ABSTRACT
INTRODUCTION: The purpose of this study is to describe the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) disease characteristics and management in children admitted to the pediatric intensive care units (PICU). METHODS: The present study was based on a national multicentric prospective registry including PICU patients with SARS-CoV2 infection or symptoms of multisystem inflammatory syndrome in children (MIS-C). RESULTS: A total of 298 patients were admitted to 41 different Spanish PICUs. A total of 76% of them were previously healthy. The most frequent manifestation was MIS-C (69.8%). On admission, 59.4% of patients did not have respiratory distress, and only 17.4% needed conventional mechanical ventilation (MV). The need for MV was associated with age (incidence rate ratios [IRR] 1.21, p < .012), pediatric sequential organ failure assessment score (p-SOFA) Score (IRR 1.12, p = .001), and need for transfusion (IRR 4.5, p < .004) in MIS-C patients, and with vasoactive drug use (IRR 2.73, p = .022) and the diagnosis of acute respiratory distress syndrome (IRR 2.83, p = .018) in patients admitted for other reasons. During the first day of admission, 56% of patients met shock criteria and 50.7% needed vasoactive drugs. In MIS-C patients, their use was associated with higher p-SOFA score (IRR 1.06, p < .001) and with the diagnosis of shock (IRR 5.78, p < .001). In patients without MIS-C, it was associated with higher p-SOFA score (IRR 1.05, p = .022). The mortality rate was 3%, being lower in MIS-C patients compared to patients admitted for other reasons (0.5% vs. 9.4%, p < .001). It was also lower in previously healthy patients compared to patients with previous comorbidities (0.9% vs. 9.7%, p < .001). CONCLUSIONS: Severe SARS-CoV2 infection is uncommon in the pediatric population. In our series, respiratory distress was rare, being MIS-C the most frequent cause of PICU admission related to SARS-CoV2. In most cases, the course of the disease was mild except in children with previous diseases.
Subject(s)
COVID-19 , Child , Humans , COVID-19/epidemiology , COVID-19/therapy , SARS-CoV-2 , RNA, Viral , Intensive Care Units, Pediatric , Registries , Data Analysis , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapyABSTRACT
BACKGROUND: Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. METHODS: A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. RESULTS: Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. CONCLUSIONS: MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.
Subject(s)
COVID-19/epidemiology , Pneumonia, Viral/epidemiology , Systemic Inflammatory Response Syndrome/epidemiology , Adolescent , Child , Child, Preschool , Female , Humans , Intensive Care Units, Pediatric , Male , Pandemics , Prospective Studies , Registries , SARS-CoV-2 , Spain/epidemiologyABSTRACT
A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.
Subject(s)
Intensive Care Units, Pediatric/standards , Patient Admission/standards , Patient Discharge/standards , Triage/standards , Child , Humans , SpainABSTRACT
La unidad de cuidados intensivos pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica. La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España. Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica
A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous intensive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition
Subject(s)
Humans , Child , Intensive Care Units, Pediatric/organization & administration , Triage/methods , Patient Discharge Summaries/standards , Admitting Department, Hospital/organization & administration , Hospitalization/trends , Critical Care/methods , Quality of Health Care/trends , Patient SafetyABSTRACT
La unidad de cuidados intensivos pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica. La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España. Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica
A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition
Subject(s)
Humans , Child , Patient Admission , Patient Discharge/standards , Triage/standards , Intensive Care Units/standards , Critical Care , Patient Safety , SpainABSTRACT
A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.
Subject(s)
Intensive Care Units, Pediatric/organization & administration , Patient Admission/standards , Patient Discharge/standards , Triage/standards , Child , Clinical Decision-Making , Diagnosis-Related Groups , Guideline Adherence , Humans , Intensive Care Units, Pediatric/statistics & numerical data , Organizational Policy , Patient Handoff/standards , SpainABSTRACT
INTRODUCTION: Complex liver injuries carry high morbidity and mortality ranging between 40 and 80%. OBJECTIVES: To describe the characteristics of patients with liver trauma in the intensive care unit of our hospital, and the causes, severity scales, diagnoses, and treatments of these injuries, as well as length of hospital stay, morbidity and mortality. PATIENTS AND METHOD: We retrospectively reviewed the patients with liver trauma admitted to our intensive care unit (ICU) from January 2000 to December 2005. There were two groups of patients: those who underwent surgery and those who received conservative treatment. RESULTS: Univariate analysis revealed statistically significant differences between the two groups in the Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission to the ICU, the Injury Severity Score (ISS), and the percentage of severelesions according to the Liver Injury Scale (LIS), as well as in the coexistence of lesions in the large intestine. CONCLUSIONS: From the statistical point of view, the two main variables guiding the therapeutic approach were hemodynamic instability and the need for transfusion. The indication for surgery showed a clear, although non-significant, association with mortality. Lastly, there was an association between the surgical option of packing and mortality.
Subject(s)
Liver/injuries , Adult , Female , Humans , Male , Retrospective Studies , Wounds and Injuries/diagnosis , Wounds and Injuries/epidemiology , Wounds and Injuries/therapyABSTRACT
Objetivos. Describir las características de los pacientes con traumatismo hepático ingresados en la Unidad de Cuidados Intensvos (UCI) de nuestro hospital, los mecanismos lesionales, las escalas de gravedad, los diagnósticos y los tratamientos, así como la estancia hospitalaria y la morbimortalidad. Pacientes y método. Se han analizado de forma retrospectiva los casos de traumatismo hepático que ingresaron en nuestra unidad de cuidados intensivos desde enero de 2000 hasta diciembre de 2005. Se diferenciaron dos grupos de pacientes según la opción terapéutica utilizada: pacientes intervenidos quirúrgicamente y pacientes tratados de forma conservadora. Resultados. Comparando las características de los pacientes sometidos a uno u otro tipo de tratamiento, comprobamos, mediante análisis univariable, que hubo diferencias estadísticamente significativas entre ambos grupos en la puntuación de la escala de gravedad APACHE II al ingreso en UCI, el Injury Severity Score (ISS), el porcentaje de lesiones hepáticas graves según la Liver Injury Scale (LIS), así como la concomitancia de lesión en el intestino grueso relacionada. Conclusiones. La inestabilidad hemodinámica y la necesidad de transfusión han sido, desde el punto de vista estadístico, las dos principales variables en las que se apoyó la decisión de la opción terapéutica que desarrollar. La indicación quirúrgica sin llegar a la significación estadística presenta una clara tendencia a tener relación con la mortalidad. Por último, también encontramos asociación entre la opción quirúrgica de realizar packing y mortalidad (AU)
Introduction. Complex liver injuries carry high morbidity and mortality ranging between 40 and 80%. Objectives. To describe the characteristics of patients with liver trauma in the intensive care unit of our hospital, and the causes, severity scales, diagnoses, and treatments of these injuries, as well as length of hospital stay, morbidity and mortality. Patients and method. We retrospectively reviewed the patients with liver trauma admitted to our intensive care unit (ICU) from January 2000 to December 2005. There were two groups of patients: those who underwent surgery and those who received conservative treatment. Results. Univariate analysis revealed statistically significant differences between the two groups in the Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission to the ICU, the Injury Severity Score (ISS), and the percentage of severelesions according to the Liver Injury Scale (LIS), as well as in the coexistence of lesions in the large intestine. Conclusions. From the statistical point of view, the two main variables guiding the therapeutic approach were hemodynamic instability and the need for transfusion. The indication for surgery showed a clear, although non-significant, association with mortality. Lastly, there was an association between the surgical option of packing and mortality (AU)
