Presentation and outcome of severe anticholinesterase insecticide poisoning

Aims: To document the patterns of presentation and outcome of severe anticholinesterase insecticide poisoning in children requiring intensive care. Methods: Retrospective case note review of all 5541 children admitted to the paediatric intensive care unit (PICU) of a university hospital during the 10 years from January 1990 to May 2000. Fifty four children (1%) with anticholinesterase insecticide poisoning were identified. Presenting features, route of exposure, treatment, complications, and mortality were recorded. Data were analysed by the Fisher''s exact and Mann–Whitney tests. Results: More children than expected were from a rural area (46% versus 25%). Decontamination occurred in 50% of children prior to PICU admission. Enteral exposure was most common (n = 27; 50%). Median pseudocholinesterase level was 185 IU/l (range 75–7404). Median total dose of atropine required to maintain mydriasis was 0.3 mg/kg (range 0.03–16.7) over a median of 10 hours (range 1–160). Complications included coma (31%), seizures (30%), shock (9%), arrhythmias (9%), and respiratory failure requiring ventilation (35%). No significant differences were detected in incidence of seizures, cardiac arrhythmias, respiratory failure, mortality, duration of ventilation, or PICU stay, according to route of exposure, or state of decontamination. Four children died (7%). Mortality was associated with the presence of a cardiac arrhythmia (likelihood ratio 8.3) and respiratory failure (likelihood ratio 3.3). Conclusion: The mortality and morbidity of severe anticholinesterase insecticide poisoning in childhood is not related to route of exposure, or to delay in decontamination. However, the presence of either a cardiac arrhythmia or respiratory failure is associated with a poor prognosis.     

Demographic profile and outcome analysis of a tertiary level pediatric intensive care unit

Objective : To study the profile and outcome of children admitted to a tertiary level pediatric intensive care unit (PICU) in India.Methods : Prospective study of patient demographics, PRISM III scores, diagnoses, treatment, morbidity and mortality of all PICU admissions.Results : 948 children were admitted to the PICU. Mean age was 41.48 months. Male to female ratio was 2.95:1. Mean PRISM III score on admission was 18.50. Diagnoses included respiratory (19.7%), cardiac (9.7%), neurological (17.9%), infectious (12.5%), trauma (11.7%), other surgical (8.8%).196 children (20.68%) required mechanical ventilation. Average duration of ventilation was 6.39 days. 27 children (30.7 children /1000 admissions) had acute respiratory distress syndrome. Gross mortality was 6.7% (59 patients). PRISMIII adjusted mortality was directly proportional to PRISMIII scores. 49.5% of nonsurvivors had multiorgan failure. Average length of PICU stay was 4.52 +/−2.6 days. Complications commonly encountered Were atelectasis (6.37%), accidental extubation (2%), and pneumothorax (0.9%). Incidence of nosocomial infections was 16.86%.Conclusion : Our data appears to be similar with regards to PRISMIII scores and adjusted mortality, length of the PICU stay, and duration of ventilation, to previously published western data. Multiorgan failure remains a major cause of death. As expected, Dengue and malaria were common. Incidence of nosocomial infections was somewhat high. Interestingly, more boys got admitted to the PICU as compared to girls. Clearly more studies are required to assess the overall outcomes of critically ill children in India     

Bronchiolitis treated with mechanical ventilation: prognosis factors and outcome in a series of 135 children]

Viral bronchiolitis is usually associated with favorable outcome as regard to mortality. Only few studies reported severe bronchiolitis requiring mechanical ventilation, and respiratory outcome is not well described. METHODS: Therefore, we conducted a retrospective study in a series of 135 children admitted in a single Pediatric Intensive Care Unit (PICU) over a four year period (1994-1998). All of them were admitted for viral bronchiolitis requiring mechanical ventilation. RESULTS: At admission, 83% of them were less than three months old. Prematurity at birth was present in 33,3%. Mortality was observed in four cases (2,9%), all premature babies with mechanical ventilation at birth. Univariate analysis showed as main factors associated to mortality: prematurity (P =0,056) and acute respiratory distress syndrome (P =0,017). Childhood asthma was observed in 40,4% of children without any associated factor wether at birth or in PICU related to such outcome. CONCLUSION: Bronchiolitis associated with mechanical ventilation is particularly observed in very young babies and prematurity is the main factor associated to mortality. Mechanical ventilation seems not to be associated with unfavorable respiratory outcome. Considering physiology and population, non invasive ventilation could be an effective alternative of mechanical ventilation.     

