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Outcome of children with neuromuscular disease admitted to paediatric intensive care
1Department of Paediatric Intensive Care, The Children's Hospital at Westmead, Sydney, Australia.
Insights
Most children with neuromuscular disease (NMD) admitted to pediatric intensive care units (PICUs) recover well. However, many require readmission and ongoing non-invasive ventilation support.
Area of Science:
- Pediatric critical care medicine
- Neuromuscular disease management
- Intensive care outcomes
Background:
- Neuromuscular diseases (NMD) present unique challenges in pediatric intensive care.
- Understanding outcomes for children with NMD in the PICU is crucial for optimizing care.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients with neuromuscular disease (NMD) admitted to a tertiary pediatric intensive care unit (PICU).
Main Methods:
- A retrospective study of children with chronic NMD admitted to the PICU between July 1986 and June 2001.
- Data collected included mortality, PICU length of stay, duration of mechanical ventilation, and readmission rates.
Main Results:
- 28 children experienced 69 PICU admissions over 15 years; 57% had multiple admissions.
- The median PICU stay was 4 days. 36% of children died, with 14% in the PICU.
- Children with severe functional impairment had a higher mortality rate.
Conclusions:
- Most children with NMD admitted to the PICU survive and are discharged without prolonged invasive ventilation.
- Non-invasive home ventilation is common in this population, and further PICU admissions are likely.
Aims:
To determine the outcome of children with neuromuscular disease (NMD) following admission to a tertiary referral paediatric intensive care (PICU).
Methods:
All children with chronic NMD whose first PICU admission was between July 1986 and June 2001 were followed up from their first PICU admission to time of study. The outcomes recorded were death in or outside of PICU, duration of PICU admission, artificial ventilation during admission and following discharge from PICU, and readmission to PICU.
Results:
Over 15 years, 28 children were admitted on 69 occasions. Sixteen (57%) children had more than one admission. The median duration of PICU admission was 4 days (range 0.5-42). Twenty three per cent of unplanned admissions resulted in the commencement of respiratory support that was continued after discharge from the PICU. Severity of functional impairment was not associated with longer duration of stay or higher PRISM scores. Ten children (36%) died, with four (14%) deaths in the PICU. A higher proportion of children with severe limitation of function were among children that died compared to survivors.
Conclusion:
Most children with NMD admitted to the PICU recover and are discharged without the need for prolonged invasive ventilation. However, in this group of children, the use of non-invasive home based ventilation is common and they are likely to require further PICU admission.
