The importance of advance care planning for children with chronic respiratory failure

Miles, Alison; Turnbull, Alison E.; Sterni, Laura M.

doi:10.1002/ppul.24979

Cited by 1 publication

(1 citation statement)

References 15 publications

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“…When long ICU stays become stressful for patients, families and clinicians, ICU teams may feel the pressure to “do something.” 11 24 25 26 27 28 29 Previous studies have shown that families of patients with PCCI felt that often not enough time was given between ICU treatment changes, 11 and the current study supports that belief. Parents and caregivers are an integral part of the treatment team and may have key insights about their child's baseline status and response to treatments.…”

Section: Discussionsupporting

confidence: 72%

Slow and Steady: Optimizing Intensive Care Unit Treatment Weans for Children with Chronic Critical Illness

Troch

Lazzara

Yazigi

et al. 2023

J Pediatr Intensive Care

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Pediatric chronic critical illness (PCCI) is characterized by prolonged and recurrent hospitalizations, multiorgan conditions, and use of medical technology. Our prior work explored the mismatch between intensive care unit (ICU) acute care models and the chronic needs of patients with PCCI. The objective of this study was to examine whether the number and frequency of treatment weans in ICU care were associated with clinical setbacks and/or length of stay for patients with PCCI. A retrospective chart review of the electronic medical record for 300 pediatric patients with PCCI was performed at the neonatal intensive care unit, pediatric intensive care unit, and cardiac intensive care unit of two urban children's hospitals. Daily patient care data related to weans and setbacks were collected for each ICU day. Data were analyzed using multilevel mixed multiple logistic regression analysis and a multilevel mixed Poisson regression. The patient-week level adjusted regression analysis revealed a strong correlation between weans and setbacks: three or more weekly weans yielded an odds ratio of 3.35 (95% confidence interval [CI] = 2.06–5.44) of having one or more weekly setback. There was also a correlation between weans and length of stay, three or more weekly weans were associated with an incidence rate ratio of 1.09 (95% CI = 1.06–1.12). Long-stay pediatric ICU patients had more clinical setbacks and longer hospitalizations if they had more than two treatment weans per week. This suggests that patients with PCCI may benefit from a slower pace of care than is traditionally used in the ICU. Future research to explore the causative nature of the correlation is needed to improve the care of such challenging patients.

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