PICU儿童先天性心脏病心导管术后并发症及处理(附69例分析)

目的总结我院7年来先天性心脏病(先心病)心导管术患儿,需入重症监护病房(PICU)治疗的严重并发症的类型及处理方法。方法回顾性分析入PICU治疗的69例患儿并发症类型、发生率、死亡原因及防治等。结果需入PICU的先心病患儿心导管术并发症包括麻醉后呼吸抑制及呼吸道分泌物增加、肺瘀血、术中心率下降、严重心功能不全和/或低血压或肺水肿、严重心律失常、介入治疗后心包积液、缺氧发作、麻醉后低血压、造影剂过敏等。并发症发生率为1.5%。入住PICU时间为30.5 h,呼吸机使用时间为26.9 h。死亡4例。结论对于不同类型并发症采取不同的处理方法,减少心导管术后严重并发症的病死率。     

Factores pronósticos de evolución complicada en la bronquiolitis que requiere ingreso en cuidados intensivos pediátricos

ObjectiveTo analyse the prognostic factors for complications in children with bronchiolitis admitted to a pediatric intensive care unit (PICU).Patients and methodA retrospective study was performed on children with bronchiolitis admitted into a PICU between 2000 and 2006. Univariate and multivariate analysis were performed to study the prognostic factors of complications, mechanical ventilation requirements, mortality and PICU stays of more than 15 days.ResultsA total of 110 patients were studied, of whom 72 (65.5%) had high risk factors: prematurity (39.1%), cardiac disease (38.2%) and bronchopulmonary dysplasia (16.3%). A total of 82.7% of patients had complications; 26% need invasive mechanical ventilation and the mortality was 3.6%, and 16.4% stayed in PICU for more than 15 days. Factors associated with mechanical ventilation were the clinical Wood-Downes score and heart disease. A weight less than 5 kg was associated with complications; heart disease and invasive mechanical ventilation were associated with a longer PICU stay; prematurity and mechanical ventilation were associated with mortality.ConclusionsChildren with bronchiolitis admitted into the PICU had a high frequency of complications, often needed mechanical ventilation and had long stays in the PICU, but the mortality is low. The best prognostic factors on admission into the PICU were the acute respiratory insufficiency score, the presence of heart disease and were premature at birth.     

Glycemic level in mechanically ventilated children with bronchiolitis.

OBJECTIVE: To evaluate in children with bronchiolitis requiring mechanical ventilation the association between blood glucose level and duration of mechanical ventilation and pediatric intensive care unit (PICU) stay. DESIGN: Retrospective cohort study. SETTING: University hospital PICU. PATIENTS: Children admitted to a university hospital PICU over a period of 3 yrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic data, infection with respiratory syncytial virus, history of prematurity, mechanical ventilator settings, and use of inotrope during illness were noted. In addition, C-reactive protein, alanine transaminase, and glucose levels were recorded. Data from 50 children with median (interquartile range) age of 2.2 (1.3-4.7) months were analyzed. There were 37 boys, 21 children had been premature babies, and 30 children were positive for respiratory syncytial virus. Hyperglycemia at any time was frequent (peak glucose > or =6.1 mmol/L [110 mg/dL] in 98% and >8.3 mmol/L [150 mg/dL] in 72%). Children with sustained hyperglycemia were more likely to be boys with higher alanine transaminase and C-reactive protein, requiring inotrope (p < .05). These children are more likely to have required high-frequency oscillation ventilation, required higher airway pressures, and had longer duration of mechanical ventilation and PICU stay (p < .05). Peak glucose and sustained peak glucose were not independently associated with duration of mechanical ventilation or PICU stay. Multiple regression showed that age, C-reactive protein, the need for inotrope, and respiratory syncytial virus infection were independent factors associated with duration of PICU stay. Glucose level was not a factor. CONCLUSIONS: Our findings show that hyperglycemia is frequent in children with bronchiolitis requiring mechanical ventilation, but we failed to show that this phenomenon was independently associated with prolonged duration of mechanical ventilation or PICU stay. Our observations raise the question whether tight glycemic control should be used in children with bronchiolitis.     

