Sidra Ishaque, Nazia Bibi, Zaiba Shafik Dawood, Janeeta Hamid, Quratulain Maha, Syeda Asma Sherazi, Ali Faisal Saleem, Qalab Abbas, Naveed Ur Rehman Siddiqui, Anwar Ul Haque
{"title":"儿科重症监护病房呼吸系统疾病的负担：巴基斯坦一家三级医疗中心儿科重症监护室的经验。","authors":"Sidra Ishaque, Nazia Bibi, Zaiba Shafik Dawood, Janeeta Hamid, Quratulain Maha, Syeda Asma Sherazi, Ali Faisal Saleem, Qalab Abbas, Naveed Ur Rehman Siddiqui, Anwar Ul Haque","doi":"10.1155/2024/6704727","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to determine the burden of respiratory disease by examining clinical profiles and associated predictors of morbidity and mortality of patients admitted to a Pediatric Intensive Care Unit (PICU) in Pakistan, a resource limited country. We also stratified the respiratory diseases as defined by the Pediatric Advanced Life Support (PALS) Classification.</p><p><strong>Methods: </strong>A retrospective study was conducted on children aged 1 month to 18 years who were diagnosed with respiratory illness at the PICU in a tertiary hospital in Karachi, Pakistan. Demographics, essential clinical details including immunization status, and the outcome in terms of mortality or survival were recorded. Predictors of mortality and morbidity including prolonged intubation and mechanical ventilation in the PICU were analyzed using the chi-square test or Fischer's exact test as appropriate.</p><p><strong>Results: </strong>279 (63.8% male; median age 9 months, IQR 4-36 months) patients were evaluated of which 44.2% were malnourished and 23.3% were incompletely immunized. The median length of stay in the PICU was 3 days (IQR 2-5 days). Pneumonia was the principal diagnosis in 170 patients (62%) and accounted for most deaths. 76/279 (27.2%) were ventilated, and 67/279(24.0%) needed inotropic support. A high Pediatric Risk of Mortality (PRISM) III score, pneumothorax, and lower airway disease were significantly associated with ventilation support. The mortality rate of patients was 14.3%. Predictors of mortality were a high PRISM III score (OR 1.179; 95% CI 1.024-1.358, <i>P</i>=0.022) and a positive blood culture (OR 4.305; 95% CI 1.062-17.448, <i>P</i>=0.041).</p><p><strong>Conclusion: </strong>Pneumonia is a significant contributor of respiratory diseases in the PICU in Pakistan and is the leading cause of morbidity and mortality. A high PRISM III score, pneumothorax, and lower airway disease were predictors for ventilation support. 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We also stratified the respiratory diseases as defined by the Pediatric Advanced Life Support (PALS) Classification.</p><p><strong>Methods: </strong>A retrospective study was conducted on children aged 1 month to 18 years who were diagnosed with respiratory illness at the PICU in a tertiary hospital in Karachi, Pakistan. Demographics, essential clinical details including immunization status, and the outcome in terms of mortality or survival were recorded. Predictors of mortality and morbidity including prolonged intubation and mechanical ventilation in the PICU were analyzed using the chi-square test or Fischer's exact test as appropriate.</p><p><strong>Results: </strong>279 (63.8% male; median age 9 months, IQR 4-36 months) patients were evaluated of which 44.2% were malnourished and 23.3% were incompletely immunized. The median length of stay in the PICU was 3 days (IQR 2-5 days). Pneumonia was the principal diagnosis in 170 patients (62%) and accounted for most deaths. 