儿科重症监护结果：儿科危重症期间新发病症的发展
Pediatric intensive care outcomes: development of new morbidities during pediatric critical care.
作者信息
Pollack Murray M, Holubkov Richard, Funai Tomohiko, Clark Amy, Berger John T, Meert Kathleen, Newth Christopher J L, Shanley Thomas, Moler Frank, Carcillo Joseph, Berg Robert A, Dalton Heidi, Wessel David L, Harrison Rick E, Doctor Allan, Dean J Michael, Jenkins Tammara L
机构信息
1Department of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ. 2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Pediatrics, Children's National Medical Center, Washington, DC. 4Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 5Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 6Department of Pediatrics, University of Michigan, Ann Arbor, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 9Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 10Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 11Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, the National Institutes of Health, Bethesda, MD.
出版信息
Pediatr Crit Care Med. 2014 Nov;15(9):821-7. doi: 10.1097/PCC.0000000000000250.
OBJECTIVE
To investigate significant new morbidities associated with pediatric critical care.
DESIGN
Randomly selected, prospective cohort.
SETTING
PICU patients from eight medical and cardiac PICUs.
PATIENTS
This was a randomly selected, prospective cohort of PICU patients from eight medical and cardiac PICUs.
MEASUREMENTS AND MAIN RESULTS
The main outcomes measures were hospital discharge functional status measured by Functional Status Scale scores and new morbidity defined as an increase in the Functional Status Scale of more than or equal to 3. Of the 5,017 patients, there were 242 new morbidities (4.8%), 99 PICU deaths (2.0%), and 120 hospital deaths (2.4%). Both morbidity and mortality rates differed (p < 0.001) among the sites. The worst functional status profile was on PICU discharge and improved on hospital discharge. On hospital discharge, the good category decreased from a baseline of 72% to 63%, mild abnormality increased from 10% to 15%, moderate abnormality status increased from 13% to 14%, severe status increased from 4% to 5%, and very severe was unchanged at 1%. The highest new morbidity rates were in the neurological diagnoses (7.3%), acquired cardiovascular disease (5.9%), cancer (5.3%), and congenital cardiovascular disease (4.9%). New morbidities occurred in all ages with more in those under 12 months. New morbidities involved all Functional Status Scale domains with the highest proportions involving respiratory, motor, and feeding dysfunction.
CONCLUSIONS
The prevalence of new morbidity was 4.8%, twice the mortality rate, and occurred in essentially all types of patients, in relatively equal proportions, and involved all aspects of function. Compared with historical data, it is possible that pediatric critical care has exchanged improved mortality rates for increased morbidity rates.
目的
研究与儿科重症监护相关的重大新发疾病。
设计
随机选择的前瞻性队列研究。
地点
来自八个内科和心脏重症监护病房（PICU）的患者。
患者
这是一个从八个内科和心脏重症监护病房随机选择的PICU患者前瞻性队列。
测量指标及主要结果
主要结局指标为通过功能状态量表评分衡量的出院时功能状态，以及定义为功能状态量表增加大于或等于3的新发疾病。在5017例患者中，有242例新发疾病（4.8%），99例PICU死亡（2.0%），120例医院死亡（2.4%）。各中心的发病率和死亡率均有差异（p<0.001）。功能状态最差的情况出现在PICU出院时，出院时有所改善。出院时，良好类别从基线的72%降至63%，轻度异常从10%增至15%，中度异常状态从13%增至14%，重度状态从4%增至5%，极重度保持不变，为1%。新发疾病发生率最高的是神经科诊断（7.3%）、后天性心血管疾病（5.9%）、癌症（5.3%）和先天性心血管疾病（4.9%）。所有年龄段均有新发疾病，12个月以下的患儿更多。新发疾病涉及功能状态量表的所有领域，其中呼吸、运动和喂养功能障碍所占比例最高。
结论
新发疾病的患病率为4.8%，是死亡率的两倍，几乎发生在所有类型的患者中，比例相对均衡，且涉及功能的各个方面。与历史数据相比，儿科重症监护有可能是以提高发病率为代价换取了死亡率的降低。
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