ABSTRACT
We retrospectively audited children with sickle cell disease (SCD) admitted to paediatric intensive care (PICU) at King's College Hospital between January 2000 and December 2008. Forty-six children with SCD were admitted, on 49 separate occasions. Ages ranged from 4 months to 15 years (median 7.6 years). Three children died in PICU, however two presented to hospital in cardiorespiratory arrest; overall mortality was 6%. The most common reason for admission was acute chest syndrome (43%). 88% of admissions required blood transfusion, of which 74% had exchange blood transfusions. The mortality among children with SCD admitted to PICU is low.
Subject(s)
Anemia, Sickle Cell/therapy , Critical Care/methods , Acute Chest Syndrome/etiology , Adolescent , Anemia, Sickle Cell/complications , Anti-Bacterial Agents/therapeutic use , Blood Transfusion , Cardiotonic Agents/therapeutic use , Child , Child, Preschool , Hospitalization , Humans , Infant , Intensive Care Units, Pediatric , Length of Stay/statistics & numerical data , Respiration, Artificial , Retrospective Studies , Treatment OutcomeABSTRACT
RATIONALE: Indices that assess the load on the respiratory muscles, such as the tension-time index (TTI), may predict extubation outcome. OBJECTIVES: To evaluate the performance of a noninvasive assessment of TTI, the respiratory muscle tension time index (TTmus), by comparison to that of the diaphragm tension time index (TTdi) and other predictors of extubation outcome in ventilated children. METHODS: Eighty children (median [range] age 2.1 yr [0.15-16]) admitted to pediatric intensive care units at King's College and St Mary's Hospitals who required mechanical ventilation for more than 24 hours were studied. MEASUREMENTS AND MAIN RESULTS: TTmus, maximal inspiratory pressure, respiratory drive, respiratory system mechanics, and functional residual capacity using a helium dilution technique, the rapid shallow breathing and CROP indices (compliance, rate, oxygenation, and pressure) indexed for body weight were measured and standard clinical data recorded in all patients. TTdi was measured in 28 of the 80 children using balloon catheters. Eight children (three in the TTdi group) failed extubation. TTmus (0.199 vs. 0.09) and TTdi (0.157 vs. 0.07) were significantly higher in children who failed extubation. TTmus greater than 0.18 (n = 80) and TTdi greater than 0.15 (n = 28) had sensitivities and specificities of 100% in predicting extubation failure. The other predictors performed less well. CONCLUSIONS: Invasive and noninvasive measurements of TTI may provide accurate prediction of extubation outcome in mechanically ventilated children.