Risk factors associated with pediatric intensive care unit admission and mortality after pediatric stem cell transplant: possible role of renal involvement

Background

Hematopoietic stem-cell transplant (HSCT) is associated with many risk factors for life-threatening complications. Post-transplant critical illness often requires admission to the pediatric intensive care unit (PICU).

Methods

A retrospective analysis was made on the risk factors associated with PICU admission and mortality of all HSCT patients at Helen DeVos Children’s Hospital from October 1998 to November 2008.

Results

One hundred and twenty-four patients underwent HSCT, with 19 (15.3%) requiring 29 PICU admissions. Fifty patients received autologous, 38 matched sibling, and 36 matched un-related donor HSCT, with 10%, 13% and 25% of these patients requiring PICU admission, respectively (P=0.01). Among the HSCT patients, those who were admitted to the PICU were more likely to have renal involvement by either malignancy requiring nephrectomy or a post transplant complication increasing the likelihood of decreased renal function (21.1% vs. 4.8%, P=0.03). PICU admissions were also more likely to receive pre-transplant total body irradiation (52.6% vs. 27.6%, P=0.03). Among 29 patients with PICU admission, 3 died on day 1 after admission, and 5 within 30 days (a mortality rate of 17%). Thirty days after PICU admission, non-survivors had a higher incidence of respiratory failure and septic shock on admission compared with survivors (80% vs. 16.7%, P=0.01 and 80% vs. 4.2%, respectively, P=0.001). Two survivors with chronic renal failure underwent renal transplantation successfully.

Conclusions

Total body irradiation and renal involvement are associated with higher risk for PICU admissions after HSCT in pediatric patients, while septic shock upon admission and post-admission respiratory failure are associated with mortality.     

Children with human immunodeficiency virus infection admitted to a paediatric intensive care unit in South Africa

BACKGROUND: Early data regarding the outcome of human immunodeficiency virus (HIV)-infected children in paediatric intensive care units (PICU) suggested mortality as high as 100%. Recent studies report mortality of 38%. Survival depends on the indication for admission. OBJECTIVES: To describe the prevalence, duration of stay, and outcome of HIV-infected patients in a single PICU over a 1-year period. Additional objectives included describing the indications for admission as well as the clinical and laboratory characteristics of HIV-infected infants and children requiring PICU admission. METHOD: Retrospective chart review of all children with serological proof of HIV admitted to PICU at Tygerberg Children's Hospital from 1 January to 31 December 2003. RESULTS: Of the 465 patients admitted, 47 (10%) were HIV-infected. For HIV-infected children the median age on admission was 4 months. The median duration of stay was 6 days, significantly longer than for the non-HIV group (p = 0.0001). Fifty-seven percent had advanced clinical and immunological disease. Seventeen died in PICU and four shortly afterwards, poor PICU outcome was significantly associated with HIV status (p = 0.001). Lower total lymphocyte count (p = 0.004) and higher gamma globulin level (p = 0.04) were paradoxically the only findings significantly associated with survival. Acute respiratory failure (ARF) accounted for 76% of admissions, including Pneumocystis jiroveci in 38%. Fifty-one percent had evidence of cytomegalovirus infection. CONCLUSIONS: HIV-infected children requiring PICU can survive despite the lack of availability of antiretroviral therapy.     

