Triage of Mechanical Ventilation for Pediatric Patients During a Pandemic

Kim, Kristin M.; Cinti, Sandro; Goold, Susan Dorr; Barnosky, Andrew R.; Lozon, Marie M.

doi:10.1001/dmp.2012.19

Cited by 12 publications

(11 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…MA was found in more than 60% of critically ill children at admission to the PICU. Commonly used human clinical scoring systems include the Acute Physiology and Chronic Health Evaluation (APACHE), Sequential Organ Failure Assessment (SOFA), Multiple Organ Dysfunction Score, and Simplified Acute Physiology Score (SAPS) in adults and the PIM, PRISM, and PELOD in children (16)(17)(18). The effect of disruption of the integrity of the endothelial barrier is manifested as altered glomerular endothelial permeability in the kidneys, allowing increased amounts of albumin to escape into the glomerular ultrafiltrate.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Microalbuminuria in Predicting Patient Outcome in a PICU

Anıl

Anıl²,

Yıldız³

et al. 2014

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

The Importance of Microalbuminuria in Predicting Patient Outcome in a PICU

Anıl

Anıl²,

Yıldız³

et al. 2014

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Prediction of overall PICU resource use could aid with triage of patients based on bed and nursing availability during a disaster, while prediction of the specific types of and duration of need for resources may optimize allocation of these resources. Ventilator triage is a particular area of interest given the likelihood for shortage with a large influx of patients at high risk for respiratory failure (10,(23)(24)(25). We found that models to predict ventilator need and duration of use performed better than for any other resource.…”

Section: Discussionmentioning

confidence: 87%

“…Although pediatric providers are divided on the use of protocols for triage decisions (7), both the PEMCC Task Force and CHEST guidelines recommend that objective protocols rather than ad hoc clinical judgment be used to determine allocation of limited resources during crises (1,8). Several pediatric illness severity scores have been evaluated for ventilator-triage protocols; however, only the Pediatric Logistic Organ Dysfunction (PELOD) score (9) fulfills all criteria deemed important for use in a triage algorithm (10).…”

mentioning

confidence: 99%

“…A major limitation to the use of PELOD (11,12) and other pediatric scoring systems (10,13) in a disaster is that they have primarily been validated to predict mortality; however, very few children would reach a mortality probability threshold that would suggest limitation of resources if a triage algorithm was based solely on mortality (4). The PEMCC Task Force proposed that a scoring system be developed that identifies patients likely to require an extended duration of critical care in order to survive (4).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Prediction of Pediatric Critical Care Resource Utilization for Disaster Triage*

Killien

Mills

Errett

et al. 2020

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Objectives: Pediatric protocols to guide allocation of limited resources during a disaster lack data to validate their use. The 2011 Pediatric Emergency Mass Critical Care Task Force recommended that expected duration of critical care be incorporated into resource allocation algorithms. We aimed to determine whether currently available pediatric illness severity scores can predict duration of critical care resource use. Design: Retrospective cohort study. Setting: Seattle Children's Hospital. Patients: PICU patients admitted 2016-2018 for greater than or equal to 12 hours (n = 3,206). Interventions: None. Measurements and Main Results: We developed logistic and linear regression models in two-thirds of the cohort to predict need for and duration of PICU resources based on Pediatric Risk of Mortality-III, Pediatric Index of Mortality-3, and serial Pediatric Logistic Organ Dysfunction-2 scores. We tested the predictive accuracy of the models with the highest area under the receiver operating characteristic curve (need for each resource) and R 2 (duration of use) in a validation cohort of the remaining one of three of the sample and among patients admitted during one-third of the sample and among patients admitted during surges of respiratory illness. Pediatric Logistic Organ Dysfunction score calculated 12 hours postadmission had higher predictive accuracy than either Pediatric Risk of Mortality or Pediatric Index of Mortality scores. Models incorporating 12-hour Pediatric Logistic Organ Dysfunction score, age, Pediatric Overall Performance Category, Pediatric Cerebral Performance Category, chronic mechanical ventilation, and postoperative status had an area under the receiver operating characteristic curve = 0.8831 for need for any PICU resource (positive predictive value 80.2%, negative predictive value 85.9%) and area under the receiver operating characteristic curve = 0.9157 for mechanical ventilation (positive predictive value 85.7%, negative predictive value 89.2%) within 7 days of admission. Models accurately predicted greater than or equal to 24 hours of any resource use for 78.9% of patients and greater than or equal to 24 hours of ventilation for 83.1%. Model fit and accuracy improved for prediction of resource use within 3 days of admission, and was lower for noninvasive positive pressure ventilation, vasoactive infusions, continuous renal replacement therapy, extracorporeal membrane oxygenation, and length of stay. Conclusions: A model incorporating 12-hour Pediatric Logistic Organ Dysfunction score performed well in estimating how long patients may require PICU resources, especially mechanical ventilation. A pediatric disaster triage algorithm that includes both likelihood for survival and for requiring critical care resources could minimize subjectivity in resource allocation decision-making.

show abstract

“…PELOD-2 was developed and validated to assess the severity of pediatric multiple organ dysfunction syndrome cases [46], based on the PELOD created in 1999 [47] and validated in pandemic settings [48]. The PELOD-2 score, different from its original version, includes mean arterial pressure and lactatemia in cardiovascular dysfunction and does not include liver dysfunction [46].…”

Section: Clinical Criteriamentioning

confidence: 99%

COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

et al. 2020

View full text Add to dashboard Cite

After the World Health Organization declared COVID-19 to be a pandemic, the elaboration of comprehensive and preventive public policies became important in order to stop the spread of the disease. However, insufficient or ineffective measures may have placed health professionals and services in the position of having to allocate mechanical ventilators. This study aimed to identify instruments, analyze their structures, and present the main criteria used in the screening protocols, in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the COVID-19 pandemic. The instruments have a low level of scientific evidence, and, in general, are structured by various clinical, non-clinical, and tiebreaker criteria that contain ethical aspects. Few instruments included public participation in their construction or validation. We believe that the elaboration of these guidelines cannot be restricted to specialists as this question involves ethical considerations which make the participation of the population necessary. Finally, we propose seventeen elements that can support the construction of screening protocols in the COVID-19 pandemic.

show abstract

Triage of Mechanical Ventilation for Pediatric Patients During a Pandemic

Cited by 12 publications

References 25 publications

The Importance of Microalbuminuria in Predicting Patient Outcome in a PICU

The Importance of Microalbuminuria in Predicting Patient Outcome in a PICU

Prediction of Pediatric Critical Care Resource Utilization for Disaster Triage*

COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

Contact Info

Product

Resources

About