76/279 (27.2%) were ventilated, and 67/279(24.0%) needed inotropic support. A high Pediatric Risk of Mortality (PRISM) III score, pneumothorax, and lower airway disease were significantly associated with ventilation support. The mortality rate of patients was 14.3%. Predictors of mortality were a high PRISM III score (OR 1.179; 95% CI 1.024-1.358, <i>P</i>=0.022) and a positive blood culture (OR 4.305; 95% CI 1.062-17.448, <i>P</i>=0.041).</p><p><strong>Conclusion: </strong>Pneumonia is a significant contributor of respiratory diseases in the PICU in Pakistan and is the leading cause of morbidity and mortality. A high PRISM III score, pneumothorax, and lower airway disease were predictors for ventilation support. 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引用次数: 0
摘要
简介：巴基斯坦是一个资源有限的国家，我们的目的是通过研究巴基斯坦儿科重症监护病房（PICU）收治的患者的临床特征以及发病率和死亡率的相关预测因素，确定呼吸系统疾病的负担。我们还根据儿科高级生命支持（PALS）分类对呼吸系统疾病进行了分层：我们对巴基斯坦卡拉奇一家三甲医院 PICU 诊断为呼吸系统疾病的 1 个月至 18 岁儿童进行了回顾性研究。研究人员记录了这些患儿的人口统计学特征、包括免疫接种情况在内的基本临床细节以及死亡率或存活率。结果：共评估了 279 名患者（63.8% 为男性；中位年龄为 9 个月，IQR 为 4-36 个月），其中 44.2% 营养不良，23.3% 免疫接种不完全。儿童重症监护室的中位住院时间为 3 天（IQR 2-5 天）。肺炎是 170 名患者（62%）的主要诊断，也是大多数死亡的原因。76/279（27.2%）例患者接受了呼吸机治疗，67/279（24.0%）例患者需要肌力支持。儿科死亡率风险（PRISM）III评分较高、气胸和下气道疾病与通气支持显著相关。患者的死亡率为 14.3%。死亡率的预测因素是 PRISM III 评分高（OR 1.179；95% CI 1.024-1.358，P=0.022）和血培养阳性（OR 4.305；95% CI 1.062-17.448，P=0.041）：肺炎是巴基斯坦 PICU 呼吸系统疾病的主要致病因素，也是发病和死亡的主要原因。PRISM III 评分高、气胸和下呼吸道疾病是通气支持的预测因素。在我们的研究中，PRISM III 评分高和血液培养阳性是预测患者死亡率的因素。
Burden of Respiratory Disease in Pediatric Intensive Care Unit: Experience from a PICU of a Tertiary Care Center in Pakistan.
Introduction: We aimed to determine the burden of respiratory disease by examining clinical profiles and associated predictors of morbidity and mortality of patients admitted to a Pediatric Intensive Care Unit (PICU) in Pakistan, a resource limited country. We also stratified the respiratory diseases as defined by the Pediatric Advanced Life Support (PALS) Classification.
Methods: A retrospective study was conducted on children aged 1 month to 18 years who were diagnosed with respiratory illness at the PICU in a tertiary hospital in Karachi, Pakistan. Demographics, essential clinical details including immunization status, and the outcome in terms of mortality or survival were recorded. Predictors of mortality and morbidity including prolonged intubation and mechanical ventilation in the PICU were analyzed using the chi-square test or Fischer's exact test as appropriate.
Results: 279 (63.8% male; median age 9 months, IQR 4-36 months) patients were evaluated of which 44.2% were malnourished and 23.3% were incompletely immunized. The median length of stay in the PICU was 3 days (IQR 2-5 days). Pneumonia was the principal diagnosis in 170 patients (62%) and accounted for most deaths. 76/279 (27.2%) were ventilated, and 67/279(24.0%) needed inotropic support. A high Pediatric Risk of Mortality (PRISM) III score, pneumothorax, and lower airway disease were significantly associated with ventilation support. The mortality rate of patients was 14.3%. Predictors of mortality were a high PRISM III score (OR 1.179; 95% CI 1.024-1.358, P=0.022) and a positive blood culture (OR 4.305; 95% CI 1.062-17.448, P=0.041).
Conclusion: Pneumonia is a significant contributor of respiratory diseases in the PICU in Pakistan and is the leading cause of morbidity and mortality. A high PRISM III score, pneumothorax, and lower airway disease were predictors for ventilation support. A high PRISM III score and a positive blood culture were predictors of patient mortality in our study.
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