Clinical-demographic characteristics of chronically critically-ill pediatric subjects in a weaning center
Abstract
Objective: To describe the clinical-demographic characteristics of chronically critically-ill pediatric subjects hospitalized in a weaning center. The secondary objective is to describe the weaning and decannulation success rate and mortality rate.
Materials and method: A descriptive case series study of chronically critically-ill pediatric subjects hospitalized in a rehabilitation unit.
Results: The subjects had at least two categories of chronic conditions according to Feudtner´s classification, the most frequent being technology dependence. Congenital, cardiovascular, and neurological conditions were the most common medical history. The rate of weaning, decannulation, mortality, and home discharge of subjects admitted with a tracheostomy tube was 50%, 18%, 9%, and 27%, respectively.
Conclusion: Chronically critically-ill tracheostomized pediatric subjects hospitalized in our rehabilitation unit had at least two categories of chronic conditions. Most subjects were male, under two years of age, and with prolonged hospitalization. Although half of the subjects achieved weaning success, only 18% were decannulated, with a low mortality rate. Therefore, pediatric subjects with technology dependence and high survival rate need to receive care in specialized and cost-efficient units, with a multidisciplinary approach.
References
Penela-Sánchez D, Ricart S, Vidiella N, García-García JJ. A study of paediatric patients with complex chronic conditions admitted to a paediatric department over a 12 month period. An Pediatr (Engl Ed). 2021 Oct;95(4):233-239. doi: 10.1016/j.anpede.2020.07.022
Crossref
| Google Scholar
Zorko D, McNally JD, Rochwerg B, Pinto N, Couban R, O'Hearn K, Choong K. Pediatric Chronic Critical Illness: Protocol for a Scoping Review. JMIR Res Protoc. 2021 Oct 1;10(10):e30582. doi: 10.2196/30582
Crossref
| Google Scholar
Volsko TA, Parker SW, Deakins K, Walsh BK, Fedor KL, Valika T, et al. AARC Clinical Practice Guideline: Management of Pediatric Patients With Tracheostomy in the Acute Care Setting. Respir Care. 2021 Jan;66(1):144-155. doi: 10.4187/respcare.08137
Crossref
| Google Scholar
Peterson-Carmichael SL, Cheifetz IM. The chronically critically ill patient: pediatric considerations. Respir Care. 2012 Jun;57(6):993-1002; discussion 1002-3. doi: 10.4187/respcare.01738
Crossref
| Google Scholar
Shapiro MC, Henderson CM, Hutton N, Boss RD. Defining Pediatric Chronic Critical Illness for Clinical Care, Research, and Policy. Hosp Pediatr. 2017 Apr;7(4):236-244. doi: 10.1542/hpeds.2016-0107
Crossref
| Google Scholar
Murphy Salem S, Graham RJ. Chronic Illness in Pediatric Critical Care. Front Pediatr. 2021 May 14;9:686206. doi: 10.3389/fped.2021.686206
Crossref
| Google Scholar
Pordes E, Gordon J, Sanders LM, Cohen E. Models of Care Delivery for Children With Medical Complexity. Pediatrics. 2018 Mar;141(Suppl 3):S212-S223. doi: 10.1542/peds.2017-1284F
Crossref
| Google Scholar
Marcus KL, Henderson CM, Boss RD. Chronic Critical Illness in Infants and Children: A Speculative Synthesis on Adapting ICU Care to Meet the Needs of Long-Stay Patients. Pediatr Crit Care Med. 2016 Aug;17(8):743-52. doi: 10.1097/PCC.0000000000000792
Crossref
| Google Scholar
Berry JG, Hall M, Cohen E, O'Neill M, Feudtner C. Ways to Identify Children with Medical Complexity and the Importance of Why. J Pediatr. 2015 Aug;167(2):229-37. doi: 10.1016/j.jpeds.2015.04.068
Crossref
| Google Scholar
Troch R, Schwartz J, Boss R. Slow and Steady: A Systematic Review of ICU Care Models Relevant to Pediatric Chronic Critical Illness. J Pediatr Intensive Care. 2020 Dec;9(4):233-240. doi: 10.1055/s-0040-1713160
Crossref
| Google Scholar
Lail J, Schoettker PJ, White DL, Mehta B, Kotagal UR. Applying the Chronic Care Model to Improve Care and Outcomes at a Pediatric Medical Center. Jt Comm J Qual Patient Saf. 2017 Mar;43(3):101-112. doi: 10.1016/j.jcjq.2016.12.002
Crossref
| Google Scholar
Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr. 2014 Aug 8;14:199. doi: 10.1186/1471-2431-14-199
Crossref
| Google Scholar
Climent Alcalá FJ, García Fernández de Villalta M, Escosa García L, Rodríguez Alonso A, Albajara Velasco LA. Unidad de niños con patología crónica compleja. Un modelo necesario en nuestros hospitales [Children's medically complex diseases unit. A model required in all our hospitals]. An Pediatr (Engl Ed). 2018 Jan;88(1):12-18. Spanish. doi: 10.1016/j.anpedi.2017.04.002
Crossref
| Google Scholar
Feudtner C, Kang TI, Hexem KR, Friedrichsdorf SJ, Osenga K, Siden H, et al. Pediatric palliative care patients: a prospective multicenter cohort study. Pediatrics. 2011 Jun;127(6):1094-101. doi: 10.1542/peds.2010-3225
Crossref
| Google Scholar
Zenteno D, Torres-Puebla G, Navarro X, Rivas C, Tapia J, Rodríguez-Núñez I, Cepeda J. Experience in a Pediatric Prolonged Mechanical Ventilation Unit from a public hospital in Chile. Arch Argent Pediatr. 2021 Feb;119(1):25-31. doi: 10.5546/aap.2021.eng.25
Crossref
| Google Scholar
Foy CM, Koncicki ML, Edwards JD. Liberation and mortality outcomes in pediatric long-term ventilation: A qualitative systematic review. Pediatr Pulmonol. 2020 Nov;55(11):2853-2862. doi: 10.1002/ppul.25003
Crossref
| Google Scholar
Can FK, Anıl AB, Anıl M, Gümüşsoy M, Çitlenbik H, Kandoğan T, Zengin N. The outcomes of children with tracheostomy in a tertiary care pediatric intensive care unit in Turkey. Turk Pediatri Ars. 2018 Sep 1;53(3):177-184. doi: 10.5152/TurkPediatriArs.2018.6586
Crossref
| Google Scholar
