Comparison of outcomes between children ventilated in a non‐paediatric intensive care and a paediatric intensive care unit: A retrospective analysis
Background. Lack of paediatric intensive care infrastructure, human resources and expertise in low- and middle-income countries (LMICs) often results in critically ill children being managed in non-intensive-care unit (ICU) settings. Objectives. To compare the mortality between critically ill patien...
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| Format: | Article |
| Language: | English |
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South African Medical Association
2022-10-01
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| Series: | African Journal of Thoracic and Critical Care Medicine |
| Subjects: | |
| Online Access: | https://samajournals.co.za/index.php/ajtccm/article/view/247 |
| _version_ | 1797326633371172864 |
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| author | X L Jingxi P Tinarwo R Masekela M Archary |
| author_facet | X L Jingxi P Tinarwo R Masekela M Archary |
| author_sort | X L Jingxi |
| collection | DOAJ |
| description | Background. Lack of paediatric intensive care infrastructure, human resources and expertise in low- and middle-income countries (LMICs) often results in critically ill children being managed in non-intensive-care unit (ICU) settings.
Objectives. To compare the mortality between critically ill patients who required ventilation for more than 24 hours in a non-paediatric ICU (PICU) setting v. those admitted directly to a PICU.
Methods. Participants were enrolled if they were between one month and 13 years of age and were ventilated in a non-PICU ward in a regional hospital and a PICU ward in a tertiary/quaternary hospital during the study period of January 2015 - December 2017 in KwaZulu- Natal, South Africa. Descriptive statistics, chi-square test, Wilcoxon test and binary logistic regression were used for data analysis. Ethics approval was obtained (approval number BE568/18 BREC) from the Biostatistics Research Council of the University of KwaZulu-Natal.
Results. Of the 904 admissions, 25.1% (n=227) were admitted to non-PICU and 74.9% (n=677) to a PICU. A significantly higher proportion of non-PICU patients were malnourished than PICU patients (26.4% v. 13.3%, p<0.001). Patients ventilated in a PICU were 76% less likely to die (p<0.001), while patients who required inotropes were 15.08 (9.68 - 24.34) times more likely to die (p<0.001). There was a statistically significant association between admission setting and survival outcome, with higher mortality in the non-PICU setting than in the PICU setting (46.3% v. 19.5%, p<0.001).
Conclusion. Critically ill children ventilated in a non-PICU setting in KwaZulu-Natal are more likely to be malnourished, require inotropes and have higher mortality. Although increasing access to PICU bed availability is a long-term goal, the high mortality in the non-PICU setting highlights the need to optimise the availability of resources in these non-PICU wards, optimise and train the staff, and improve primary healthcare services. |
| first_indexed | 2024-03-08T06:27:03Z |
| format | Article |
| id | doaj.art-2b325c2e55d44bfd8b84b5d4ac448de4 |
| institution | Directory Open Access Journal |
| issn | 2617-0191 2617-0205 |
| language | English |
| last_indexed | 2024-03-08T06:27:03Z |
| publishDate | 2022-10-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | African Journal of Thoracic and Critical Care Medicine |
| spelling | doaj.art-2b325c2e55d44bfd8b84b5d4ac448de42024-02-03T13:30:13ZengSouth African Medical AssociationAfrican Journal of Thoracic and Critical Care Medicine2617-01912617-02052022-10-0110911410.7196/AJTCCM.2022.v28i3.215251Comparison of outcomes between children ventilated in a non‐paediatric intensive care and a paediatric intensive care unit: A retrospective analysisX L Jingxi0P Tinarwo1R Masekela2M Archary3Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaDepartment of Paediatrics, King Edward VIII Hospital, Durban, South AfricaDepartment of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Department of Dietetics, King Edward VIII Hospital, Durban, South AfricaDepartment of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Department of Biostatistics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South AfricaBackground. Lack of paediatric intensive care infrastructure, human resources and expertise in low- and middle-income countries (LMICs) often results in critically ill children being managed in non-intensive-care unit (ICU) settings. Objectives. To compare the mortality between critically ill patients who required ventilation for more than 24 hours in a non-paediatric ICU (PICU) setting v. those admitted directly to a PICU. Methods. Participants were enrolled if they were between one month and 13 years of age and were ventilated in a non-PICU ward in a regional hospital and a PICU ward in a tertiary/quaternary hospital during the study period of January 2015 - December 2017 in KwaZulu- Natal, South Africa. Descriptive statistics, chi-square test, Wilcoxon test and binary logistic regression were used for data analysis. Ethics approval was obtained (approval number BE568/18 BREC) from the Biostatistics Research Council of the University of KwaZulu-Natal. Results. Of the 904 admissions, 25.1% (n=227) were admitted to non-PICU and 74.9% (n=677) to a PICU. A significantly higher proportion of non-PICU patients were malnourished than PICU patients (26.4% v. 13.3%, p<0.001). Patients ventilated in a PICU were 76% less likely to die (p<0.001), while patients who required inotropes were 15.08 (9.68 - 24.34) times more likely to die (p<0.001). There was a statistically significant association between admission setting and survival outcome, with higher mortality in the non-PICU setting than in the PICU setting (46.3% v. 19.5%, p<0.001). Conclusion. Critically ill children ventilated in a non-PICU setting in KwaZulu-Natal are more likely to be malnourished, require inotropes and have higher mortality. Although increasing access to PICU bed availability is a long-term goal, the high mortality in the non-PICU setting highlights the need to optimise the availability of resources in these non-PICU wards, optimise and train the staff, and improve primary healthcare services.https://samajournals.co.za/index.php/ajtccm/article/view/247non-picupicuoutcomesmortalityinterim ventilation |
| spellingShingle | X L Jingxi P Tinarwo R Masekela M Archary Comparison of outcomes between children ventilated in a non‐paediatric intensive care and a paediatric intensive care unit: A retrospective analysis African Journal of Thoracic and Critical Care Medicine non-picu picu outcomes mortality interim ventilation |
| title | Comparison of outcomes between children ventilated in a non‐paediatric intensive care and a paediatric intensive care unit: A retrospective analysis |
| title_full | Comparison of outcomes between children ventilated in a non‐paediatric intensive care and a paediatric intensive care unit: A retrospective analysis |
| title_fullStr | Comparison of outcomes between children ventilated in a non‐paediatric intensive care and a paediatric intensive care unit: A retrospective analysis |
| title_full_unstemmed | Comparison of outcomes between children ventilated in a non‐paediatric intensive care and a paediatric intensive care unit: A retrospective analysis |
| title_short | Comparison of outcomes between children ventilated in a non‐paediatric intensive care and a paediatric intensive care unit: A retrospective analysis |
| title_sort | comparison of outcomes between children ventilated in a non paediatric intensive care and a paediatric intensive care unit a retrospective analysis |
| topic | non-picu picu outcomes mortality interim ventilation |
| url | https://samajournals.co.za/index.php/ajtccm/article/view/247 |
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