Journal of Pediatric Intensive Care最新文献

{"title":"Analyzing Mortality Trends in the UK Pediatric Critical Care Long-Stay Patient Cohort","authors":"T. Kothari, N. Kelly, H. Kanthimathinathan","doi":"10.1055/s-0043-1770990","DOIUrl":"https://doi.org/10.1055/s-0043-1770990","url":null,"abstract":"Abstract Long-stay patients in pediatric intensive care unit (PICU) are at risk of higher mortality. The long-stay PICU population is growing larger. Identification of indicators of adverse outcomes in this cohort may provide opportunities for timely counseling and support. We aim to analyze the factors associated with higher mortality in the long-stay PICU patient cohort. Retrospective single-center study of long-stay PICU admissions defined as a PICU length of stay of at least 28 days during a 3-year study period (April 1, 2017–March 31, 2020). Outcomes analyzed included in-PICU mortality and mortality within 12 months of PICU discharge. Variables analyzed for association with outcomes included primary diagnostic category, number and nature of additional comorbidities, long-term ventilation (LTV) pathway, etc. During a 3-year period, there were 2,848 unique individual patient admissions to the PICU; 165 children had 172 long-stay admissions. The overall in-PICU mortality of long-stay patient was 30.2% compared with 6.4% ( p  < 0.0001) for whole PICU population; 42% of the long-stay patients had died by 12 months postdischarge. Certain primary diagnostic groups, for example, hematology/oncology, had a statistically significant increased likelihood of death (odds ratio [OR] 8.6 [ p  = 0.004, confidence interval, CI, 2.0–39.5]). Children on an LTV pathway had relatively lower odds of death (OR 0.1 [ p  = 0.003, CI 0.01–0.34]). We described factors associated with higher and lower mortality rates in a group of long-stay PICU patients. Understanding the impact of specific combinations of factors as shown in this analysis on outcomes may be important for clinicians to help counsel families.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"55 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75778720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription Practices and Outcome Analysis of PICU Patients at a Newly Established Tertiary Care Hospital—A Retrospective Study","authors":"Leo Francis Chalissery, Madhavi Eerike, Madhusudan Samprati, M. Reddy, Chandru Elango, Kalpana Mali Ramanna, Jhilmil Gupta","doi":"10.1055/s-0043-1770991","DOIUrl":"https://doi.org/10.1055/s-0043-1770991","url":null,"abstract":"Abstract Prescription analysis studies play a crucial role in monitoring prescription patterns and establishing guidelines for effective drug delivery and health care management. Given the physiological differences between the pediatric and adult populations, it is essential to analyze the prescription records specifically for pediatric patients, considering their unique diseases, drugs, and dosages. The objectives of this study were to analyze the prescribing patterns of drugs, rationality, outcomes, and antimicrobial use and drugs from National List of Essential Medicines (NLEM) in pediatric intensive care unit (PICU) patients. A retrospective study design was employed, and data were collected from medical records, including demographic information, diagnoses, drug details, and treatment outcomes of PICU patients. The collected data were then analyzed according to the World Health Organization (WHO) indicators for rational drug use, WHO Access, Watch, and Reserve (AWaRe) guidelines for antimicrobial use, and the proportion of essential drugs prescribed. Descriptive statistics was used to express the data in this study. A total of 184 patient records were analyzed, with 57.6% were males. On average, 4.5 drugs were prescribed per prescription, with injections and syrups comprising nearly 28% each. Approximately 71.5% of prescriptions contained generic drug names. Furthermore, 49% of the prescribed drugs were listed in the NLEM. Antibiotics were present in 50% of the prescriptions, with 50% of them falling under the WHO AWaRe Watch category and 31% in Access category. Majority of the drugs being prescribed in the PICU were with generic names, and less than half the prescriptions contained antibiotics. Watch class of antibiotics was most commonly prescribed.