A Constructivist Grounded Theory Study on the Use of Patient Diaries in pAediatric inTensive carE from parents' and nurses' perspectives: The UPDATE Study.

Background and objective: Childhood asthma is recognized to be one of the most common chronic diseases in children. Several national and international reports have demonstrated an increase in the prevalence of pediatric asthma and asthma-related Pediatric Intensive Care Unit (PICU) admissions. In addition, PICU admission among asthmatic children has been associated with an increase in the risk of asthma-related mortality. However, the predictors and risk factors of acute severe asthma that required PICU admission haven’t been identified. Thus, the purpose of this study was to investigate the predictive factors for PICU admission in children with asthma exacerbation.   Methodology: This study was conducted at the inpatient pediatric department of Maternity and Children Hospital (MCH), Alahsa, Saudi Arabia. Seventy-eight asthmatic patients, aged 1-13 years, who were admitted to either PICU or general pediatric ward as a case of asthma exacerbation between October 2022 and May 2023, were enrolled in this study. The diagnosis of asthma was identified by a pediatric allergist or pulmonologist who were involved in the inpatient or outpatient management care. The study design was a cross-sectional. The data collection sheet consisted of 6 sections of different variables including demographical data, characteristics of the current acute asthma exacerbation, asthma history, classification of asthma severity, asthma controlling therapy, and environmental triggers and atopy. The data was collected from the patients’ medical records and by interviewing the patients’ parents/caregivers.   Results: A total of 78 patients were enrolled in the study over a period of 8 months. Fifty-seven patients (73.1%) were admitted to the pediatric ward and 21 patients (26.9%) were admitted to the PICU. The gender ratio was approximately equal, with slight male predominance (56.4%). The mean age for the overall study population was 4.0 ± 2.6 years. The majority of the patients have healthy weight (42.3%) in both groups, with no obese patient was admitted to the PICU. Baseline mean SPO2 saturation was found to be higher in those admitted to the ward (p=.000). Around 87% of the patients received systemic steroids at the ED before hospitalization. The percentage of patients who used systemic steroids in the ED was higher for those admitted to the PICU. Around 97% of the patients’ exacerbations were triggered by infection. Meanwhile, mean length of stay was found to be approximately 33% (4.4 ± 2.2) higher in the PICU admissions (p=.043). Less than one-fifth of the total cohort has been found to be following up in the outpatient clinic the previous year (11/78, 14%). The history of prior therapy with ICS was found to be more prevalent in those who were admitted to PICU. Similarly, previous PICU admissions and prior hospital admissions were also more prevalent in those admitted to the PICU. However, it hasn’t been shown to be statically significant. Statistically significant differences were detected between SpO2 levels among children who were admitted to PICU as compared to those admitted to the pediatric ward, (86.2 ± 6.8%, p=.000). For each unit increase in the SpO2, there is a 0.8-fold increase in the odds of being admitted to the PICU (OR 0.8, 95% CI: 0.7–0.8, p=0.001). Nevertheless, pCO2 was another predictive factor for PICU admission, (OR 1.1, 95% CI: 1.0–1.2, p=0.013). Notably, previous PICU admission, last year admissions, and last year ED visits could not be quantified as predictive factors for PICU admission with statistical significance. Similarly, risk analysis between PICU admission and the type and severity of asthma did not reveal statistically significant results. Conclusion: Oxygen saturation (SpO2) measurements at the ED and pCO2 level are predictors of needing intensive care admission for children with acute severe asthma exacerbation, aged 1–13 years. Further large-scale studies are needed to explore the modifiable predictors that would help in identifying children with a high risk for intensive care admissions.

