of patients with systemic inflammatory response syndrome upon admission to HCPA pediatric intensive care unit was elevated, with a predominance of infectious syndromes, responsible for longer stays, increased risk of mortality and increased mortality of patients during the period evaluated.J Pediatr (Rio J). 2005;81(2):143-8: Systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, prevalence, mortality, intensive care, children.

Epidemiology of sepsis in pediatric intensive care units

“…Other studies coincide with our findings with a frequency of identifications ranging between 26% and 50% (24,25,33,40,41). Only one study reported identifying a causative pathogen in 84% of cases (21).…”

“…The average PICU length of stay was close to 10 days with very wide ranges, which is consistent with findings from previous studies (25,(40)(41)(42).…”

Stress ulcer prophylaxis in pediatric intensive care units

“…No presente estudo, foi verificado, em relação às características gerais da amostra, um perfil de pacientes semelhante ao de outros estudos realizados em UTIP [11][12][13][14][15] . Para o uso de profilaxia de UE, foi demonstrada uma alta prevalência em todas as UTIP avaliadas, com 77,5% dos pacientes utilizando profilaxia em algum momento da internação.…”

Aspectos epidemiológicos da sepse em unidades de terapia intensiva

“…Estas, portanto, são as maiores responsáveis pelo aumento do tempo de permanência nessas unidades, pelo maior DISCUSSÃO DOI: 10.5205/reuol.581-3802-1-RV.0304200951 ISSN 1981-8963 risco de morte e maior mortalidade dos pacientes de UTI. 18 Quanto aos patógenos mais comumente encontrados em pacientes sépticos, alguns autores 25 ressaltam que para detectar e diagnosticar a sepse deve ser realizada uma avaliação microbiológica incluindo culturas e exames diretos de sangue, urina, liquor, fezes e secreções. No caso de pacientes hospitalizados, a coleta de material para cultura deve incluir todas as "quebras de barreira" do hospedeiro, ou seja, cateteres venosos ou arteriais, sonda vesical, tubo traqueal, e suturas ou cicatrizes de procedimento cirúrgico recente.…”