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"13 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81750246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enteral Feeding for Children on Bilevel Positive Pressure Ventilation for Status Asthmaticus.","authors":"Kavipriya Komeswaran,&nbsp;Aayush Khanal,&nbsp;Kimberly Powell,&nbsp;Giovanna Caprirolo,&nbsp;Ryan Majcina,&nbsp;Randall S Robbs,&nbsp;Sangita Basnet","doi":"10.1055/s-0041-1730901","DOIUrl":"https://doi.org/10.1055/s-0041-1730901","url":null,"abstract":"<p><p>A retrospective data analysis was conducted to evaluate enteral nutrition practices for children admitted with status asthmaticus in a single-center pediatric intensive care unit. Of 406 charts, 315 were analyzed (63% male); 135 on bilevel positive airway pressure ventilation (BIPAP) and 180 on simple mask. Overall median age and weight were 6.0 (interquartile range [IQR]: 6.0) years and 24.8 (IQR: 20.8) kg, respectively. All children studied were on full feeds while still on BIPAP and simple mask; 99.3 and 100% were fed per oral, respectively. Median time to initiation of feeds and full feeds was longer in the BIPAP group, 11.0 (IQR: 20) and 23.0 hours (IQR: 26), versus simple mask group, 4.3 (IQR: 7) and 12.0 hours (IQR: 15), <i>p</i>  = 0.001. The results remained similar after adjusting for gender, weight, clinical asthma score at admission, use of adjunct therapy, and duration of continuous albuterol. By 24 hours, 81.5% of patients on BIPAP and 96.6% on simple mask were started on feeds. Compared with simple mask, patients on BIPAP were sicker with median asthma score at admission of 4 (IQR: 2) versus 3 (IQR: 2) on simple mask, requiring more adjunct therapy (80.0 vs. 43.9%), and a longer median length of therapy of 41.0 (IQR: 41) versus 20.0 hours (IQR: 29), respectively, <i>p</i>  = 0.001. There were no complications such as aspiration pneumonia, and none required invasive mechanical ventilation in either group. Enteral nutrition was effectively and safely initiated and continued for children admitted with status asthmaticus, including those on noninvasive bilevel ventilation therapy.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":"31-36"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894693/pdf/10-1055-s-0041-1730901.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9229784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisystem Inflammatory Syndrome in Children Admitted to a Tertiary Pediatric Intensive Care Unit.","authors":"Emrah Gün,&nbsp;Tanıl Kendirli,&nbsp;Edin Botan,&nbsp;Nazmiye Türker,&nbsp;Anar Gurbanov,&nbsp;Burak Balaban,&nbsp;Ali Genco Gencay,&nbsp;Gül Arga,&nbsp;Selen Karagözlü,&nbsp;Mehmet Gökhan Ramoglu,&nbsp;Halil Özdemir,&nbsp;Tayfun Ucar,&nbsp;Ercan Tutar,&nbsp;Ergin Ciftci","doi":"10.1055/s-0041-1733943","DOIUrl":"https://doi.org/10.1055/s-0041-1733943","url":null,"abstract":"<p><p><b>Background</b>  Multisystem inflammatory syndrome in children (MIS-C) is characterized by persistent fever, abdominal pain, vomiting, diarrhea, rash, conjunctivitis, headaches, and mucocutaneous manifestations and it can cause circulatory dysfunction, resulting in hypotension, shock, and end-organ injury in the heart and other organs and possibly death. In this study, we aimed to analyze the clinical spectrum, treatment options and outcomes of children with MIS-C who were admitted to our pediatric intensive care (PICU). <b>Materials and Methods</b>  Clinical and laboratory findings and treatment of the patients admitted to the PICU with MIS-C between April 2020 and January 2021 were recorded, and their outcomes were evaluated. <b>Results</b>  Nineteen patients with a median age of 12.5 years (interquartile range (IQR): 5.8-14.0 years) were admitted. Eleven (57.8%) were males. The most frequent clinical and laboratory features were fever (100%), abdominal pain (94.7%), rash (63.1%), headache (68.4%), diarrhea (47.3%), seizure (10.5%), cardiac dysfunction (52.6%), acute kidney injury (26.3%), lymphopenia (84.2%), and thrombocytopenia (36.8%). However, 8 patients needed mechanical respiratory support, 11 patients needed inotropes, 2 patients needed plasma exchange, and 1 patient needed continuous renal replacement therapy. All patients received corticosteroids, 17 patients (89.2%) received intravenous immunoglobulin, 2 patients received anakinra, 10 patients received acetylsalicylic acid, and 6 patients received enoxaparin. Median PICU length of stay was 3 days (IQR: 2-5) and only one patient died. <b>Conclusion</b>  In conclusion, MIS-C may present with a variety of clinical manifestations, and it can lead to life-threatening critical illness. Most children need intensive care and the response to immunomodulation is usually favorable.