Poor Functional Outcomes in Pediatric Intensive Care Survivors in Brazil: Prevalence and Associated Factors.

Survivors of pediatric critical illnesses develop temporary or permanent functional impairments. We do not have enough data on Brazilian children, however, and the available evidence mainly shows results from high-income countries. Our objective was to assess changes in the functional status of children and adolescents surviving critical illnesses in Brazil, and to identify which factors contribute to these functional changes at pediatric intensive care unit (PICU) discharge. To develop this cross-sectional study, two researchers blinded to previous patient information applied the Functional Status Scale (FSS) with patients and caregivers at two different times in a tertiary PICU. The FSS examines six function domains as follows: (1) mental status, (2) sensory functioning, (3) communication, (4) motor functioning, (5) feeding, and (6) respiratory status. The functional decline/poor outcome was defined as an increase in points sufficient to alter the FSS total scores at discharge when comparing to the total baseline score. A total of 303 patients completed the study. Of these, 199 (66%) were with previous chronic conditions. The prevalence of functional decrease was 68% at PICU discharge. Young age (<12 months) and mechanical ventilation time ≥11 days increased by 1.44 (95% confidence interval [CI]: 1.20-1.74, p < 0.001) and 1.74 (95% CI: 1.49-2.03, p < 0.001), respectively, the chances of poor functional results at PICU discharge. This study is the first in Brazil to show that during the episode of critical illness, young age (≤12 months) and duration of invasive mechanical ventilation independently increased the chances of functional impairment in children.

Relationship between nutritional status and maximum inspiratory and expiratory pressures in cystic fibrosis.

BACKGROUND: Malnutrition might be expected to result in reduced maximum respiratory pressure and pulmonary function in cystic fibrosis (CF). OBJECTIVE: To assess the relationship between nutritional status and maximum respiratory pressures in patients with CF. METHODS: We performed a prospective cross-sectional study of patients > or = 16 y old attending the Adult CF Program at Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. Maximum inspiratory and expiratory pressures (MIP and MEP) were measured as indexes of respiratory muscle strength. Nutritional status was assessed via body mass index (BMI), triceps-skin-fold thickness and mid-upper-arm-muscle circumference. The patients were classified into 2 groups according to BMI: normal and nutritional depletion. Spirometry was performed by all subjects. RESULTS: The study included 39 patients (23 female/16 male) with a mean age of 23.7 +/- 6.4 y. The mean +/- SD percent-of-predicted MIP was 88.0 +/- 28.5% in the normal group and 83.2 +/- 27.3% in the nutritional-depletion group (p = 0.605). The mean +/- SD percent-of-predicted MEP was 84.7 +/- 24.2% in the normal group and 86.1 +/- 26.3% in the nutritional-depletion group (p = 0.874). The mean +/- SD percent-of-predicted forced expiratory volume in the first second (FEV(1)) was 55.2 +/- 27.5% in the normal group and 50.0 +/- 25.6% in the nutritional-depletion group (p = 0.568). MEP and MIP had no significant correlation to BMI or FEV(1). CONCLUSION: MEP and MIP had no significant relationship to nutritional status, clinical score, chest radiograph score, and pulmonary function.