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Risk factors and outcomes of unplanned PICU postoperative admissions: a nested case-control study

Paulo Sergio Lucas da Silva1, Vânia Euzébio de Aguiar, Marcelo Cunio Machado Fonseca

  • 1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Estadual de Diadema-UNIFESP, São Paulo, Brazil. psls.nat@terra.com.br

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|February 27, 2013
PubMed

Insights

Unplanned intensive care admission (UIA) in children is linked to airway issues, anesthesia, and intraoperative hypoxia. Preventable adverse events in 25% of UIA cases highlight opportunities for quality improvement in pediatric care.

Area of Science:

  • Pediatric Critical Care Medicine
  • Anesthesiology
  • Healthcare Quality Improvement

Background:

  • Unplanned postoperative admission to Pediatric Intensive Care Units (PICUs), or unplanned intensive care admission (UIA), is infrequent but associated with increased morbidity and mortality.
  • Limited data exists on the specific risk factors and outcomes for pediatric UIA.

Purpose of the Study:

  • To investigate the prevalence of UIA in postoperative pediatric patients.
  • To identify risk factors associated with UIA.
  • To compare outcomes between UIA and non-UIA patients.

Main Methods:

  • A case-control study was conducted at a tertiary university-affiliated hospital.
  • 116 postoperative pediatric patients were monitored, with 28 identified as UIA cases and 88 as controls.
  • Logistic regression analysis was used to determine predictors of UIA.

Main Results:

  • The overall prevalence of UIA was 2.6%.
  • Key predictors for UIA included airway abnormality (OR 16.2), anesthetic factors (OR 5.8), and intraoperative hypoxia (OR 7.4).
  • UIA patients required longer mechanical ventilation (4.5 vs. 2 days), with 25% of UIA cases attributed to preventable adverse events.

Conclusions:

  • Airway abnormalities, anesthetic factors, and intraoperative hypoxia are significant risk factors for pediatric UIA.
  • Preventable adverse events are a substantial contributor to UIA, indicating potential for quality improvement initiatives.
  • While UIA impacts ventilation duration, overall PICU and hospital length of stay did not differ significantly between groups.
Abstract

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