中国25家儿科重症监护病房主要配置及住院状况调查分析

目的 调查中国儿科重症监护病房（PICU）的基本配置及住院患儿状况。方法 应用问卷调查中国25家PICU的基本配置，应用儿童危重病例评分和美国PICU出入院指南，对2004年1月1日至2005年6月30日各PICU 29 d至14周岁住院患儿均进行为期12个月的危重病例筛选。结果 中国25家PICU平均床位数（11.4±8.0）张，呼吸机数（6.1±3.7）台，44.0%（11/25）的PICU能进行中心静脉压监测。收治病例12 018例，危重病例60.5％（7 269/12 018）。危重病例中内科疾病占769%（5 590/7 269），外科疾病占16.8%（1 233/7 269），其他科室疾病占6.3%（456/ 7 269）；平均住院日6.3 d；肺炎41.4%（3 013/7 269），脓毒症95%（688/7 269），外伤5.5%（397/7 269），呼吸衰竭27.6%（2 009/7 269）； 行机械通气26.9 %（1 957/7 269），行机械通气>24 h 17.9%（1 300/7 269），ARDS 1.44%（105/7 269）。研究期间，危重病例中病死率为6.7%（485/7 269，95% CI:6.1%～7.3%），PICU中病死率为40%（485/12 018，95% CI:3.7%～4.4%）。主要疾病病死率为1.3%～61.0%，不同PICU间收治患儿及病死率均存在差异。结论 中国PICU配置仍处于初级水平，收治患儿标准及危重患儿病死率可能存在差异。     

Mechanical ventilation in children

Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between January 2002-May 2005. Medical records of 407 patients were reviewed. Ninety-one patients (22.3%) were treated with mechanical ventilation. Ages of all patients were between 1-180 (median: 8) months. The mechanical ventilation time was 18.8 +/- 14.1 days. Indication of mechanical ventilation could be divided into four groups as respiratory failure (64.8%), cardiovascular failure (19.7%), central nervous system disease (9.8%) and safety airway (5.4%). Tracheostomy was performed in four patients. The complication ratio of mechanically ventilated children was 42.8%, and diversity of complications was as follows: 26.3% atelectasia, 17.5% ventilator-associated pneumonia, 13.1% pneumothorax, 5.4% bleeding, 4.3% tracheal edema, and 2.1% chronic lung disease. The mortality rate of mechanically ventilated patients was 58.3%, but the overall mortality rate in the PICU was 12.2%. In conclusion, there are few published epidemiological data on the follow-up results and mortality in infants and children who are mechanically ventilated.     

2005~2012年中国医科大学附属盛京医院PICU疾病谱分析

目的：总结中国医科大学附属盛京医院PICU 2005~2012年间收治患儿的疾病谱及导致死亡的常见疾病种类,以指导PICU的临床治疗工作。方法：回顾性分析2005~2012年间该院PICU收治的4484例患儿的临床资料。结果：2005~2012年间4484例患儿中,急性支气管肺炎居疾病谱中第1位,占24.51%(1099/4484);颅内感染、脓毒症、手足口病、外伤等疾病有逐年上升趋势,而非创伤性颅内出血、癫癎、先天性心脏病等疾病呈下降趋势。2005~2012年间病死率呈逐年下降趋势,由2005年的11.5%下降到2012年的3.1%,其中2005~2008年与2009~2012年前后4年病死率比较差异有统计学意义（11.98% vs 4.41%;P<0.01）。急性重症支气管肺炎、重度脓毒症、复杂性先天性心脏病、重度颅脑外伤、呼吸衰竭、重症手足口病、急性中毒、循环衰竭等为患儿主要死因。结论：急性支气管肺炎等感染性疾病是2005~2012年间该院PICU的主要病种,但疾病谱随着时间的变化发生了一些改变。2005~2012年间患儿病死率呈逐年下降趋势,急性重症支气管肺炎、重度脓毒症等为患儿主要死因。     

Cardiac arrhythmias in infants and children

This study presents an analysis of ninety children with cardiac arrhythmias among 1700 children attending the cardiac clinic. Arrhythmias with rapid heart rate formed the predominant group (40%), arrhythmias with slow heart rate was next (28·8%) followed by arrhythmias with normal heart rate (27·7%). A very small group had mixed arrhythmia (3·3%). Paroxysmal supraventricular tachycardia was the commonest form of tachycardia (83%) while complete heart block was predominant among bradycardias (69%). In 24 per cent of children there was associated underlying heart disease. Clinical features varied from asymptomatic to symptoms resulting from severe hemodynamic effects secondary to arrhythmia. Overall mortality was more in the neonatal period due to lack of adaptation. Drugs used in the treatment should be selected with an understanding of the underlying mechanism and site of origin of the arrhythmia.     