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":"37-43"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894696/pdf/10-1055-s-0041-1733943.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10662334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperchloremia on Admission to Pediatric Intensive Care in Mechanically Ventilated Children is Associated with Impaired Renal Function.","authors":"Rebecca B Mitting,&nbsp;Padmanabhan Ramnarayan,&nbsp;David P Inwald","doi":"10.1055/s-0041-1728788","DOIUrl":"https://doi.org/10.1055/s-0041-1728788","url":null,"abstract":"<p><p><b>Objective</b>  There is recent interest in the association between hyperchloremic metabolic acidosis and adverse outcomes. In vitro, hyperchloremia causes renal vasoconstriction and fall in glomerular filtration rate (GFR). The objective of this retrospective, observational study is to examine associations between chloride level at admission to pediatric intensive care (PICU) and worst GFR and requirement for renal replacement therapy. <b>Materials and Methods</b>  All admissions to PICU between 2009 and 2019 who received invasive mechanical ventilation and had blood gas analysis performed were included. Data analyzed included patient characteristics (age, gender, diagnosis, pediatric index of mortality [PIM]-2 score); results of initial blood gas; and maximum serum creatinine (then used to calculate minimum GFR). Primary outcome measure was worst GFR during PICU stay. Secondary outcome measures were requirement for renal replacement therapy and PICU mortality. Multivariable regression analysis was used to assess if admission chloride level was independently predictive of minimum GFR during PICU stay and to examine associations between hyperchloremia (>110 mEq/L) at admission and requirement for renal replacement therapy after adjustment for confounders. <b>Results</b>  Data were available for 2,217 patients. Median age was 16.4 months and 39% of patients were hyperchloremic at admission to PICU. Admission chloride level was independently predictive of worst GFR during PICU stay after adjustment for known confounders. Patients with hyperchloremia were not more likely to require renal replacement therapy or die than patients with normochloremia. <b>Conclusion</b>  Prospective studies are necessary to determine if high chloride, specifically chloride containing resuscitation fluids, have a causal relationship with poor outcomes.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":"18-23"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894692/pdf/10-1055-s-0041-1728788.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9214109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increase in Pediatric Intensive Care Unit Hospitalizations Due to Toxic Ingestions during the COVID-19 Pandemic.","authors":"Jennifer L van Helmond,&nbsp;Brittany Fitts,&nbsp;Jigar C Chauhan","doi":"10.1055/s-0041-1727249","DOIUrl":"https://doi.org/10.1055/s-0041-1727249","url":null,"abstract":"<p><p>The coronavirus disease 2019 (COVID-19) pandemic and related community mitigation measures had a significant psychosocial impact. We suspected that more patients were admitted to our pediatric intensive care unit (PICU) for toxic ingestions since the start of the pandemic. We therefore investigated if PICU admissions related to toxic ingestions were higher in 2020 as a result of COVID-19 compared with previous years. We completed a cross-sectional study at a tertiary children's hospital comparing admissions to our PICU between April 2020 and October 2020, during which COVID-19 and community mitigation measures were in place, to those during the same 7-month period in the previous 3 years. Total PICU admissions, admissions for all toxic ingestions (intentional ingestions and accidental ingestions), and demographic and clinical characteristics of patients were compared. Total PICU admissions in 2020 during COVID-19 pandemic months were lower compared with the same months in the preceding 3 years (-16%, <i>p</i> < 0.001), however, admissions for toxic ingestions were higher during COVID-19 (+64%, <i>p</i> < 0.001). When separated by type, intentional (+55%, <i>p</i>  = 0.012) and accidental ingestions (+94%, <i>p</i>  = 0.021) were higher during COVID-19. COVID-19 with community mitigation measures has led to an increase in PICU admissions for intentional and accidental ingestions, indicating an increase in severity of toxic ingestions in children associated with the pandemic. Mental health of adolescents, and safety of infants and toddlers in their home environment, should be targeted with specific interventions in the ongoing COVID-19 pandemic.