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The Clinical Impact of Pediatric Pulmonologist Involvement in Intensive Care Units: Bridging Expertise and Outcomes
Satı Özkan Tabakçı1, Murat Alperan Yavuz2, Murat Yasin Gençoğlu3
1Department of Pediatric Pulmonology, Ankara Bilkent City Hospital, Ankara, Turkey, satiozkan.md@gmail.com.
Insights
Early pediatric pulmonologist (PP) consultation for critically ill children may improve outcomes. This study suggests timely PP involvement in pediatric intensive care units (ICUs) is linked to shorter hospital stays.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Healthcare outcomes research
Background:
- Respiratory illnesses are a significant cause of mortality and morbidity in pediatric and neonatal intensive care units (ICUs).
- Understanding the impact of specialized consultations is crucial for optimizing patient care in critical settings.
Purpose of the Study:
- To determine the impact of pediatric pulmonologist (PP) consultation on clinical outcomes for children in ICUs.
- To assess differences in outcomes between early and late PP consultations.
Main Methods:
- A single-center, retrospective, cross-sectional cohort study of 287 children (0-18 years) requiring PP consultation.
- Patients were divided into early (≤14 days) and late (>14 days) consultation groups.
- Comparison of demographic, clinical, radiologic characteristics, and length of stay (LOS) in hospital, ICU, and on mechanical ventilator (MV).
Main Results:
- The most common reasons for PP consultation included respiratory failure (39.4%), preoperative evaluation (14.6%), and pneumonia (8.7%).
- Early PP consultation (Group 1) was associated with significantly shorter hospital, ICU, and MV LOS compared to late consultation (Group 2) (p<0.001).
- Prolonged mechanical ventilation, respiratory failure, and late PP consultation were key contributors to extended ICU LOS.
Conclusions:
- Early PP consultation in pediatric and neonatal ICUs may be linked to improved patient outcomes.
- Further comprehensive research is needed due to the retrospective nature and potential confounding factors influencing LOS.
Introduction:
Respiratory illnesses are a major cause of mortality and morbidity in pediatric and neonatal intensive care units (ICUs). This study aimed to determine the impact of pediatric pulmonologist (PP) consultation on children in ICUs and assess differences in clinical outcomes.
Methods:
This single-center, retrospective, cross-sectional cohort study included children aged 0-18 years for whom PP consultations were requested between June 2022 and June 2023. Children were divided into two groups based on the median time from ICU admission to the consultation request. Group 1 (n = 221) received consultations within 14 days, defined as early consultation, while group 2 (n = 66) received consultations after 14 days, defined as late consultation. We compared demographic, clinical, and radiologic characteristics and the length of stay (LOS) in the hospital, ICU, and mechanical ventilator (MV).
Results:
Two hundred eighty-seven children were consulted by PPs. The most common reasons for the PP consultation were respiratory failure (39.4%), preoperative evaluation (14.6%), pneumonia (8.7%), atelectasis (5.9%), and suspicion of foreign body aspiration (5.6%). The median LOS in the hospital was 33 (IQR = 61) days, in the ICU was 13 (IQR = 33) days, and on the MV was 10.50 (IQR = 30.50) days. Group 1 had significantly lower LOS in the hospital, ICU, and MV than group 2 (p < 0.001 for all). We found that being monitored on an MV (p < 0.001), being consulted for prolonged intubation or respiratory failure (p < 0.001), and being consulted by a PP after a median of 14 days are the main contributors to prolonged ICU LOS.
Conclusions:
Early PP consultation for children treated in the PICU and NICU may be associated with better outcomes. Nevertheless, the retrospective nature of our study, the lack of risk scoring data for patients, and the numerous factors that can influence the LOS in the ICU and hospital for pediatric patients necessitate further comprehensive research to substantiate our findings.
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