The influence of poor nutrition on the necessity of mechanical ventilation among children admitted to the Pediatric Intensive Care Unit

Abstract

ResumoObjetivo: determinar a relação entre a influência do estado nutricional de crianças no dia de sua admissão na unidade de terapia intensiva pediátrica (UTIP), com a necessidade, o tempo de ventilação mecânica durante a internação, e a mortalidade em UTIP.Métodos: estudo de coorte, entre 01/07/1995 e 30/06/1999, envolvendo todas as crianças (entre 28 dias e 48 meses de idade), admitidas na UTIP do Hospital São Lucas da PUCRS, e com um tempo de permanência superior a 8 horas. Foram excluídas as crianças com cardiopatias complexas, ou aquelas admitidas para realizar procedimentos eletivos, ou por falta de vaga em outra unidade (ausência de critérios de admissão em UTIP), ou, ainda, quando a ventilação mecânica foi considerada eletiva (pós-operatório cardíaco, torácico ou outra grande cirurgia). Os dados foram colhidos diariamente no período de estudo, por uma equipe especialmente treinada para este estudo e não envolvida com a rotina assistencial da unidade. No dia da admissão, os pacientes eram classificados quanto ao grau de nutrição através do escore Z e quanto à gravidade através do escore de PRISM (Pediatric Risk Mortality). No acompanhamento diário, eram coletados dados referentes aos aspectos demográficos, necessidade de ventilação mecânica com o respectivo tempo total, diagnóstico principal e evolução (desfecho clínico).Resultados: a desnutrição promoveu um significativo aumento no uso de ventilação mecânica, principalmente quando associado com: (i) idade inferior a um ano (RR= 2,4; 1,4-3,8), (ii) crianças admitidas na UTI pediátrica com baixos escores de gravidade -PRISM inferior a 10 -(RR=2,5; 1,3-4,7), (iii) pacientes admitidos por problemas respiratórios (RR=2,1; 1,3-4,7). O tempo de ventilação mecânica, independentemente da causa básica, foi significativamente maior no grupo de crianças definidas como desnutridas (RR=1,5; 1,1-2,3). Entretanto, a mortalidade não foi afetada significativamente pela presença de desnutrição.Conclusões: em nosso estudo, tivemos oportunidade de documentar que a presença de desnutrição em crianças menores de 4 anos admitidas em UTI pediátrica representa um fator decisivo na sua evolução, aumentando significativamente a necessidade de ventilação mecânica, o tempo de ventilação e o tempo de permanência em UTI pediátrica.J Pediatr (Rio J) 2002; 78 (2): 146-52: desnutrição, ventilação mecânica, insuficiência respiratória. AbstractObjective: to determine the relation between children's nutritional status when they are admitted to the Pediatric Intensive Care Unit, the necessity and length of mechanical ventilation and the mortality rate.Methods: a cohort study was conducted between July 1st, 1995 and June 30th, 1996. This study involved all children (28 days old to 48 months old) admitted to the pediatric intensive care unit of Hospital São Lucas, who stayed there longer than 8 hours. Exclusion criteria were complex cardiac disease, admission to the pediatric intensive care unit for elective procedure (regardless of pediatric intensive care unit admission criteria) or electiv...

Influence of nutritional status on clinical outcomes in critically ill children

“…16 In malnutrition, muscle function is affected, originating muscle fatigue and a reduction of up to 75% in work intensity and hence resulting in respiratory failure. [17][18] There was no statistically significant difference in mortality among the 3 groups similar to a single center retrospective study conducted by Goh et al on mechanically ventilated children, overweight, obese or severely obese children did not have any significant difference in mortality, length of stay or duration of mechanical ventilation, when compared to patients with normal weight. 19 Present results highlight the prevalence of malnutrition in PICUs and the importance of anthropometry to allow early interventions to be targeted in high-risk critically ill children.…”

Underweight Status Is an Independent Predictor of In‐Hospital Mortality in Pediatric Patients on Extracorporeal Membrane Oxygenation

“…As is evident from this review of the literature evaluating the impact of nutrition status on outcome, there is a great deal of heterogeneity in how malnutrition and underweight status are defined. While some studies have used weight for age or height for age, the use of weight for length and/or BMI for age, as in the current study, may be a more reliable measure of the nutrition status in children . This heterogeneity in how malnutrition has been defined may account for the differing results among studies.…”

“…While the adult literature has shown malnutrition to be associated with increased ICU length of stay and mortality, prior pediatric ICU studies have demonstrated inconsistent relationships between nutrition status and outcome in a variety of populations . In a prospective study from Brazil involving 332 PICU patients <4 years old, malnutrition (defined as height for age <2 SD below the median) was found to be associated with increased need for mechanical ventilation and ICU length of stay, but no difference in mortality was observed . De Souza Menezes et al studied a cohort of 385 PICU patients classified as malnourished if their BMI‐for‐age or weight‐for‐age was 2 z scores below the mean standard value.…”

“…Inadequate nutrition is associated with impaired immunity, resulting in a higher risk of infectious complications . It also contributes to lower muscle mass, including the respiratory muscles, which may contribute to prolonged mechanical ventilation and ICU stay . Malnutrition has also been associated with decreased cardiac output, which may lead to prolonged hemodynamic instability.…”

Enteral Nutrition in the PICU: Current Status and Ongoing Challenges

“…These and other studies corroborate the ongoing prevalence of malnutrition in the PICU population, which can substantially worsen during hospitalization and has been associated with prolonged mechanical ventilation, increased length of stay, and poor patient outcomes. [6][7][8][9] EN is preferred in those children with a functioning gastrointestinal (GI) tract. 10,11 Demonstrated to be cost-effective, EN is more physiologic and well tolerated by many critically ill children.…”