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":"12-17"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894694/pdf/10-1055-s-0041-1727249.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9214114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environment and Culture, a Cross-Sectional Survey on Drivers of Burnout in Pediatric Intensive Care.","authors":"Nupur N Dalal,&nbsp;Laura M Gaydos,&nbsp;Scott E Gillespie,&nbsp;Christina J Calamaro,&nbsp;Rajit K Basu","doi":"10.1055/s-0041-1730917","DOIUrl":"https://doi.org/10.1055/s-0041-1730917","url":null,"abstract":"<p><p>Very little data is available to understand the drivers of burnout amongst health care workers in the pediatric intensive care unit. This is a survey-based, cross-sectional, point-prevalence analysis within a single children's health system with two free-standing hospitals (one academic and one private) to characterize the relationship of demographics, organizational support, organizational culture, relationship quality, conflict and work schedules with self-reported burnout. Burnout was identified in 152 (39.7%) of the 383 (38.7%) respondents. No significant relationship was identified between burnout and demographic factors or work schedule. A more constructive culture (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.77-0.90; <i>p</i>  < 0.001), more organizational support (OR, 0.94; 95% CI, 0.92-0.96; <i>p</i> <0 0.001), and better staff relationships (OR, 0.54, 95% CI, 0.43-0.69; <i>p</i>  < 0.001) reduced odds of burnout. More conflict increased odds (OR, 1.25; 95% CI, 1.12-1.39; <i>p</i>  < 0.001). Less organizational support ( <i>Z</i> _β  = 0.425) was the most important factor associated with burnout overall. A work environment where staff experience defensive cultures, poor relationships, more frequent conflict, and feel unsupported by the organization is associated with significantly higher odds of burnout in pediatric critical care. The effect of targeted interventions to promote constructive cultures, collegiality, and organizational support on burnout in pediatric intensive care should be studied.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":"44-54"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9897953/pdf/10-1055-s-0041-1730917.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10662335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Factors of High-Flow Nasal Cannula Oxygen Success in Children.","authors":"Gokce Iplik,&nbsp;Dincer Yildizdas,&nbsp;Ahmet Yontem","doi":"10.1055/s-0041-1730915","DOIUrl":"https://doi.org/10.1055/s-0041-1730915","url":null,"abstract":"<p><p>This study was aimed to evaluate the success rate of high-flow nasal cannula (HFNC) oxygen therapy and factors causing therapy failure. This prospective observational study included 131 children who received HFNC oxygen and followed-up in the pediatric emergency department, pediatric clinics, and pediatric intensive care unit between March 2018 and December 2019. The median age was 23.0 months (interquartile range [IQR]: 9.0-92.0) and 65 patients were male (49.6%). The most common reason for requiring HFNC oxygen therapy was pneumonia ( <i>n</i>  = 75, 57.3%). A complex chronic condition was present in 112 (85.5%) patients. Therapy success was achieved in 116 patients (88.5%). The reason for requiring treatment and the patients' complex chronic condition did not affect the success of the therapy ( <i>p</i>  = 0.294 and 0.091, respectively). In the first 24 hours of treatment, a significant improvement in pulse rate, respiratory rate, pH, and lactate level were observed in successful HFNC oxygen patients ( <i>p</i>  < 0.05). In addition, these patients showed a significant improvement in SpO ₂ and SpO ₂ /FiO ₂ ratio, and a significant decrease in FiO ₂ and flow rate ( <i>p</i>  < 0.05). HFNC oxygen success rate was 95.6% in patients with SpO ₂ /FiO ₂ ≥ 150 at the 24th hour; it was 58.0% in those with SpO ₂ /FiO ₂  < 150 ( <i>p</i>  < 0.001). Caution should be exercised in terms of HFNC oxygen failure in patients with no significant improvement in vital signs and with SpO ₂ /FiO ₂  < 150 during treatment.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":"71-78"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894699/pdf/10-1055-s-0041-1730915.