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Gastrointestinal Complications in Critically Ill Children: Experience from A Resource-Limited Country
Sidra Ishaque1, Mariam Shakir2, Asma Ladak3
1Dr. Sidra Ishaque, FCPS. Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan.
Insights
Gastrointestinal complications are common in critically ill children, impacting their outcomes. Sedative use and multiorgan dysfunction syndrome are key contributing factors in the Pediatric Intensive Care Unit (PICU).
Area of Science:
- Pediatric Critical Care Medicine
- Gastroenterology
- Clinical Research
Background:
- Gastrointestinal complications (GIC) are a significant concern in critically ill pediatric patients.
- Understanding the frequency and predictors of GIC is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence and identify predictors of gastrointestinal complications in critically ill children.
- To analyze the association between GIC and clinical outcomes in a pediatric intensive care unit (PICU) setting.
Main Methods:
- A prospective descriptive study was conducted in a Pediatric Intensive Care Unit (PICU) from September 2015 to January 2017.
- Data on defined GIC (vomiting, high gastric residue volume, diarrhea, constipation, gastrointestinal bleed) were collected daily for the first week of PICU stay.
- Inclusion criteria involved children aged one month to 18 years admitted to the PICU, with parental informed consent.
Main Results:
- Gastrointestinal complications developed in 41% of patients within the first 48 hours of admission.
- High gastric residue volume (47.4%) and constipation (39.7%) were the most frequent GIC.
- Patients with GIC had a longer median length of stay (8 days vs. 4 days).
- Mechanical ventilation, sedatives, multiorgan dysfunction syndrome (MODS), and inotropes were associated with a higher frequency of GIC.
Conclusions:
- Gastrointestinal complications are frequent in the PICU and are linked to poorer clinical outcomes.
- The use of sedative drugs and the presence of shock with MODS are significant contributing factors to GIC.
- Early identification and management of risk factors may improve outcomes for critically ill children experiencing GIC.
Objectives:
To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children.
Methods:
This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), The Aga Khan University Hospital (AKUH), Karachi, from September 2015 to January 2017. After obtaining approval from the Ethical Review Committee of AKUH and informed consent from the parents, all children (aged one month to 18 years), of either gender, admitted to the Pediatric Intensive Care Unit (PICU) during the study period were included. The frequency of the defined GIC: vomiting, high gastric residue volume (GRV), diarrhea, constipation, and gastrointestinal bleed were recorded daily for the first week of the PICU stay. The data was collected by the primary investigator on a predesigned data collection form with inclusion of variables and predictors in light of existing literature and local expertise. The questionnaire was shared with the Pediatric Critical Care Medicine faculty and a consensus was sought on the elements to be incorporated.
Results:
GIC developed within the first 48 hours of admission in 78 (41%) patients. Of the patients who developed GIC, 37 (47.4%) patients developed high GRV: 31 (39.7%) patients developed constipation, 18 (23.1%) patients developed vomiting, 14 (17.9%) patients developed abdominal distension. With regards to prevalence by occurrence, 32/78 (41%) of patients presented with two GI complications, followed by 21 patients (27%) who presented with a single GIC. Only 11 patients (14%) presented with more than three complications. Median length of stay was higher in patients with GIC (8 days) than with those who did not develop GIC (4 days). The frequency of gastrointestinal complications was significantly higher in children receiving mechanical ventilation, on sedatives and relaxants and those with multiorgan dysfunction syndrome (MODS) and inotropes.
Conclusion:
GI complications are a frequent occurrence in the PICU and are associated with worse clinical outcomes. The use of sedative drugs and the presence of shock with MODS were amongst the important contributing factors.
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