ABSTRACT
Objective: The objective of the current study was to evaluate the timing of first extubation and compare the outcome of patient extubated early with others; we also evaluated the predictors of early extubation in our cohort. Materials and Methods: This prospective cohort study included children <1 year of age undergoing surgery for congenital heart disease. Timing of first extubation was noted, and patients were dichotomized in the group taking 6 h after completion of surgery as cutoff for early extubation. The outcome of the patients extubated early was compared with those who required prolonged ventilation. Variables were compared between the groups, and predictors of early extubation were evaluated using multivariate logistic regression analysis. Results: One hundred and ninety-four (33.8%) patients were extubated early including 2 extubation in operating room and 406 (70.7%) were extubated within 24 h. Four (0.7%) patients died without extubation. No significant difference in mortality and reintubation was observed between groups. Patient extubated early had a significant lower incidence of sepsis (P = 0.003) and duration of Intensive Care Unit (ICU) stay (P = 0.000). Age <6 months, risk adjustment for congenital heart surgery category ≥3, cardiopulmonary bypass time ≥80 min, aortic cross-clamp time ≥ 60 min, and vasoactive-inotropic score >10 were independently associated with prolonged ventilation. Conclusion: Early extubation in infants postcardiac surgery lowers pediatric ICU stay and sepsis without increasing the risk of mortality or reintubation. Age more than 6 months, less complex of procedure, shorter surgery time, and lower inotropic requirement are independent predictors of early extubation.
ABSTRACT
Background: The objective of the current study was to evaluate the ability of PRISM III score calculated within 24 hours of PICU admission to predict outcome in patients with dengue fever. Materials & Methods: The prospective cohort study included children admitted to PICU with diagnosis of ‘Dengue with warning sign’ and ‘Severe Dengue’. Outcome included PICU mortality, length of PICU stay (LOS), need for mechanical ventilation and renal replacement therapy (RRT). PRISM III score was calculated and compared with outcome groups. Calibration of the score was measured using Hosmer‑Lemeshow modification of chi square test and discrimination using Area under the curve of Receiver Operating Characteristic curves. Results: This study included 151 patients with 54.3% Dengue with warning signs and 45.7% severe Dengue. Median PRISM III-24 score of patients who died (p-0.001), required RRT (p-0.006), mechanical ventilation (p-0.032) and those with prolonged LOS (p-0.003) were significantly higher. Hosmer‑Lemeshow modification of chi square test to assess calibration showed good fit of PRISM III-24 model to predict mortality (χ2-2.022; p-0.846), need for RRT (χ2-3.564; p-0.614), prolonged LOS (χ2-4.360; p-0.499) and need for mechanical ventilation (χ2-7.497; p-0.186). ROC curve for the PRISM III-24 model to predict the discriminating power yield an AUC of 0.923 (95% CI: 0.829-1.000) for mortality, 0.953 (95% CI: 0.896-1.000) for need for RRT, 0.682 (95% CI: 0.494-0.870) for need for mechanical ventilation and 0.663 (95% CI: 0.563-0.764) for prolonged LOS. Conclusion: PRISM III is an effective tool to predict mortality and need for RRT in patient with dengue fever