Fluid administration is essential in patients undergoing hematopoietic stem cell transplant (HSCT). Admission to pediatric intensive care unit (PICU) is required for 11-29% of pediatric HSCT recipients and is associated with high mortality. The objective of this study was to determine if a positive fluid balance acquired during the HSCT procedure is a risk factor for PICU admission. The medical records of 87 consecutive children who underwent a first HSCT were reviewed retrospectively for the following periods: from admission for HSCT to PICU admission for the first group (PICU group), and from admission for HSCT to hospital discharge for the second group (non-PICU group). Fluid balance was determined on the basis of weight gain (WG) and fluid overload (FO). PICU group consisted of 19 patients (21.8%). Among these, 13 (68.4%) developed>or=10% WG prior to PICU admission compared with 15 (22.1%) in the non-PICU group (p<0.001). Thirteen patients (68.4%) developed>or=10% FO prior to PICU admission compared with 31 (45.6%) in the non-PICU group (p=0.075). Following multivariate analysis, >or=10% WG (p=0.018) and cardiac dysfunction on admission for HSCT (p=0.036) remained independent risk factors for PICU admission. Smaller children (p=0.033) and patients with a twofold increase in serum creatinine (p=0.026) were at risk of developing>or=10% WG. This study shows that WG is a risk factor for PICU admission in pediatric HSCT recipients. Further research is needed to better understand the pathophysiology of WG in these patients and to determine the impact of WG prevention on PICU admission.

Near-Fatal Asthma: An Ounce of Prevention May be Worth More than a Pound of Cure

Important Outcomes for Parents of Critically Ill Children.

BackgroundLong-term morbidity after pediatric intensive care unit (PICU) admission is a growing concern. Both critical illness and accompanying PICU treatments may impact neurocognitive development as assessed by its gold standard measure; intelligence. This meta-analysis and meta-regression quantifies intelligence outcome after PICU admission and explores risk factors for poor intelligence outcome.MethodsPubMed, Embase, CINAHL and PsycINFO were searched for relevant studies, published from database inception until September 7, 2021. Using random-effects meta-analysis, we calculated the standardized mean difference in full-scale intelligence quotient (FSIQ) between PICU survivors and controls across all included studies and additionally distinguishing between PICU subgroups based on indications for admission. Relation between demographic and clinical risk factors and study’s FSIQ effect sizes was investigated using random-effects meta-regression analysis.ResultsA total of 123 articles was included, published between 1973 and 2021, including 8,119 PICU survivors and 1,757 controls. We found 0.47 SD (7.1 IQ-points) lower FSIQ scores in PICU survivors compared to controls (95%CI -0.55 to -0.40, p < .001). All studied PICU subgroups had lower FSIQ compared to controls (range 0.38–0.88 SD). Later year of PICU admission (range 1972–2016) and longer PICU stay were related to greater FSIQ impairment (R2 = 21%, 95%CI -0.021 to -0.007, p < .001 and R2 = 2%, 95%CI -0.027 to -0.002, p = .03, respectively), whereas male sex and higher rate of survivors were related to smaller FSIQ impairment (R2 = 5%, 95%CI 0.001 to 0.014, p = .03 and R2 = 11%, 95%CI 0.006 to 0.022, p < .001, respectively). Meta-regression in PICU subgroups showed that later year of PICU admission was related to greater FSIQ impairment in children admitted after cardiac surgery and heart- or heart–lung transplantation. Male sex was related to smaller FSIQ impairment in children admitted after cardiac surgery. Older age at PICU admission and older age at follow-up were related to smaller FSIQ impairment in children admitted after heart- or heart–lung transplantation.ConclusionsPICU survivors, distinguished in a wide range of subgroups, are at risk of intelligence impairment. Length of PICU stay, female sex and lower rate of survivors were related to greater intelligence impairment. Intelligence outcome has worsened over the years, potentially reflecting the increasing percentage of children surviving PICU admission.

BackgroundAnemia is prevalent at pediatric intensive care unit (PICU) admission and incident during PICU stay, but little is known about anemia at PICU discharge. Anemia after critical illness is an important issue because it could impact post-PICU outcome. We aimed to estimate the prevalence of anemia at PICU discharge and to determine its risk markers.MethodsThis is an ancillary study of a prospective observational study on transfusion practices conducted in the PICU of a tertiary care children’s hospital. All children consecutively admitted to the PICU during a 1-year period were considered for inclusion. Data were prospectively collected from medical charts, except for hemoglobin (Hb) levels at PICU and hospital discharge that were collected retrospectively. Anemia was defined by an Hb concentration below the lower limit of the normal range for age.ResultsAmong the 679 children retained for analysis, 390 (57.4%) were anemic at PICU discharge. After multivariate adjustment, anemia at PICU admission was the strongest risk marker of anemia at PICU discharge. The strength of this association varied according to age (interaction): The odds ratio (OR) (95% CI) of anemia at PICU discharge was 4.85 (1.67–14.11) for 1–5-month-old infants anemic versus not anemic at PICU admission, and it was 73.13 (13.43, 398.19) for adolescents anemic versus not anemic at PICU admission. Children admitted after a non-cardiac surgery had an increased risk of anemia at PICU discharge [OR 2.30 (1.37, 3.88), p = 0.002]. The proportion of anemic children differed between age categories, while the median Hb level did not exhibit significant variations according to age.ConclusionsAnemia is highly prevalent at PICU discharge and is strongly predicted by anemia at PICU admission. The usual age-based definitions of anemia may not be relevant for critically ill children. The consequences of anemia at PICU discharge are unknown and deserve further scrutiny.

