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Evaluating treatment and care outcomes for neuromuscular diseases in a pediatric intermediate care setting
Giacomo Brisca1, Marina F Strati1,2, Francesca Canzoneri2
1Neonatal and Pediatric Intensive Care Unit, and Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Insights
A new pediatric Intermediate Care Unit (IMCU) effectively manages children with complex neuromuscular disorders (NMDs). This specialized unit reduces Intensive Care Unit (ICU) admissions and stays, improving patient care.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Respiratory medicine
Background:
- Neuromuscular disorders (NMDs) require specialized care, often necessitating a balance between general pediatric wards and Intensive Care Units (ICUs).
- The establishment of a pediatric Intermediate Care Unit (IMCU) addresses the gap in care for NMD patients needing more than general ward capabilities but less than full ICU intensity.
Purpose of the Study:
- To evaluate the role and impact of a newly established pediatric IMCU in managing patients with NMDs.
- To assess the effectiveness of the IMCU in patient outcomes, resource utilization, and care pathway optimization.
Main Methods:
- A single-center retrospective observational study was conducted.
- Data from patients with NMDs admitted to the pediatric IMCU between January 2021 and June 2023 were analyzed.
- Demographics, clinical characteristics, treatments, length of stay, and outcomes were assessed.
Main Results:
- Sixty-three patients were included, with admissions primarily due to neurological (39.7%) and respiratory (22%) issues.
- Nearly 60% of patients required respiratory support initiation or potentiation.
- Factors like tracheostomy, antibiotics, and parenteral nutrition were linked to ICU admissions, while steroid treatment prolonged IMCU stay.
Conclusions:
- The pediatric IMCU demonstrates effectiveness in managing NMD patients, acting as a vital step-down from ICU and step-up from lower-acuity units.
- The IMCU contributes to reduced ICU admissions and shorter ICU stays, potentially lowering healthcare costs and enhancing patient comfort.
- Pediatric IMCUs are crucial for providing specialized, intermediate-level care for children with NMDs, optimizing monitoring and treatment in a suitable setting.
Background:
Neuromuscular disorders (NMDs) represent a complex group requiring specialized care, often straddling the needs between general pediatric wards and Intensive Care Units (ICUs). Our research focuses on the role of a newly established pediatric Intermediate Care Unit (IMCU) in this context.
Methods:
We conducted a single-center retrospective observational study, encompassing patients with NMDs admitted to the newly established pediatric IMCU at IRCCS Istituto Giannina Gaslini, Genoa, Italy, from January 2021 to June 2023. The study assessed demographics, clinical characteristics, therapeutic management, length of stay, and outcomes including mortality 28 days post-discharge.
Results:
Sixty-three patients (median age 12, female 58.7%) were included. The majority of admissions were due to neurological issues (39.7%) and respiratory complications (22%), with a significant proportion of patients requiring initiation or potentiation of respiratory support (59%). Factors such as the presence of tracheostomy (p = 0.021), the need for antibiotics (p = 0.025), and parenteral nutrition (p = 0.026) were associated with ICU admissions while steroid treatment (p = 0.047) increased IMCU stay.
Conclusions:
The establishment of the IMCU has shown promising results in managing NMDs patients, serving as a crucial step-down unit for ICU patients and a step-up unit for those with worsening conditions in low-intensity care units. It has led to decreased ICU admissions and shorter ICU stays, suggesting potential healthcare costs and patient comfort benefits. The study underscores the importance of pediatric IMCUs in providing specialized care for children with NMDs, balancing the need for intensive monitoring and treatment in a less intensive setting than an ICU.
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