Declining Procedures in Pediatric Critical Care Medicine Using a National Database

Area of Science:

• Pediatric critical care medicine
• Healthcare quality improvement
• Medical procedure trends

Background:

• Invasive procedures are common in pediatric intensive care units (PICUs).
• Understanding trends in invasive procedure rates and respiratory support is crucial for optimizing patient care and training.

Purpose of the Study:

• To analyze changes in the rates of key invasive procedures per admission in North American PICUs from 2009 to 2017.
• To examine shifts in the types of respiratory support utilized during the same period.

Main Methods:

• Retrospective analysis of prospectively collected data from the Virtual Pediatric Systems (VPS) database.
• Inclusion of over 900,000 admissions from 161 North American PICUs between January 2009 and December 2017.
• Statistical control for illness severity and unit-level effects to determine procedural rate changes.

Main Results:

• A significant decrease was observed in the rates of endotracheal intubation, central venous catheter, and arterial catheter insertions per admission.
• The rate of peripheral inserted central venous catheter insertion per admission increased over the study period.
• A decline in invasive mechanical ventilation use was noted, alongside an increase in noninvasive respiratory support methods.

Conclusions:

• The study demonstrates a declining trend in several invasive procedures and invasive mechanical ventilation in PICUs.
• There is a concurrent rise in the utilization of noninvasive respiratory support.
• Findings underscore the need for enhanced training and competency evaluation for invasive procedures in PICU settings.