ABSTRACT
AIM: To investigate the opinion and personal experience of parents of children born with Hypoplastic Left Heart Syndrome and what advice they would give to other parents who have to decide between treatment options. METHODS: We conducted a qualitative, descriptive and retrospective study by means of a survey directed to parents of children born with Hypoplastic Left Heart Syndrome in a tertiary hospital in Buenos Aires (Argentina). Their answers and data regarding medical procedures were analysed. RESULTS: Parents of thirteen out of sixteen patients with Hypoplastic Left Heart Syndrome were surveyed. Norwood surgery had been performed in all the patients, many had received other procedures, and five had died. In relation to the decision-making process, sixty-one percent of parents would recommend other parents to remain at peace after having done everything possible and 54% would suggest to not feel guilt despite the final result. None of the parents would recommend rejecting surgical treatment and choosing comfort care. CONCLUSION: The majority of parents of children with Hypoplastic Left Heart Syndrome would recommend continuing with the therapeutic effort in order to feel at peace and reduce feelings of guilt.
Subject(s)
Hypoplastic Left Heart Syndrome , Norwood Procedures , Child , Humans , Hypoplastic Left Heart Syndrome/surgery , Retrospective Studies , Parents , EmotionsABSTRACT
BACKGROUND: Nearly 90% children with cancer reside in low- and middle-income countries, which face multiple challenges delivering high-quality pediatric onco-critical care (POCC). We recently identified POCC quality and capacity indicators for PROACTIVE (PediatRic Oncology cApaCity assessment Tool for IntensiVe carE), a tool that evaluates strengths and limitations in POCC services. This study describes pilot testing of PROACTIVE, development of center-specific reports, and identification of common POCC challenges. METHODS: The original 119 consensus-derived PROACTIVE indicators were converted into 182 questions divided between 2 electronic surveys for intensivists and oncologists managing critically ill pediatric cancer patients. Alpha-testing was conducted to confirm face-validity with four pediatric intensivists. Eleven centers representing diverse geographic regions, income levels, and POCC services conducted beta-testing to evaluate usability, feasibility, and applicability of PROACTIVE. Centers' responses were scored and indicators with mean scores ≤75% in availability/performance were classified as common POCC challenges. RESULTS: Alpha-testing ensured face-validity and beta-testing demonstrated feasibility and usability of PROACTIVE (October 2020-June 2021). Twenty-two surveys (response rate 99.4%) were used to develop center-specific reports. Adjustments to PROACTIVE were made based on focus group feedback and surveys, resulting in 200 questions. Aggregated data across centers identified common POCC challenges: (1) lack of pediatric intensivists, (2) absence of abstinence and withdrawal symptoms monitoring, (3) shortage of supportive care resources, and (4) limited POCC training for physicians and nurses. CONCLUSIONS: PROACTIVE is a feasible and contextually appropriate tool to help clinicians and organizations identify challenges in POCC services across a wide range of resource-levels. Widespread use of PROACTIVE can help prioritize and develop tailored interventions to strengthen POCC services and outcomes globally.
