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Incidence and Risk Factors of Perioperative Mortality in Pediatric ICU Patients
John Aubrey1,2, Hui Zha1,3,4, Koichi Yuki1,4
1Department of Anesthesiology, Critical Care and Pain Medicine, Cardiac Anesthesia Division, Boston Children's Hospital, MA, USA.
Insights
Pediatric intensive care unit (ICU) patients undergoing procedures under general anesthesia had a 12.6% mortality rate. Positive blood stream infections, often linked to immunological disorders, were the leading risk factor for mortality in these critically ill children.
Area of Science:
- Pediatric critical care medicine
- Anesthesiology
- Infectious disease
Background:
- Limited data exists on pediatric intensive care unit (ICU) patients undergoing procedures under general anesthesia.
- Understanding mortality and associated risk factors in this population is crucial.
Purpose of the Study:
- To evaluate the mortality rate of pediatric ICU patients undergoing procedures under general anesthesia.
- To identify risk factors associated with mortality in this specific patient group.
Main Methods:
- Retrospective study utilizing electronic medical records of pediatric ICU patients.
- Analysis of mortality incidence and risk factors using univariable logistic regression.
Main Results:
- Mortality was 12.6% for pediatric ICU patients undergoing procedures under general anesthesia, significantly higher than other ICU admissions (3.5% and 0.4%).
- Key risk factors included higher ASA class, emergency cases, advanced ventilator support, inotrope use, blood transfusion, and specific surgical procedures.
- Positive blood stream infection (BSI) showed the highest odds ratio (102.00) for mortality, with affected patients often having underlying immunological/hematological disorders.
Conclusions:
- Pediatric ICU patients undergoing procedures under general anesthesia exhibit the highest mortality within the ICU setting.
- Positive blood stream infections are a critical risk factor, strongly associated with immunological and hematological disorders, demanding targeted interventions.
Background:
There is a limited data of pediatric patients who presented to the intensive care unit (ICU) and undergo procedures under general anesthesia. The primary objective of this study was to evaluate the mortality of this population and assess the risk factors associated with mortality.
Methods:
Retrospective study of electronic medical records of pediatric patients who admitted to medical/surgical ICU and underwent produces under general anesthesia during the same ICU admission was performed. Incidence of mortality was obtained and risk factors associated with these mortalities were examined using Univariable logistic regression analysis.
Results:
The mortality of pediatric patients who were admitted to the ICU and underwent procedures under general anesthesia was 12.6%, while the mortalities of patients without procedures under general anesthesia and patients who admitted to ICU for postoperative management were 3.5% and 0.4%, respectively. Higher ASA class, emergency cases, higher ventilator support, more inotrope requirement, positive microbe in blood stream, blood transfusion requirement, and general surgery or hematological procedures were highly associated with mortalities. Among them, positive blood stream infection was highest odds ratio (102.00, 95% confidence interval 9.78-1064.09). The profile of patients with positive blood stream infection showed that most of them had underlying immunological/hematological disorders.
Conclusion:
In our institution, pediatric patients who admitted to the ICU and underwent procedures under general anesthesia demonstrated the highest mortality among other patients who admitted to ICU. Risk factor analysis demonstrated that patients with positive blood stream infection had highest odds ratio, and were highly associated with immunological/ hematological disorders.
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