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9214110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Cornell Assessment of Pediatric Delirium Scale in Mechanically Ventilated Children.","authors":"Neha Gupta,&nbsp;Saurabh Talathi,&nbsp;Allison Woolley,&nbsp;Stephanie Wilson,&nbsp;Mildred Franklin,&nbsp;Johanna Robbins,&nbsp;Candice Colston,&nbsp;Leslie Hayes","doi":"10.1055/s-0041-1728784","DOIUrl":"https://doi.org/10.1055/s-0041-1728784","url":null,"abstract":"<p><p>Accuracy of delirium diagnosis in mechanically ventilated children is often limited by their varying developmental abilities. The purpose of this study was to examine the performance of the Cornell Assessment of Pediatric Delirium (CAPD) scale in these patients. This is a single-center, prospective, observational study of patients requiring sedation and mechanical ventilation for 2 days or more. CAPD scale was implemented in our unit for delirium screening. Each CAPD assessment was accompanied by a physician assessment using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Sensitivity analysis was performed to determine the best cut-off score in our target population. We also evaluated ways to improve the accuracy of this scale in patients with and without developmental delay. A total of 837 paired assessments were performed. Prevalence of delirium was 19%. Overall, CAPD score ≥ 9 had sensitivity of 81.8% and specificity of 44.8%. Among typically developed patients, the sensitivity and specificity were 76.7 and 65.4%, respectively, whereas specificity was only 16.5% for developmentally delayed patients. The best cut-off value for CAPD was 9 for typically developed children and 17 for those with developmental delay (sensitivity 74.4%, specificity 63.2%). Some CAPD questions do not apply to patients with sensory and neurocognitive deficits; upon excluding those questions, the best cut-off values were 5 for typically developed and 6 for developmentally delayed children. In mechanically ventilated patients with developmental delay, CAPD ≥ 9 led to a high false-positive rate. This emphasizes the need for either a different cut-off score or development of a delirium scale specific to this patient population.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":"24-30"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894695/pdf/10-1055-s-0041-1728784.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9229781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Pediatric Palliative Care Consults in Hospitalized Patients with Heart Disease.","authors":"Danielle J Green,&nbsp;Erin Bennett,&nbsp;Lenora M Olson,&nbsp;Sarah Wawrzynski,&nbsp;Stephanie Bodily,&nbsp;Dominic Moore,&nbsp;Kelly J Mansfield,&nbsp;Victoria Wilkins,&nbsp;Lawrence Cook,&nbsp;Claudia Delgado-Corcoran","doi":"10.1055/s-0041-1730916","DOIUrl":"https://doi.org/10.1055/s-0041-1730916","url":null,"abstract":"<p><p>Pediatric palliative care (PPC) provides an extra layer of support for families caring for a child with complex heart disease as these patients often experience lifelong morbidities with frequent hospitalizations and risk of early mortality. PPC referral at the time of heart disease diagnosis provides early involvement in the disease trajectory, allowing PPC teams to longitudinally support patients and families with symptom management, complex medical decision-making, and advanced care planning. We analyzed 113 hospitalized pediatric patients with a primary diagnosis of heart disease and a PPC consult to identify timing of first PPC consultation in relation to diagnosis, complex chronic conditions (CCC), and death. The median age of heart disease diagnosis was 0 days with a median of two CCCs while PPC consultation did not occur until a median age of 77 days with a median of four CCCs. Median time between PPC consult and death was 33 days (interquartile range: 7-128). Death often occurred in the intensive care unit ( <i>n</i>  = 36, 67%), and the most common mode was withdrawal of life-sustaining therapies ( <i>n</i>  = 31, 57%). PPC referral often occurred in the context of medical complexity and prolonged hospitalization. Referral close to the time of heart disease diagnosis would allow patients and families to fully utilize PPC benefits that exist outside of end-of-life care and may influence the mode and location of death. PPC consultation should be considered at the time of heart disease diagnosis, especially in neonates and infants with CCCs.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":"63-70"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894702/pdf/10-1055-s-0041-1730916.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9550179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}