Pediatric Critical Care Outcomes

Perry-Eaddy, Mallory A.; Dervan, Leslie A.; Manning, Joseph; Watson, R. Scott; Curley, Martha A. Q.

doi:10.1016/j.ccc.2022.09.007

Cited by 11 publications

(5 citation statements)

References 95 publications

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“…As a beneficial side effect, the fact that outcomes are measured may increase awareness for the need to follow-up PICU patients. Even though not directly recorded, this may also bring into consciousness the recently described post-PICU syndrome ( 39 , 40 ), hopefully fostering the implementation of structured PICU aftercare programs.…”

Section: Discussionmentioning

confidence: 99%

Pediatric intensive care unit admissions network—rationale, framework and method of operation of a nationwide collaborative pediatric intensive care research network in Germany

Bruns,

Dohna-Schwake,

Olivieri

et al. 2024

Front. Pediatr.

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The Pediatric Intensive Care Unit Admissions (PIA) network aims to establish a nationwide database in Germany to gather epidemiological, clinical, and outcome data on pediatric critical illness. The heterogeneity of pediatric patients in intensive care units (PICU) poses challenges in obtaining sufficient case numbers for reliable research. Multicentered approaches, such as patient registries, have proven effective in collecting large-scale data. However, Germany lacks a systematic registration system for pediatric intensive care admissions, hindering epidemiological and outcome assessments. The PIA network intends to address these gaps and provide a framework for clinical and epidemiological research in pediatric intensive care. The network will interconnect PICUs across Germany and collect structured data on diagnoses, treatment, clinical course, and short-term outcomes. It aims to identify areas for improvement in care, enable disease surveillance, and potentially serve as a quality control tool. The PIA network builds upon the existing infrastructure of the German Pediatric Surveillance Unit ESPED and utilizes digitalized data collection techniques. Participating units will complete surveys on their organizational structure and equipment. The study population includes patients aged ≥28 days admitted to participating PICUs, with a more detailed survey for cases meeting specific criteria. Data will be collected by local PIA investigators, anonymized, and entered into a central database. The data protection protocol complies with regulations and ensures patient privacy. Quarterly data checks and customized quality reports will be conducted to monitor data completeness and plausibility. The network will evaluate its performance, data collection feasibility, and data quality. Eligible investigators can submit proposals for data analyses, which will be reviewed and analyzed by trained statisticians or epidemiologists. The PIA network aims to improve pediatric intensive care medicine in Germany by providing a comprehensive understanding of critical illness, benchmarking treatment quality, and enabling disease surveillance.

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Section: Discussionmentioning

confidence: 99%

Pediatric intensive care unit admissions network—rationale, framework and method of operation of a nationwide collaborative pediatric intensive care research network in Germany

Bruns,

Dohna-Schwake,

Olivieri

et al. 2024

Front. Pediatr.

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“…Optimizing short-and long-term recovery in critically ill children is a key global priority (13). Despite international recommendations for early rehabilitation, there are a paucity of studies evaluating its efficacy on patient-centered outcomes (14,15).…”

Section: Discussionmentioning

confidence: 99%

Post-Intensive Care Sequelae in Pediatrics—Results of an Early Rehabilitation Implementation Study