Cardiac arrhythmias in infants and children

This study presents an analysis of ninety children with cardiac arrhythmias among 1700 children attending the cardiac clinic. Arrhythmias with rapid heart rate formed the predominant group (40%), arrhythmias with slow heart rate was next (28·8%) followed by arrhythmias with normal heart rate (27·7%). A very small group had mixed arrhythmia (3·3%). Paroxysmal supraventricular tachycardia was the commonest form of tachycardia (83%) while complete heart block was predominant among bradycardias (69%). In 24 per cent of children there was associated underlying heart disease. Clinical features varied from asymptomatic to symptoms resulting from severe hemodynamic effects secondary to arrhythmia. Overall mortality was more in the neonatal period due to lack of adaptation. Drugs used in the treatment should be selected with an understanding of the underlying mechanism and site of origin of the arrhythmia.     

Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children.

OBJECTIVE: To study the association of timing, duration, and intensity of hyperglycemia with pediatric intensive care unit (PICU) mortality in critically ill children. DESIGN: Retrospective cohort study. SETTING: PICU of a university-affiliated, tertiary care, children's hospital. PATIENTS: A total of 152 critically ill children receiving vasoactive infusions or mechanical ventilation. INTERVENTIONS: None. METHODS: With institutional review board approval, we reviewed a cohort of 179 consecutive children, 1 mo to 21 yrs of age, treated with mechanical ventilation or vasoactive infusions. We excluded 18 with <3 microg.kg(-1).min(-1) dopamine only, diabetes, or solid organ transplant and nine who died within 24 hrs of PICU admission. Peak blood glucose (BG) and time to peak BG during PICU admission, duration of hyperglycemia (percentage of PICU days with any BG of >126 mg/dL), and intensity of hyperglycemia (median BG during first 48 PICU hours) were analyzed for association with PICU mortality using chi-square, Student's t-test, and logistic regression. MEASUREMENTS AND MAIN RESULTS: Peak BG of >126 mg/dL occurred in 86% of patients. Compared with survivors, nonsurvivors had higher peak BG (311 +/- 115 vs. 205 +/- 80 mg/dL, p <.001). Median time to peak BG was similar in nonsurvivors (23.5 hrs; interquartile ratio, 5-236 hrs) and survivors (19 hrs; interquartile ratio, 6-113 hrs). Duration of hyperglycemia was longer in nonsurvivors (71% +/- 14% of PICU days) vs. survivors (37% +/- 5% of PICU days, p <.001). Nonsurvivors had more intense hyperglycemia during the first 48 hrs in the PICU (126 +/- 38 mg/dL) vs. survivors (116 +/- 34 mg/dL, p <.05). Univariate logistic regression analysis showed that peak BG and the duration and intensity of hyperglycemia were each associated with PICU mortality (p <.05). Multivariate modeling controlling for age and Pediatric Risk of Mortality scores showed independent association of peak BG and duration of hyperglycemia with PICU mortality (p <.05). CONCLUSIONS: Hyperglycemia is common in critically ill children. Peak BG and duration of hyperglycemia are independently associated with mortality in our PICU. A prospective, randomized trial of strict glycemic control in this subset of critically ill children who are at high risk of mortality is both warranted and feasible.     