Subject(s)
Neoplasms , Resource-Limited Settings , Humans , Child , Neoplasms/diagnosis , Neoplasms/therapy , Quality of Health Care , Surveys and Questionnaires , Critical CareABSTRACT
Introducción: El trasplante de células progenitoras hematopoyéticas (TPH) en niños es un procedimiento no exento de complicaciones graves. El ingreso de esta población a unidades de cuidados intensivos pediátricos (UCIP) se asocia con elevada mortalidad. Objetivos: Analizar la sobrevida y los factores predictivos de la mortalidad en niños que recibieron TPH e ingresaron a la UCIP y elaborar un modelo predictivo de mortalidad en esta población. Materiales y métodos: Revisión retrospectiva de niños y adolescentes que recibieron un TPH entre el 01/01/2005 y el 31/12/2019 e ingresaron a la UCIP de un hospital universitario de alta complejidad. Resultados: De un total de 264 niños que recibieron el trasplante, 114 ingresaron a la UCIP. La mortalidad general fue del 29 % (n = 34). El tipo de trasplante, enfermedad basal, evento de neutropenia febril, infección por citomegalovirus, insuficiencia respiratoria, enfermedad de injerto contra huésped (EICH), quimioterapia mieloablativa y desnutrición previa se asociaron con tasas de mortalidad más elevadas. En el análisis multivariado, la EICH (razón de posibilidades [OR, por su sigla en inglés]: 2,23; intervalo de confianza del 95 % [IC 95 %]: 1,92-2,98), la necesidad de ventilación mecánica invasiva (OR: 2,47; IC95 %: 1,39-5,73), el trasplante de donante alternativo (OR: 1,58; IC 95 %: 1,14-2,17) y la desnutrición previa (OR: 1,78; IC 95 %: 1,223-3,89) se asociaron con mayor mortalidad. Conclusión: En la población estudiada, dos de cada tres niños que recibieron TPH e ingresaron a la UCIP sobrevivieron. La EICH, ventilación mecánica, trasplante de donante alternativo y desnutrición previa fueron factores predictivos de mortalidad
Introduction: Hematopoietic stem cell transplantation (HSCT) in children is a procedure that is not exempt of severe complications. Admission to the pediatric intensive care unit (PICU) is associated with a high mortality rate. Objectives: To analyze survival and predictors of mortality among children who received a HSCT and were admitted to the PICU, and to develop a mortality prediction model in this population. Materials and methods: Retrospective review of children and adolescents who received a HSCT between January 1st, 2005 and December 31st, 2019 and were admitted to the PICU of a tertiary care teaching hospital. Results: Out of 264 children receiving the transplant 114 were admitted to the PICU. The overall mortality rate was 29 % (n = 34). The type of transplant, underlying disease, febrile neutropenia event, cytomegalovirus infection, respiratory failure, graft versus host disease (GVHD), myeloablative chemotherapy, and previous malnutrition were associated with higher mortality rates. In the multivariate analysis, GVHD (odds ratio [OR]: 2.23; 95 % confidence interval [CI]: 1.92-2.98), need for mechanical ventilation (OR: 2.47; 95 % CI: 1.39-5.73), alternative donor transplant (OR: 1.58; 95 % CI: 1.14-2.17), and previous malnutrition (OR: 1.78; 95 % CI: 1.22-3.89) were associated with a higher mortality rate. Conclusion: In the studied population, 2 out of 3 children who received a HSCT and were admitted to the PICU survived. GVHD, mechanical ventilation, alternative donor transplant, and previous malnutrition were predictors of mortality
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric/statistics & numerical data , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/mortality , Respiration, Artificial , Retrospective Studies , Critical Illness , Sepsis , Malnutrition , Graft vs Host DiseaseABSTRACT
INTRODUCTION: Hematopoietic stem cell transplantation (HSCT) in children is a procedure that is not exempt of severe complications. Admission to the pediatric intensive care unit (PICU) is associated with a high mortality rate. Objectives: To analyze survival and predictors of mortality among children who received a HSCT and were admitted to the PICU, and to develop a mortality prediction model in this population. MATERIALS AND METHODS: Retrospective review of children and adolescents who received a HSCT between January 1st, 2005 and December 31st, 2019 and were admitted to the PICU of a tertiary care teaching hospital. RESULTS: Out of 264 children receiving the transplant, 114 were admitted to the PICU. The overall mortality rate was 29% (n = 34). The type of transplant, underlying disease, febrile neutropenia event, cytomegalovirus infection, respiratory failure, graft versus host disease (GVHD), myeloablative chemotherapy, and previous malnutrition were associated with higher mortality rates. In the multivariate analysis, GVHD (odds ratio [OR]: 2.23; 95% confidence interval [CI]: 1.92-2.98), need for mechanical ventilation (OR: 2.47; 95% CI: 1.39- 5.73), alternative donor transplant (OR: 1.58; 95% CI: 1.14-2.17), and previous malnutrition (OR: 1.78; 95% CI: 1.22-3.89) were associated with a higher mortality rate. CONCLUSION: In the studied population, 2 out of 3 children who received a HSCT and were admitted to the PICU survived. GVHD, mechanical ventilation, alternative donor transplant, and previous malnutrition were predictors of mortality.
