具有喂养和呼吸技术依赖的儿童重症特征和结局。
Characteristics and Outcomes of Critical Illness in Children With Feeding and Respiratory Technology Dependence.
机构信息
Department of Pediatrics, Children's National Health System and the George Washington School of Medicine and Health Sciences, Washington, DC.
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
出版信息
Pediatr Crit Care Med. 2019 May;20(5):417-425. doi: 10.1097/PCC.0000000000001868.
OBJECTIVES
Children with dependence on respiratory or feeding technologies are frequently admitted to the PICU, but little is known about their characteristics or outcomes. We hypothesized that they are at increased risk of critical illness-related morbidity and mortality compared with children without technology dependence.
DESIGN
Secondary analysis of prospective, probability-sampled cohort study of children from birth to 18 years old. Demographic and clinical characteristics were assessed. Outcomes included death, survival with new morbidity, intact survival, and survival with functional status improvement.
SETTING
General and cardiovascular PICUs at seven participating children's hospitals as part of the Trichotomous Outcome Prediction in Critical Care study.
SUBJECTS
Children from birth to 18 years of age as part of the Trichotomous Outcome Prediction in Critical Care study.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Children with technology dependence composed 19.7% (1,989/10,078) of PICU admissions. Compared with those without these forms of technology dependence, these children were younger, received more ICU-specific therapeutics, and were more frequently readmitted to the ICU. Death occurred in 3.7% of technology-dependent patients (n = 74), and new morbidities developed in 4.5% (n = 89). Technology-dependent children who developed new morbidities had higher Pediatric Risk of Mortality scores and received more ICU therapies than those who did not. A total of 3.0% of technology-dependent survivors (n = 57) showed improved functional status at hospital discharge.
CONCLUSIONS
Children with feeding and respiratory technology dependence composed approximately 20% of PICU admissions. Their new morbidity rates are similar to those without technology dependence, which contradicts our hypothesis that children with technology dependence would demonstrate worse outcomes. These comparable outcomes, however, were achieved with additional resources, including the use of more ICU therapies and longer lengths of stay. Improvement in functional status was seen in some technology-dependent survivors of critical illness.
目的
依赖呼吸或喂养技术的儿童经常被收入儿科重症监护病房（PICU），但他们的特征和结局鲜为人知。我们假设与无技术依赖的儿童相比，他们患有与危重病相关的发病率和死亡率的风险增加。
设计
对儿童从出生到 18 岁的前瞻性、概率抽样队列研究进行二次分析。评估了人口统计学和临床特征。结局包括死亡、存活但出现新的发病率、完整存活和存活且功能状态改善。
地点
参与危重病三分类结局预测研究的 7 家儿童医院的普通和心血管儿科重症监护病房。
对象
危重病三分类结局预测研究中的儿童，年龄从出生到 18 岁。
干预措施
无。
测量和主要结果
依赖技术的儿童占 PICU 入院人数的 19.7%（1989/10078）。与无这些形式的技术依赖的儿童相比，这些儿童更年轻，接受更多的 ICU 特定治疗，并且更频繁地重新入住 ICU。有 3.7%（74 例）依赖技术的患者死亡，4.5%（89 例）发生新的发病率。发生新发病率的依赖技术儿童的儿科死亡率评分较高，并且接受的 ICU 治疗也多于未发生新发病率的儿童。依赖技术的幸存者中，有 3.0%（57 例）在出院时功能状态改善。
结论
依赖喂养和呼吸技术的儿童占 PICU 入院人数的 20%左右。他们的新发病率与无技术依赖的儿童相似，这与我们的假设即依赖技术的儿童的结局会更差相矛盾。然而，这些可比的结局是通过额外的资源实现的，包括使用更多的 ICU 治疗和更长的住院时间。一些依赖技术的危重病幸存者的功能状态得到了改善。
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