Five-Year Survival of Children With Chronic Critical Illness in Australia and New Zealand*

Namachivayam, Siva P.; Alexander, Janet; Slater, Anthony; Millar, Johnny; Erickson, Simon; Tibballs, James; Festa, Marino S.; Ganu, Subodh; Segedin, Liz; Schlapbach, Luregn J.; Williams, Gary; Shann, Frank; Butt, Warwick

doi:10.1097/ccm.0000000000001076

Cited by 58 publications

(53 citation statements)

References 29 publications

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“…In a study that examined children with prolonged pediatric ICU stay via the Australia and New Zealand registry, children with cardiac anomalies comprised the second poorest long-term survival among the examined disease categories, with single-ventricle anomalies being an independent risk factor of death. 18 In our surgical cohort, we demonstrated that there was an increase in mortality risk beyond hospital discharge with the majority of deaths occurring within the first year after the operation. Of importance, the vast majority of deaths were cardiac and many readmissions occurred after cardiac arrest with subsequent deterioration of status and patient demise.…”

Section: Discussionmentioning

confidence: 65%

Outcomes of neonates requiring prolonged stay in the intensive care unit after surgical repair of congenital heart disease

Mori

Maher

Kogon

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 65%

Outcomes of neonates requiring prolonged stay in the intensive care unit after surgical repair of congenital heart disease

Mori

Maher

Kogon

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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“…However, as pointed out by Vincent et al, such findings may reflect the ability to support even severe organ dysfunction in the ICU as well as the limitations of organ dysfunction scores to capture the full breadth of physiological changes. Nonetheless, as in adult sepsis, our findings suggest that clinicians should not necessarily be reassured when organ dysfunction appears to have stabilized and that many pediatric patients with severe sepsis experience a state of “chronic critical illness” prior to death (27). …”

Section: Discussionmentioning

confidence: 85%

The Epidemiology of Hospital Death Following Pediatric Severe Sepsis: When, Why, and How Children With Sepsis Die*

Weiss

Balamuth

Hensley

et al. 2017

Pediatric Critical Care Medicine

142

101

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Objective The epidemiology of in-hospital death after pediatric sepsis has not been well characterized. We investigated the timing, cause, mode, and attribution of death in children with severe sepsis, hypothesizing that refractory shock leading to early death is rare in the current era. Design Retrospective observational study. Setting Emergency departments and intensive care units at two academic children’s hospitals. Patients Seventy-nine patients <18 years-old treated for severe sepsis/septic shock in 2012–2013 who died prior to hospital discharge. Measurements and Main Results Time to death from sepsis recognition, cause and mode of death, and attribution of death to sepsis were determined from medical records. Organ dysfunction was assessed via daily PELOD-2 scores for seven days preceding death with an increase ≥5 defined as worsening organ dysfunction. The median time to death was 8 (IQR 1–12) days with 25%, 35%, and 49% of cumulative deaths within 1, 3, and 7 days of sepsis recognition, respectively. The most common cause of death was refractory shock (34%), then MODS after shock recovery (27%), neurologic injury (19%), single-organ respiratory failure (9%), and non-septic comorbidity (6%). Early deaths (≤3 days) were mostly due to refractory shock in young, previously healthy patients while MODS predominated after three days. Mode of death was withdrawal in 72%, unsuccessful CPR in 22%, and irreversible loss of neurologic function in 6%. Ninety percent of deaths were attributable to acute or chronic manifestations of sepsis. Only 23% had a rise in PELOD-2 that indicated worsening organ dysfunction. Conclusions Refractory shock remains a common cause of death in pediatric sepsis, especially for early deaths. Later deaths were mostly attributable to MODS, neurologic, and respiratory failure after life-sustaining therapies were limited. A pattern of persistent, rather than worsening, organ dysfunction preceded most deaths.

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“…Anecdotally and from studies that record more admissions than patients (1–2), it is known that some children, for example those with complex chronic conditions (CCC), are repeatedly admitted to pediatric intensive care units (PICUs) for both planned and unplanned reasons. Unplanned readmissions are a focus of healthcare quality measurement, as they may be preventable (3) and are associated with worse outcomes (4–5) and higher costs (6–7).…”

Section: Introductionmentioning

confidence: 99%

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

Edwards

Lucas

Boscardin

et al. 2017

Critical Care Medicine

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Objectives To determine the incidence of unplanned readmissions to pediatric intensive care units (PICUs) within one year and examine risk factors associated with repeated readmission. Design, Settings, & Patients Retrospective cohort study of 93,379 patients discharged between 2009 and 2010 from 76 North American PICUs. Measurements Outcomes of index admissions and unplanned readmissions were compared. Timing of readmissions and variation of proportion of readmissions across sites were examined. Cumulative incidence curves for readmission were constructed. Time-to-event analyses were performed to examine factors associated with readmission within one year and to estimate their hazard ratios (HR). Main Results Eleven percent (10,233) of patients had 15,625 unplanned readmissions within one year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared to index admissions (4.0% versus 2.5%, and 2.5 versus 1.6 days, all P<0.001). Median time to readmission was 30 days for all readmissions; 3.5 days for readmissions during the same hospitalization; and 66 days for different hospitalizations. Time-to-event analyses showed that having more complex chronic conditions (CCCs) was associated with earlier readmission—adjusted HR 2.9 for one CCC; HR 4.8 for two CCC; HR 9.6 for three or more CCC, all P<0.001 compared no CCC). Most specific CCC conferred a greater risk of readmission, and some had considerably higher risk than others. Conclusions Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with CCCs and particular conditions were at much higher risk for readmission.

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Five-Year Survival of Children With Chronic Critical Illness in Australia and New Zealand*

Cited by 58 publications

References 29 publications

Outcomes of neonates requiring prolonged stay in the intensive care unit after surgical repair of congenital heart disease

Outcomes of neonates requiring prolonged stay in the intensive care unit after surgical repair of congenital heart disease

The Epidemiology of Hospital Death Following Pediatric Severe Sepsis: When, Why, and How Children With Sepsis Die*

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

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