Introducción: El trasplante de células progenitoras hematopoyéticas (TPH) en niños es un procedimiento no exento de complicaciones graves. El ingreso de esta población a unidades de cuidados intensivos pediátricos (UCIP) se asocia con elevada mortalidad. Objetivos: Analizar la sobrevida y los factores predictivos de la mortalidad en niños que recibieron TPH e ingresaron a la UCIP y elaborar un modelo predictivo de mortalidad en esta población. Materiales y métodos: Revisión retrospectiva de niños y adolescentes que recibieron un TPH entre el 01/01/2005 y el 31/12/2019 e ingresaron a la UCIP de un hospital universitario de alta complejidad. Resultados: De un total de 264 niños que recibieron el trasplante, 114 ingresaron a la UCIP. La mortalidad general fue del 29% (n = 34). El tipo de trasplante, enfermedad basal, evento de neutropenia febril, infección por citomegalovirus, insuficiencia respiratoria, enfermedad de injerto contra huésped (EICH), quimioterapia mieloablativa y desnutrición previa se asociaron con tasas de mortalidad más elevadas. En el análisis multivariado, la EICH (razón de posibilidades [OR, por su sigla en inglés]: 2,23; intervalo de confianza del 95% [IC 95%]: 1,92-2,98), la necesidad de ventilación mecánica invasiva (OR: 2,47; IC95%: 1,39-5,73), el trasplante de donante alternativo (OR: 1,58; IC 95%: 1,14-2,17) y la desnutrición previa (OR: 1,78; IC 95%: 1,223-3,89) se asociaron con mayor mortalidad. Conclusión: En la población estudiada, dos de cada tres niños que recibieron TPH e ingresaron a la UCIP sobrevivieron. La EICH, ventilación mecánica, trasplante de donante alternativo y desnutrición previa fueron factores predictivos de mortalidad.
Subject(s)
Hematopoietic Stem Cell Transplantation , Intensive Care Units, Pediatric , Adolescent , Child , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Respiration, Artificial , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCTION: Submersion injury is associated with high morbidity and mortality, being the third leading cause of accidental death among children. OBJECTIVES: To analyze and describe risk factors, prognosis, and survival of victims, admitted to a third level Community Teaching Hospital. Population, material and methods. A retrospective, observational, analytical study. We studied patients admitted to the pediatric critical care unit, between 06/2000 and 01/2008. The following variables were analyzed: age, sex, length of stay, days of mechanical ventilation, Glasgow Coma Scale (GCS) score, apnea, bradycardia; baseline, 24 and 48 h lactacidemia, submersion time, swimming pool watchers of the victims. Stata 8.0 software was used; continuous variables were analyzed using Wilcoxon test; for categorical variables Z test and Chi square test were used, and a logistic regression analysis was performed. RESULTS: 30 near-drowning victims were admitted, median age was 25 months (R = 11-144 months). 41.3% occurred during summer, 60% were under parental supervision. Sibling supervision was associated with an increased risk of near-drowning (RR: 2.1; 95% CI 1.1-3.2). Immersion time was > 10 minutes in 3.4%; 26% had apnea, and the GCS score was < 5 in 19.99%. Lactic acid at admission was > 3 mmol/l in 10 patients. Risk factors like glucose level > or = 300 mg% (OR: 3.325), apnea (OR: 2.752), bradycardia (OR: 4.74), GCS <5 (OR: 3.550) and inmersion time > 10 minutes (OR: 5.12), were associated with poor prognosis. Mortality was 2/30 patients. CONCLUSION: In our population, the presence of apnea, bradycardia, GCS <5, glucose level > or = 300 mg%, submersion time > 10 minutes, and lactic acid > 6 mmol/l at admission and the first 24 h, were associated with a poor prognosis and serious injury.
