Related Experiment Video
Updated: May 10, 2025
Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Strain in the Pediatric Intensive Care Unit and its Association with Patient Outcomes
Matthew S Baker1,2, Kristen R Miller1, Jaime S LaVelle2
1University of Colorado School of Medicine, Aurora, CO, USA.
Insights
High pediatric intensive care unit (PICU) occupancy and patient turnover indicate strain. Increased PICU strain correlates with a higher likelihood of adverse post-ICU events, necessitating further multicenter research.
Area of Science:
- Pediatric Critical Care Medicine
- Healthcare Operations Research
- Patient Safety
Background:
- Pediatric intensive care units (PICUs) experience periods of high demand, referred to as strain.
- Understanding the impact of PICU strain on patient outcomes is crucial for optimizing care delivery and patient safety.
Purpose of the Study:
- To characterize measures of pediatric intensive care unit (PICU) strain.
- To investigate the association between PICU strain metrics and patient outcomes, specifically post-ICU floor escalation events.
Main Methods:
- Retrospective cohort study of PICU admissions from 2014-2023.
- Daily measurement of PICU strain metrics: percent occupancy, percent turnover, and acuity.
- Multivariable logistic regression analysis to assess the association between strain metrics and floor escalation events.
Main Results:
- PICU occupancy and turnover were significantly higher during peak viral seasons.
- Higher percent occupancy (above 87.5%) and turnover were independently associated with an increased risk of floor escalation events.
- Acuity metrics did not significantly differ between peak and non-peak seasons.
Conclusions:
- Percent occupancy and turnover are key indicators of PICU strain.
- Elevated PICU occupancy and turnover are linked to an increased incidence of post-ICU floor escalation events.
- Further multicenter studies are warranted to validate these findings across diverse PICU settings.
Abstract:
Objective: To characterize measures of pediatric intensive care unit (PICU) strain and test for associations between strain and patient outcomes. We hypothesized that periods of increased strain would be associated with increased odds of experiencing a post-ICU floor escalation event. Design: Retrospective cohort study. Setting: Quaternary care children's hospital PICU. Study Population: PICU admissions (2014-2023). Interventions: None. Measurements and Main Results: We measured PICU strain metrics daily including percent occupancy, percent turnover, and acuity. Percent occupancy and turnover were higher during annual peak viral season versus non-peak season (percent occupancy: median 84.4 [interquartile range (IQR) 72.9, 91.7] versus 68.8 [IQR 56.3, 82.1], P < .001; percent turnover: median 25.0 [IQR 20.0, 31.3] versus 21.9 [IQR 15.6, 28.1], P < .001). Acuity metrics did not differ during these periods. In patients admitted for respiratory or neurologic illness, we used multivariable logistic regression to test for associations between strain metrics on the day of transfer and odds of a floor escalation event defined as an unplanned PICU readmission or rapid response or code blue activation within 48 h of transfer. Of 12 832 patient transfers, 429 (3.3%) experienced a floor escalation event. After controlling for patient and clinical characteristics, percent occupancy and turnover were independently associated with an increase in floor escalation events. This risk was not linear for occupancy: above 87.5% (95% confidence interval (CI): 80.4, 94.6%), per 5% increase in occupancy patients experienced more floor escalation events (odds ratio [OR] 1.29 [95% CI: 1.07, 1.57]). For every 5% increase in turnover, patients experienced more floor escalation events (OR 1.06 [95% CI: 1.01, 1.12]). Conclusions: Occupancy and turnover characterized recognized periods of PICU strain. High occupancy and turnover were associated with more floor escalation events. Multicenter studies are needed to evaluate the generalizability of these findings across other PICUs.
More Related Videos
10:38Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
05:56Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit
Published on: September 6, 2024
Related Concept Videos
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...