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Acute and chronic paediatric intensive care patients: current trends and perspectives on resource utilization
G Briassoulis1, O Filippou, L Natsi
1Pediatric Intensive Care Unit, 'Aghia Sophia' Children's Hospital, Thivon & Levadias street, Goudi 11527, Athens, Greece. briassg@otenet.gr
Insights
Critically ill children, especially those with chronic conditions, are using more paediatric intensive care unit (PICU) beds and ventilators. Resource utilization increased, but mortality rates remained stable.
Area of Science:
- Pediatric Critical Care Medicine
- Healthcare Resource Management
- Patient Outcomes Research
Background:
- Advances in pediatric critical care have improved survival rates for critically ill children.
- Many survivors require long-term mechanical ventilation, impacting resource utilization.
Purpose of the Study:
- To analyze current trends in resource utilization within a pediatric intensive care unit (PICU).
- To identify challenges in managing both acute and chronic pediatric intensive care patients.
Main Methods:
- An open observational study evaluated 1629 consecutive admissions over five years.
- Resource utilization was measured by mean length of stay (LOS), length of mechanical ventilation (LOMV), and the LOMV/LOS ratio.
- Severity scoring systems were employed to assess patient risk.
Main Results:
- Mean LOS increased significantly from 5.3 days in 1998 to 8.7 days in 2001.
- Patients hospitalized for over two weeks accounted for 55% of LOS and 57% of LOMV.
- Critically ill children requiring long-term care (>3 months) consumed a disproportionate amount of resources.
Conclusions:
- The rise in PICU bed and ventilator days may be linked to increased admissions of chronic care pediatric patients.
- Severity scoring accurately predicted resource consumption but not overall mortality trends.
- Effective management strategies are needed for long-term pediatric critical care patients.
Background:
Advances in paediatric critical care have resulted in increased survival of critically ill patients, many of whom require long-term ventilation as a means of life support.
Aim:
To determine current trends in resource utilization, and problems in the care of acute and chronic paediatric intensive care patients.
Design:
Open observational study.
Methods:
We evaluated consecutive admissions (n = 1629) to a 10-bed paediatric intensive care unit (PICU) over a 5-year period. Three previously defined criteria for resource utilization were used: mean length of stay (LOS); length of mechanical ventilation (LOMV); and LOMV/LOS ratio.
Results:
A total of 10 310 patient bed days and 5223 ventilator days were used. Mean LOS increased from 5.3 +/- 12 days in 1998 to 8.7 +/- 27 days in 2001 (p < 0.05). Although LOMV/LOS ratio (50.7%) was significantly correlated with Paediatric Risk of Mortality score (p < 0.0001), there was no significant change in mortality rate (12.6% vs. 12%). Patients hospitalized for >2 weeks (n = 320, 20%) used 55% of LOS and 57% of LOMV, in contrast to the 1298 (80%) hospitalized for <7 days, who used only 29% of LOS and 20% of LOMV. Patients hospitalized for >3 months (11, 0.7%) consumed 17% of LOS and 23% of LOMV. Five of these (45%) were eventually discharged home, two on ventilators.
Conclusion:
The increasing trend of occupation of PICU bed and ventilator days by critically ill children may be related to the increasing trend for hospitalization of chronic care patients. Severity scoring systems were predictive of resource consumption, but not of the overall trend in mortality rate.
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