Jingxi X L, Tinarwo P, Masekela R, Archary M
Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Department of Paediatrics, King Edward VIII Hospital, Durban, South Africa.
Afr J Thorac Crit Care Med. 2022 Sep 16;28(3). doi: 10.7196/AJTCCM.2022.v28i3.215. eCollection 2022.
Lack of paediatric intensive care infrastructure, human resources and expertise in low- and middle-income countries (LMICs) often results in critically ill children being managed in non-intensive-care unit (ICU) settings.
To compare the mortality between critically ill patients who required ventilation for more than 24 hours in a non-paediatric ICU (PICU) setting v. those admitted directly to a PICU.
Participants were enrolled if they were between one month and 13 years of age and were ventilated in a non-PICU ward in a regional hospital and a PICU ward in a tertiary/quaternary hospital during the study period of January 2015 - December 2017 in KwaZulu-Natal, South Africa. Descriptive statistics, chi-square test, Wilcoxon test and binary logistic regression were used for data analysis. Ethics approval was obtained (approval number BE568/18 BREC) from the Biostatistics Research Council of the University of KwaZulu-Natal.
Of the 904 admissions, 25.1% (n=227) were admitted to non-PICU and 74.9% (n=677) to a PICU. A significantly higher proportion of non-PICU patients were malnourished than PICU patients (26.4% v. 13.3%, p<0.001). Patients ventilated in a PICU were 76% less likely to die (p<0.001), while patients who required inotropes were 15.08 (9.68 - 24.34) times more likely to die (p<0.001). There was a statistically significant association between admission setting and survival outcome, with higher mortality in the non-PICU setting than in the PICU setting (46.3% v. 19.5%, p<0.001).
Critically ill children ventilated in a non-PICU setting in KwaZulu-Natal are more likely to be malnourished, require inotropes and have higher mortality. Although increasing access to PICU bed availability is a long-term goal, the high mortality in the non-PICU setting highlights the need to optimise the availability of resources in these non-PICU wards, optimise and train the staff, and improve primary healthcare services.
低收入和中等收入国家（LMICs）缺乏儿科重症监护基础设施、人力资源和专业知识，这常常导致危重症儿童在非重症监护病房（ICU）环境中接受治疗。
比较在非儿科ICU（PICU）环境中需要通气超过24小时的危重症患者与直接入住PICU的患者之间的死亡率。
纳入2015年1月至2017年12月在南非夸祖鲁 - 纳塔尔省研究期间，年龄在1个月至13岁之间，在地区医院的非PICU病房和三级/四级医院的PICU病房接受通气治疗的患者。采用描述性统计、卡方检验、威尔科克森检验和二元逻辑回归进行数据分析。获得了夸祖鲁 - 纳塔尔大学生物统计学研究委员会（批准号BE568/18 BREC）的伦理批准。
在904例入院患者中，25.1%（n = 227）入住非PICU，74.9%（n = 677）入住PICU。非PICU患者中营养不良的比例显著高于PICU患者（26.4%对13.3%，p < 0.001）。在PICU接受通气治疗的患者死亡可能性降低76%（p < 0.001），而需要使用血管活性药物的患者死亡可能性高15.08（9.68至24.34）倍（p < 0.001）。入院环境与生存结局之间存在统计学显著关联，非PICU环境中的死亡率高于PICU环境（46.3%对19.5%，p < 0.001）。
在夸祖鲁 - 纳塔尔省非PICU环境中接受通气治疗的危重症儿童更有可能营养不良、需要使用血管活性药物且死亡率更高。尽管增加PICU床位的可及性是一个长期目标，但非PICU环境中的高死亡率凸显了优化这些非PICU病房资源的可及性、优化和培训工作人员以及改善初级医疗服务的必要性。