The implementation of the approved respiratory syncytial virus (RSV) preventive interventions in immunisation programmes is advancing rapidly. Insight into healthcare costs of RSV-related paediatric intensive care unit (PICU) admissions is lacking, but of great importance to evaluate the impact of implementation. Therefore, this study aimed to determine the total annual RSV-related paediatric intensive care healthcare costs in the Netherlands. A nationwide prospective, observational, multicenter study was performed from September 2021 until June 2023. The total annual RSV-related healthcare costs on PICUs in the Netherlands were calculated using RSV-related costs (subgroup I) and consequential costs (subgroup II and III). Subgroup I comprised all PICU admitted infants ≤12 months of age with laboratory-confirmed RSV infection. Subgroup II and III consisted of postponed elective PICU admissions and refused acute PICU admissions due to RSV-related lack of PICU capacity. A total of 424 infants with RSV-related PICU admission were included. Median age at PICU admission was 46 days (IQR 25-89). The median length of PICU admission was 5 days (IQR 3-8). The total RSV-related PICU costs are € 3,826,386 in 2021-2022, and € 3,183,888 in 2022-2023. Potential costs averted by RSV preventive interventions is € 1.9 to € 2.6 million depending on season, and the duration of protection. RSV-related PICU admissions cost €3.1 to €3.8 million in the Netherlands during one season. The introduction of new RSV preventive interventions into the Dutch immunisation programme will generate significant cost-savings on PICUs and decreases the admission burden of PICUs. None.

It is extremely difficult to stratify bronchiolitis and predict the need for admission to the pediatric intensive care unit (PICU). We aimed to evaluate the capacity of a new lung ultrasound score (LUSBRO) to predict the need for admission to the PICU compared to a clinical score. This was a prospective observational single-center study that includes infants < 6 month of age admitted to a hospital due to acute bronchiolitis. Both scores were calculated at admission. The main outcome was PICU admission. Second endpoints were the need for mechanical ventilation, respiratory support duration, and the length of stay in the hospital. Eighty patients were included, with a median age of 53 days (IQR 29-115). Forty-four patients (55%) required PICU admission. LUSBRO score showed a better AUC compared to the clinical score to predict PICU admission: 0.932 (95% CI 0.873-0.990) vs. 0.675 (95% CI 0.556-0.794) and a positive correlation with the hospital length of stay. The best cut-off point for predicting the need for PICU admission for LUSBRO score was 6, showing a sensitivity of 90.91% and a specificity of 88.89%.Conclusions: The LUSBRO score is a useful tool to predict the need for admission to the PICU. What is Known • It is extremely difficult to stratify which patients affected by bronchiolitis should be precociously transferred to a third level hospital and will require pediatric intensive care unit (PICU) admission. • Clinical scores have been created but neither of them is accurate. What is New • The LUSBRO score is a useful tool to predict the need for admission to the PICU of patients with bronchiolitis and, consequently, to predict the patients who should be transferred to a tertiary hospital to optimize respiratory support.

Requiring pediatric intensive care unit (PICU) admission relates to high mortality and morbidity in patients who received hematopoietic stem cell transplantation (HSCT). In this study, we aimed to evaluate the indications for PICU admission, treatments, and the determining risk factors for morbidity and mortality in patients who had allogeneic HSCT from various donors. In this retrospective study, we enrolled to patients who required the PICU after receiving allogeneic HSCT at our Pediatric Bone Marrow Transplantation Unit between 2005 and 2020. We evaluated to indication to PICU admission, applications, mortality rate, and the determining factors to outcomes. Thirty-three (7%) patients had 47 PICU admissions and 471 patients underwent bone marrow transplantation during 16-year study period. Also, 14 repeated episodes were registered in 9 different patients. The median age of PICU admitted patients was 4 (0.3 to 18) years and 29 (62%) were male. The main reasons for PICU admission were a respiratory failure, sepsis, and neurological event in 20, 8, and 7 patients, respectively. The average length of PICU stay was 14.5 (1 to 80) days, 14 (43%) of patients survived and the mortality rate was 57%. Multiple organ failure ( P =0.001), need for respiratory support ( P =0.007), inotrope agents ( P =0.001), and renal replacement therapy ( P =0.013) were found as significant risk factors for mortality. Allogeneic HSCT recipients need PICU admission because of its related different life-threatening complications. But there is a good chance of survival with quality PICU care and different advanced organ support methods.