儿科重症监护病房脓毒性休克患儿临床特点与预后影响因素分析

目的　探讨儿科重症监护病房（PICU）脓毒性休克患儿的临床特点与预后影响因素。方法　按照我国2015版《儿童脓毒性休克（感染性休克）诊治专家共识》筛选出2015年1月至2019年12月中国医科大学附属盛京医院PICU病房的脓毒症休克患儿104例。研究其发病现状、临床特点，同时通过单因素分析和Logistic回归分析，了解与脓毒性休克预后转归相关的独立危险因素。结果　5年间共有104 例患儿诊断脓毒性休克，占PICU同期住院患儿的2%（104/5201）。其中男60例，女44例，中位年龄为8月龄，婴幼儿占77.9% （ 81/104）。总病死率55.8% （ 58 /104）；消化道是最常见原发感染部位（ 48.1% ），其次是呼吸系统（ 23.1% ）。明确病原菌感染者47例（45.2%， 47/104）；细菌感染患儿中以革兰阴性杆菌和革兰阳性球菌为主，排名前三的细菌为大肠埃希菌、铜绿假单胞菌及肺炎链球菌。47例明确病原菌感染的标本中有42例进行药敏试验，耐药率为92.9% （39/42）。单因素分析提示机械通气、血管活性药使用、呼吸心跳骤停、凝血功能、血糖、乳酸、白蛋白、血管活性药物评分（VIS）、儿童死亡风险评分（PRISM评分）、儿童危重病例评分（PCIS评分）及氧合指数（P/F）≤300与脓毒症休克患儿死亡相关；多因素逐步 Logistic 回归显示：机械通气、呼吸心跳骤停和氧合指数≤300是脓毒性休克的死亡独立危险因素，白蛋白>30 g/L是保护因素。结论　PICU脓毒性休克患儿病死率极高，应积极治疗原发病，合理使用机械通气及血管活性药改善肺功能并维持血流动力学稳定。加强机械通气管理及纠正低白蛋白血症，处理好这些预后影响因素可能是减低病死率的有效方式。     

Deprivation,ethnicity and prematurity in infant respiratory failure in PICU in the UK

Aim: To describe the epidemiology of infants admitted to Paediatric Intensive Care (PIC) with acute respiratory failure including bronchiolitis. Methods: Data from all consecutive admissions from 2004 to 2007 in all 29 designated Paediatric Intensive Care Units (PICUs) in England and Wales were collected. Admission rates, risk‐adjusted mortality, length of stay, ventilation status, preterm birth, deprivation and ethnicity were studied. Results: A total of 4641 infants under 1 year of age had an unplanned admission to PIC with acute respiratory failure (ARF), an admission rate of 1.80 per 1000 infants per year. There was a reduced rate of admission with bronchiolitis in South Asian children admitted to PICU, which is not explained by case‐mix. Children born preterm had a higher rate of admission and longer stay, but a similar low mortality. Risk‐adjusted mortality was higher in South Asian infants and the highest in those with ARF (OR 1.76, 95% CI 1.20–2.57) compared with the rest of the PICU population. Conclusion: Acute respiratory failure in infants causes most of the seasonal variation in unplanned admission to intensive care. Socioeconomic deprivation and prematurity are additional risk factors for admission. Fewer South Asian infants are admitted to PICU with a diagnosis of bronchiolitis, but risk‐adjusted mortality is higher in South Asian infants overall.     

重症监护病房中意外伤害患儿病因及影响因素的分析

目的 分析儿童重症监护病房（PICU）收治的意外伤害患儿的病因及影响因素,为预防儿童意外伤害和降低儿童意外伤害的病死率提供指导依据。方法 回顾性分析2012年12月至2017年12月PICU收治的意外伤害患儿的临床资料。结果 该阶段共收治意外伤害患儿102例,占PICU收治患儿总数的3.30%（102/3087）。儿童意外伤害的类型居前三位分别为食物/药物中毒、溺水、气道/食道异物。儿童意外伤害发生情况与性别和年龄密切相关,男孩意外伤害发生比例明显高于女孩,年龄越小意外伤害发生占比越高（P < 0.05）。儿童意外伤害类型与年龄也有明显的相关性,不同年龄组常见的意外伤害类型有差异。不同类型意外伤害的发生比例在城乡间差异无统计学意义（P > 0.05）。意外伤害后发生器官功能障碍的数量,以及呼吸、心血管、神经、肾脏、血液五大器官功能障碍与患儿死亡的发生密切相关（P < 0.05）,但不是导致患儿死亡的独立危险因素（P > 0.05）。结论 预防是降低儿童意外伤害发生的关键,应根据性别、年龄特点和不同意外伤害类型,采取有针对性的预防措施。同时应该普及急救知识,完善急救转运系统,PICU医生应该重视意外伤害患儿器官功能的保护,以降低意外伤害患儿的病死率。     

