Adhikari Debasis Das, Mahathi Krishna, Ghosh Urmi, Agarwal Indira, Chacko Anila, Jacob Ebor, Ebenezer Kala
Pediatric Emergency Services, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
J Family Med Prim Care. 2016 Jul-Sep;5(3):625-630. doi: 10.4103/2249-4863.197321.
Data on the prehospital interventions received by critically ill children at arrival to Paediatric Emergency Services (PES) is limited in developing countries. This study aims to describe the pre-hospital care scenario, transport and their impact on outcome in non-traumatic, acutely ill children presenting in PES with agonal breathing.
Prospective observational study done on children aged below 15 years arriving in PES with agonal breathing due to non-trauma related causes.
Out of 75 children studied, 69% were infants. The duration of illness among 65% of them (75) was less than 3 days. Majority of them (81%) had received treatment prior to arrival. Government sector physicians (72%), half of them (51%) being pediatricians were the major treating doctors. 37% of the children had arrived to the Emergency in an ambulance. Cardiopulmonary Resuscitation (CPR) was given to 27% on arrival in PES. Other interventions included fluid boluses to correct shock (92%) and inotrope infusion (56%). Sepsis (24%) and pneumonia (24%) were the most common diagnoses. Out of 75, 57 (76%) children who were stabilized and shifted to PICU and among them 27 (47%) survived to discharge. Normal blood pressure (=0.0410) and non-requirement of CPR (0.0047) and inotropic infusion (0.0459) in PES were associated with a higher chance of survival.
36% (27/75) of children who arrived to our PES with agonal breathing survived to hospital discharge. Survival was significantly better among those who did not need CPR.
在发展中国家，关于危重症儿童抵达儿科急诊服务（PES）时所接受的院前干预措施的数据有限。本研究旨在描述非创伤性急性病且呈濒死呼吸的儿童在PES就诊时的院前护理情况、转运情况及其对预后的影响。
对因非创伤相关原因出现濒死呼吸而抵达PES的15岁以下儿童进行前瞻性观察研究。
在研究的75名儿童中，69%为婴儿。其中65%（75名）的患病时长少于3天。大多数（81%）在抵达之前已接受治疗。政府部门的医生（72%）是主要治疗医生，其中一半（51%）为儿科医生。37%的儿童乘坐救护车抵达急诊。27%的儿童在抵达PES时接受了心肺复苏（CPR）。其他干预措施包括给予液体冲击以纠正休克（92%）和使用血管活性药物输注（56%）。脓毒症（24%）和肺炎（24%）是最常见的诊断。75名儿童中，57名（76%）病情稳定并转入儿科重症监护病房（PICU），其中27名（47%）存活至出院。在PES时血压正常（=0.0410）、无需CPR（0.0047）和血管活性药物输注（0.0459）的儿童存活几率更高。
以濒死呼吸抵达我们PES的儿童中，36%（27/75）存活至出院。无需CPR的儿童存活率明显更高。