Subject(s)
Near Drowning/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
Introducción. El ahogamiento por sumersión es un cuadro con alta morbimortalidad; es la tercera causa accidental de muerte en la población infantil. El objetivo fue analizar y describir factores de riesgo, pronóstico y supervivencia de las víctimas por casi ahogamiento, admitidas en un hospital universitario de alta complejidad. Población, material y métodos. Estudio retrospectivo, observacional, analítico. Se estudiaron los pacientes admitidos en una Unidad de Cuidados Intensivos Pediátricos, entre junio del año 2000 y enero de 2008. Se analizaron múltiples variables. Resultados. Ingresaron 30 pacientes, cuya mediana de edad fue 25 meses (intervalo: 11-144 meses), predominio masculino. El 41,3 por ciento de los episodios ocurrieron en verano, 60 por ciento de los niños estaba bajo supervisión de los padres. El tiempo medio de sumersión fue > 10 minutos en el 3,4 por ciento, tuvieron apnea al ingreso 26 por ciento y el Puntaje de Glasgow fue < 5 en 19,99 por ciento. El ácido láctico fue mayor a 3 mmol/l en 10 pacientes. Se asociaron con mal pronóstico, quienes al ingreso tuvieron glucemia ≥ 300 mg por ciento (OR: 3,325), apnea (OR: 2,752), bradicardia (OR: 4,74), Glasgow < 5 (OR: 3,550) y tiempo de sumersión > a 10 minutos (OR: 5,12). Murieron 2/30 pacientes. Conclusión. En nuestra población, la presencia de apneas, bradicardia, glucemia ≥ 300 mg por ciento, Puntaje de Glasgow < 5 y sumersión mayor a 10minutos, se asociaron a mal pronóstico. La elevación de ácido láctico > 6 mmol/l al ingreso y a las 24 h fue marcador de lesión grave.(AU)
Subject(s)
Infant, Newborn , Infant , Child, Preschool , Near Drowning/epidemiology , Risk Factors , Prognosis , Survival Analysis , Near Drowning/complications , Data Interpretation, Statistical , Retrospective Studies , Observational Studies as TopicABSTRACT
Introducción. El ahogamiento por sumersión es un cuadro con alta morbimortalidad; es la tercera causa accidental de muerte en la población infantil. El objetivo fue analizar y describir factores de riesgo, pronóstico y supervivencia de las víctimas por casi ahogamiento, admitidas en un hospital universitario de alta complejidad. Población, material y métodos. Estudio retrospectivo, observacional, analítico. Se estudiaron los pacientes admitidos en una Unidad de Cuidados Intensivos Pediátricos, entre junio del año 2000 y enero de 2008. Se analizaron múltiples variables. Resultados. Ingresaron 30 pacientes, cuya mediana de edad fue 25 meses (intervalo: 11-144 meses), predominio masculino. El 41,3 por ciento de los episodios ocurrieron en verano, 60 por ciento de los niños estaba bajo supervisión de los padres. El tiempo medio de sumersión fue > 10 minutos en el 3,4 por ciento, tuvieron apnea al ingreso 26 por ciento y el Puntaje de Glasgow fue < 5 en 19,99 por ciento. El ácido láctico fue mayor a 3 mmol/l en 10 pacientes. Se asociaron con mal pronóstico, quienes al ingreso tuvieron glucemia ≥ 300 mg por ciento (OR: 3,325), apnea (OR: 2,752), bradicardia (OR: 4,74), Glasgow < 5 (OR: 3,550) y tiempo de sumersión > a 10 minutos (OR: 5,12). Murieron 2/30 pacientes. Conclusión. En nuestra población, la presencia de apneas, bradicardia, glucemia ≥ 300 mg por ciento, Puntaje de Glasgow < 5 y sumersión mayor a 10minutos, se asociaron a mal pronóstico. La elevación de ácido láctico > 6 mmol/l al ingreso y a las 24 h fue marcador de lesión grave.