Complications and survival rate in preterm infants and neonates treated with mechanical ventilation (author's transl)]

Between January 1972 and December 1976 201 preterm infants and neonates were treated with mechanical ventilation. These children were classified into 6 groups according to the indications for mechanical ventilation: P = respiratory failure caused by pulmonary disease; Z-P = respiratory failure caused by cerebral disturbance with simultaneous respiratory disease; Z = respiratory failure caused by cerebral disturbance; C = respiratory failure caused by cardiac disease; SCH = respiratory failure through shock; M = respiratory failure caused by mechanical disturbance; Bronchopulmonary complications developed in 70% of the survivors and in 60% of the fatalities. The most serious bronchopulmonary complications were infections which occured with similar frequency in all indication groups as late-onset complications, and air-leaks which occured as early complications. The latter complication was significantly higher (38%) in the first than in the other groups. The most serious extrapulmonary complications were seizures, intracerebral hemorrhages and septicemia. 71 of the 201 patients survived. There was a significant increase in the survival rate from 21.2% in 1972-1973 to 43% in 1974-1976. The survival rates differed significantly within the indication groups. The best result was found in the p-group followed by the Z-group. The highest mortality rate was found in the SCH and C-group.     

Outcome of children with neuromuscular disease admitted to paediatric intensive care

Aims: To determine the outcome of children with neuromuscular disease (NMD) following admission to a tertiary referral paediatric intensive care (PICU). Methods: All children with chronic NMD whose first PICU admission was between July 1986 and June 2001 were followed up from their first PICU admission to time of study. The outcomes recorded were death in or outside of PICU, duration of PICU admission, artificial ventilation during admission and following discharge from PICU, and readmission to PICU. Results: Over 15 years, 28 children were admitted on 69 occasions. Sixteen (57%) children had more than one admission. The median duration of PICU admission was 4 days (range 0.5–42). Twenty three per cent of unplanned admissions resulted in the commencement of respiratory support that was continued after discharge from the PICU. Severity of functional impairment was not associated with longer duration of stay or higher PRISM scores. Ten children (36%) died, with four (14%) deaths in the PICU. A higher proportion of children with severe limitation of function were among children that died compared to survivors. Conclusion: Most children with NMD admitted to the PICU recover and are discharged without the need for prolonged invasive ventilation. However, in this group of children, the use of non-invasive home based ventilation is common and they are likely to require further PICU admission.     

Outcome of children with neuromuscular disease admitted to paediatric intensive care.

AIMS: To determine the outcome of children with neuromuscular disease (NMD) following admission to a tertiary referral paediatric intensive care (PICU). METHODS: All children with chronic NMD whose first PICU admission was between July 1986 and June 2001 were followed up from their first PICU admission to time of study. The outcomes recorded were death in or outside of PICU, duration of PICU admission, artificial ventilation during admission and following discharge from PICU, and readmission to PICU. RESULTS: Over 15 years, 28 children were admitted on 69 occasions. Sixteen (57%) children had more than one admission. The median duration of PICU admission was 4 days (range 0.5-42). Twenty three per cent of unplanned admissions resulted in the commencement of respiratory support that was continued after discharge from the PICU. Severity of functional impairment was not associated with longer duration of stay or higher PRISM scores. Ten children (36%) died, with four (14%) deaths in the PICU. A higher proportion of children with severe limitation of function were among children that died compared to survivors. CONCLUSION: Most children with NMD admitted to the PICU recover and are discharged without the need for prolonged invasive ventilation. However, in this group of children, the use of non-invasive home based ventilation is common and they are likely to require further PICU admission.