Long-stay patients in pediatric intensive care unit: Diagnostic-specific definition and predictors


Autoři: Angelo Polito aff001;  Christophe Combescure aff002;  Yann Levy-Jamet aff001;  Peter Rimensberger aff0010
Působiště autorů: Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland aff001;  Division of Clinical Epidemiology, Faculty of Medicine, University of Geneva, and Geneva University Hospitals, Geneva, Switzerland aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223369

Souhrn

Aims

To stipulate a new definition for long-stay patients (LSPs) in pediatric intensive care unit (PICU). We defined LSPs as the 10% of patients with the longest PICU length-of-stay (LOS) for each age and diagnostic group. To assess whether the thresholds (days of PICU stay) for the definition of LSPs in PICU significantly differ among diagnostic and age categories. To determine whether independent associations exist between patients’ characteristics at admission and LSPs diagnosis in pre-specified diagnostic and age groups.

Methods

This was a multicenter retrospective cohort study including all PICUs in Switzerland. Multivariable regression analysis was used to seek for association between patients’ variables at admission and LSPs

Results

We included 22,284 patients with a median (IQR) age of 12 (1–84) months. Significantly different thresholds across diagnostic and age subgroups are identified. Readmission to PICU, higher PIM2 and NEMS (a score used to quantify nursing workload at intensive care unit level) at admission were associated with higher likelihood of becoming LSPs.

Conclusions

Our results showed a significantly different definitions of LSPs for specific diagnoses and age categories. Readmission to PICU and higher acuity at admission are associated with longer PICU length-of-stay in the majority of diagnostic groups. A more personalized definition of LSPs in children based on actual patients’ characteristics should probably be used in an effort to optimize care and reduce costs.

Klíčová slova:

Death rates – Diagnostic medicine – Intensive care units – Oncology – Pediatrics – Respiratory physiology – Surgical and invasive medical procedures – Cardiac surgery


Zdroje

1. Kahn JM. Improving outcomes in prolonged mechanical ventilation: a road map. Lancet Respir Med 2015;3:501–2. doi: 10.1016/S2213-2600(15)00205-2 26003387

2. Nelson JE, Cox CE, Hope AA, et al. Chronic critical illness. Am J Respir Crit Care Med 2010;182:446–54. doi: 10.1164/rccm.201002-0210CI 20448093

3. Iwashyna TJ, Hodgson CL, Pilcher D, et al. Timing of onset and burden of persistent critical illness in Australia and New Zealand: a retrospective, population-based, observational study. Lancet Respir Med 2016;4:566–73. doi: 10.1016/S2213-2600(16)30098-4 27155770

4. Marcin JP, Slonim AD, Pollack MM, et al. Long-stay patients in the pediatric intensive care unit. Crit Care Med 2001;29:652–7. doi: 10.1097/00003246-200103000-00035 11373438

5. Weissman C. Analyzing the impact of long-term patients on ICU bed utilization. Intensive Care Med 2000;26:1319–25. doi: 10.1007/s001340000612 11089759

6. Shapiro MC, Henderson CM, Hutton N, et al. Defining Pediatric Chronic Critical Illness for Clinical Care, Research, and Policy. Hosp Pediatr 2017;7:236–44. doi: 10.1542/hpeds.2016-0107 28351944

7. Chen F, Bajwa NM, Rimensberger PC, et al. Thirteen-year mortality and morbidity in preterm infants in Switzerland. Arch Dis Child Fetal Neonatal Ed 2016;101:F377–383. doi: 10.1136/archdischild-2015-308579 27059074

8. Slater A, Shann F, McEniery J; ANICS Study Group. The ANZPIC registry diagnostic codes: a system for coding reasons for admitting children to intensive care. Intensive Care Med 2003; 29 (2): 271–7 doi: 10.1007/s00134-002-1600-3 12541153

9. Slater A, Shann F, Pearson G, Paediatric Index of Mortality (PIM) Study Group. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003; 29: 278–285 doi: 10.1007/s00134-002-1601-2 12541154

10. Iapichino G, Radrizzani D, Bertolini G, et al. Daily classification of the level of care. A method to describe clinical course of illness, use of resources and quality of intensive care assistance. Intensive Care Med 2001;27:131–6. doi: 10.1007/s001340000776 11280624

11. Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, et al. Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg 2011;40:179–84. doi: 10.1016/j.ejcts.2010.11.038 21227714

12. Bagshaw SM, Stelfox HT, Iwashyna TJ, et al. Timing of onset of persistent critical illness: a multi-centre retrospective cohort study. Intensive Care Med Published Online First: 12 November 2018. doi: 10.1007/s00134-018-5440-1 30421256

13. Nelson JE, Mercado AF, Camhi SL, et al. Communication about chronic critical illness. Arch Intern Med 2007;167:2509–15. doi: 10.1001/archinte.167.22.2509 18071175

14. Nelson JE, Hope AA. Integration of palliative care in chronic critical illness management. Respir Care 2012;57:1004–12; discussion 1012–1013. doi: 10.4187/respcare.01624 22663973

15. Nelson JE, Kinjo K, Meier DE, et al. When critical illness becomes chronic: informational needs of patients and families. J Crit Care 2005;20:79–89. 16015521

16. Boss R, Nelson J, Weissman D, et al. Integrating palliative care into the PICU: a report from the Improving Palliative Care in the ICU Advisory Board. Pediatr Crit Care Med 2014;15:762–7. doi: 10.1097/PCC.0000000000000209 25080152

17. Namachivayam P, Taylor A, Montague T, et al. Long-stay children in intensive care: long-term functional outcome and quality of life from a 20-yr institutional study. Pediatr Crit Care Med 2012;13:520–8. doi: 10.1097/PCC.0b013e31824fb989 22805156

18. Pon S, Notterman DA, Martin K. Pediatric critical care and hospital costs under reimbursement by diagnosis-related group: effect of clinical and demographic characteristics. J Pediatr 1993;123:355–64. doi: 10.1016/s0022-3476(05)81732-9 8355110

19. Simon TD, Cawthon ML, Stanford S, et al. Pediatric medical complexity algorithm: a new method to stratify children by medical complexity. Pediatrics 2014;133:e1647–1654. doi: 10.1542/peds.2013-3875 24819580

20. Briassoulis G, Filippou O, Mavrikiou M, et al. Current trends of clinical and genetic characteristics influencing the resource use and the nurse-patient balance in an intensive care setting. J Crit Care 2005;20:139–46. doi: 10.1016/j.jcrc.2005.04.003 16139154

21. Fraser LK Parslow R. Children with life-limiting conditions in paediatric intensive care units: a national cohort, data linkage study. Arch Dis Child 2018 103: 540–547 doi: 10.1136/archdischild-2017-312638 28705790


Článek vyšel v časopise

PLOS One


2019 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Léčba bolesti v ordinaci praktického lékaře
nový kurz
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se