Choong,

Fraser,

Cameron

et al. 2024

Pediatric Critical Care Medicine

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Objectives: To compare post-PICU discharge functioning, health-related quality of life (HRQL), and parental stress before and after the implementation of an early rehabilitation bundle. Design and Setting: Prospective cohort substudy within an early rehabilitation implementation program, conducted at the PICUs at McMaster Children’s Hospital and London Health Sciences, London, Ontario, Canada. Interventions: A bundle consisting of: 1) analgesia-first sedation; 2) delirium monitoring and prevention; and 3) early mobilization. Patients with an anticipated 48-hour PICU length of stay were approached for consent to participate. Patients: Critically ill children with an anticipated 48-hour PICU length of stay were approached for consent to participate. Measurements and Main Results: Patient-/proxy-reported outcome measures were assessed at baseline, PICU discharge, and 1 and 3 months post-PICU discharge using: 1) Pediatric Evaluation of Disability Inventory Computer Adaptive Test to assess physical, social, cognitive, and responsibility/caregiver domains of functioning; 2) KIDSCREEN to assess HRQL; and 3) the Pediatric Inventory for Parents to assess caregiver stress. A total of 117 participants were enrolled. Patient demographic characteristics were similar in the pre- and post-intervention groups. Following bundle implementation, 30 of 47 respondents (63.8%) experienced functional decline and 18 of 45 (40%) experienced low HRQL at PICU discharge. Eighteen of 36 (50%) at 1 month and 14 of 38 (36.8%) at 3 months experienced either persistent functional decline and/or low HRQL; 2.8% and 2.6% at 1- and 3-month follow-up, respectively, experienced both persistent functional decline and low HRQL. There were no significant differences in the rates of persistent functional decline, low HRQL, or caregiver stress scores post-bundle compared with pre-rehabilitation bundle implementation. Conclusions: We were unable to adequately determine the efficacy of a rehabilitation bundle on patient-centered outcomes as this substudy was not powered for these outcomes. Our results did reveal that persistent low functioning is common in PICU survivors, more common than low HRQL, while experiencing both functional decline and low HRQL was uncommon.

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“…Due to the retrospective character of this study, the functional outcome assessment was limited to the PCPC as a simple and common measure of PICU outcomes. Prospective investigations should also assess cognitive, emotional, and social health functioning, as their impairment contributes to post-PICU sequelae, such as the post-intensive care syndrome ( Manning et al, 2018 ; Perry-Eaddy et al, 2023 ; Rahmaty et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children

Paul,

Greve,

Hegemann

et al. 2024

Front. Neurosci.

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Background and objectivesAmplitude-integrated EEG (aEEG) is used to assess electrocortical activity in pediatric intensive care if (continuous) full channel EEG is unavailable but evidence regarding the meaning of suppressed aEEG amplitudes in children remains limited. This retrospective cohort study investigated the association of suppressed aEEG amplitudes in critically ill children with death or decline of neurological functioning at hospital discharge.MethodsTwo hundred and thirty-five EEGs derived from individual patients <18 years in the pediatric intensive care unit at the University Hospital Essen (Germany) between 04/2014 and 07/2021, were converted into aEEGs and amplitudes analyzed with respect to age-specific percentiles. Crude and adjusted odds ratios (OR) for death, and functional decline at hospital discharge in patients with bilateral suppression of the upper or lower amplitude below the 10th percentile were calculated. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were assessed.ResultsThe median time from neurological insult to EEG recording was 2 days. PICU admission occurred due to neurological reasons in 43% and patients had high overall disease severity. Thirty-three (14%) patients died and 68 (29%) had a functional decline. Amplitude suppression was observed in 48% (upper amplitude) and 57% (lower amplitude), with unilateral suppression less frequent than bilateral suppression. Multivariable regression analyses yielded crude ORs between 4.61 and 14.29 and adjusted ORs between 2.55 and 8.87 for death and functional decline if upper or lower amplitudes were bilaterally suppressed. NPVs for bilaterally non-suppressed amplitudes were above 95% for death and above 83% for pediatric cerebral performance category Scale (PCPC) decline, whereas PPVs ranged between 22 and 32% for death and 49–52% for PCPC decline.DiscussionThis study found a high prevalence of suppressed aEEG amplitudes in critically ill children. Bilaterally normal amplitudes predicted good outcomes, whereas bilateral suppression was associated with increased odds for death and functional decline. aEEG assessment may serve as an element for risk stratification of PICU patients if conventional EEG is unavailable with excellent negative predictive abilities but requires additional information to identify patients at risk for poor outcomes.

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Pediatric Critical Care Outcomes

Cited by 11 publications

References 95 publications

Pediatric intensive care unit admissions network—rationale, framework and method of operation of a nationwide collaborative pediatric intensive care research network in Germany

Pediatric intensive care unit admissions network—rationale, framework and method of operation of a nationwide collaborative pediatric intensive care research network in Germany

Post-Intensive Care Sequelae in Pediatrics—Results of an Early Rehabilitation Implementation Study

Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children

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