Kristensen Kim, Andersen Erik Arthur, Andersen Mads Holmen, Buchvald Frederik F, Christensen Henrik, Heslet Lars, Bunk Lauritsen Torsten L, Reveles Rosa M, Sorgenfrei Iben F, Winther-Rasmussen Stig
Paediatric Clinic 2, Juliane Marie Centre, Intensive Care Unit, National University Hospital Rigshospitalet, Paediatric Departments, East Denmark.
Dan Med Bull. 2002 Feb;49(1):67-9.
East Denmark has a population of 396,000 children 0-14 years and a yearly birth rate of 30,000, but at present no paediatric intensive care unit (PICU).
To perform a population based survey of paediatric mechanical ventilation with the purpose of providing the background for discussions for or against centralization of paediatric intensive care.
Case records of children 0-14 years treated with mechanical ventilation from January 1996 to December 1998 were retrospectively reviewed and the following data were obtained: Whether or not the child was settled in East Denmark, date of admission, gender, age, underlying chronic condition(s), acute condition(s) leading to mechanical ventilation, duration of positive pressure ventilation, duration of endotracheal intubation, length of stay in ICU, and outcome. Children undergoing mechanical ventilation because of neonatal problems, cardiac surgery or neurosurgery were excluded.
Data were obtained from 197 children of which 123 were boys (p < 0.001 for boys vs girls). Median age at admission to ICU was 30 months. Boys were younger than girls (median age 22 vs 41 months, p = 0.01), but as determined by mortality, duration of positive pressure ventilation, intubation and stay in ICU there were no differences between boys and girls with respect to disease course (p > 0.28). Totally, 86 (44%) had at least one underlying chronic condition. The incidence of disease leading to mechanical ventilation in children in East Denmark was estimated to 1.6/10,000/year. An average of 1.1 child was intubated each day. Taking into account the seasonal variation two beds would be required to give coverage for 85% of ICU days needed for paediatric mechanical ventilation while three beds would cover 98%. Children admitted to referral hospital RH more often had underlying chronic conditions and had more severe courses of disease than children admitted to other hospitals (p < 0.001). Mortality did not differ (p = 0.66).
The number of children requiring mechanical ventilation in East Denmark is too low to provide the background for establishing an independent PICU. However, since paediatric intensive care is a rare and complicated event further centralization of children undergoing mechanical ventilation in East Denmark should be considered.
丹麦东部有39.6万名0至14岁的儿童，年出生率为3万，但目前没有儿科重症监护病房（PICU）。
进行一项基于人群的儿科机械通气调查，为支持或反对儿科重症监护集中化的讨论提供背景依据。
回顾性审查1996年1月至1998年12月接受机械通气治疗的0至14岁儿童的病例记录，并获取以下数据：儿童是否定居在丹麦东部、入院日期、性别、年龄、潜在慢性病、导致机械通气 的急性病、正压通气持续时间、气管插管持续时间、ICU住院时间和结局。因新生儿问题、心脏手术或神经外科手术接受机械通气的儿童被排除。
获取了197名儿童的数据，其中123名是男孩（男孩与女孩相比，p<0.001）。入住ICU的中位年龄为30个月。男孩比女孩年轻（中位年龄22个月对41个月；p = 0.01），但就死亡率、正压通气持续时间、插管和ICU住院时间而言，男孩和女孩在病程方面没有差异（p>0.28）。总共有86名（44%）儿童至少有一种潜在慢性病。丹麦东部儿童中导致机械通气的疾病发病率估计为每年1.6/10000。平均每天有1.1名儿童接受插管。考虑到季节变化，需要两张床位才能覆盖儿科机械通气所需ICU天数中的85%，而三张床位可覆盖98%。转诊至RH医院的儿童比其他医院的儿童更常患有潜在慢性病，病程更严重（p<0.01）。死亡率无差异（p = ）。
丹麦东部需要机械通气的儿童数量太少，无法为建立独立PICU提供依据。然而鉴于儿科重症监护是罕见且复杂的事件，应考虑进一步集中丹麦东部接受机械通气的儿童。
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