Exploring Factors Affecting Parental Psychological Vulnerability During Their Child's PICU Admission: A Prospective Pilot Cohort Study

Indicators of Neighborhood-Level Socioeconomic Position and Pediatric Critical Illness

Risk Factors and Outcomes Related to Pediatric Intensive Care Unit Admission after Hematopoietic Stem Cell Transplantation: A Single-Center Experience

PICU admission and complications following adenotonsillectomies in pediatric patients: A retrospective cohort study

To explore and understand the impact of paediatric intensive care unit (PICU) admission on longitudinal health outcomes, experiences and support needs of children and their parents in the first 6months after PICU discharge and to examine the role of ethnicity. This study uses a prospective, longitudinal design. The sample will include children (N=110) and at least one parent (N=110) admitted to the PICU (KKH-AM start-up fund, October 2020). Quantitative study: Participants will be recruited at PICU admission. Data will be collected at five time points: during PICU admission (T0), at PICU discharge (T1), 1month (T2), 3months (T3) and 6months (T4) after PICU discharge. Questionnaires will assess physical and cognitive outcomes of the child survivor. Emotional and social health outcomes will be assessed for both the child and the parents. Qualitative study: At least 12 parents will take part in a semi-structured interview conducted at both 1 and 6months after PICU to explore their experiences and support needs after PICU discharge. All interviews will be audio-recorded with verbatim transcription. We will use framework analysis for qualitative data analysis. Understanding of Singapore health outcomes after critical illness in kids (SHACK) and their families is limited. There is an urgent need to comprehensively understand the health trajectory and consequences of the PICU child survivors and their families. This research will be the first to explore the health outcomes, needs and experiences after paediatric critical illness in Asia. This study will provide an understanding of the health outcomes and trajectory of children and parents in the first 6months after PICU discharge and examine the association between race and outcomes after PICU discharge. Identification of modifiable pre-disposing risk factors during the PICU admission will inform future interventions to improve long-term outcomes of children and parents following paediatric critical illness. Clinicaltrial.gov: ClinicalTrials.gov Identifier: NCT04637113.

To investigate risk factors for pediatric intensive care unit (PICU) admission among children with acute lymphoblastic leukemia (ALL) and risk factors for receipt of life-sustaining therapy (LST) in the PICU. Clinical data of ALL patients treated at the Children's Medical Center of the Second Xiangya Hospital from June 2016 to June 2021 were retrospectively reviewed. Patients were categorized into PICU and non-PICU groups according to PICU admission. Multivariable logistic regression was applied to identify risk factors for PICU admission. The cumulative probability of PICU admission was estimated using Kaplan-Meier curves. PICU patients were further stratified into LST and non-LST groups according to whether LST was received, and multivariable logistic regression was used to identify risk factors for receiving LST. A total of 200 children with ALL were included; 42 (21.0%) were admitted to the PICU at least once, with 48 total admissions. Multivariable logistic regression analysis showed that hyperleukocytosis at diagnosis and lactate dehydrogenase (LDH) >500 U/L were independent risk factors for PICU admission (both P<0.05). Kaplan-Meier curves demonstrated that T-cell ALL and hyperleukocytosis were associated with higher cumulative PICU admission rates. Univariate analysis showed that C-reactive protein, albumin, and respiratory failure were significantly associated with the receipt of LST (all P<0.05). Further multivariable logistic regression analysis revealed that respiratory failure was significantly associated with an increased risk of receiving LST (OR=13.254, P=0.027). Children with ALL who have hyperleukocytosis at diagnosis and LDH >500 U/L have a higher risk of PICU admission; respiratory failure is an independent risk factor for receipt of LST among PICU-admitted ALL patients.