儿童重症监护室儿童慢性危重症的病因组成及预后分析

doi:10.7499/j.issn.1008-8830.2302053

Abstract
Figure/Table
References(26)
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (550 KB) HTML
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To explore the etiology composition and outcomes of pediatric chronic critical illness (PCCI) in the pediatric intensive care unit (PICU). Methods The children who were hospitalized in the PICU of Dongguan Children's Hospital Affiliated to Guangdong Medical University and met the diagnostic criteria for PCCI from January 2017 to December 2022 were included in the study. The etiology of the children was classified based on their medical records and discharge diagnoses. Relevant clinical data during hospitalization were collected and analyzed. Results Among the 3 955 hospitalized children in the PICU from January 2017 to December 2022, 321 cases (8.12%) met the diagnostic criteria for PCCI. Among the 321 cases, the most common etiology was infection (71.3%, 229 cases), followed by unintentional injury (12.8%, 41 cases), postoperation (5.9%, 19 cases), tumors/immune system diseases (5.0%, 16 cases), and genetic and chromosomal diseases (5.0%, 16 cases). Among the 321 cases, 249 cases (77.6%) were discharged after improvement, 37 cases (11.5%) were discharged at the request of the family, and 35 cases (10.9%) died in the hospital. Among the deaths, infection accounted for 74% (26/35), unintentional injury accounted for 17% (6/35), tumors/immune system diseases accounted for 6% (2/35), and genetic and chromosomal diseases accounted for 3% (1/35). From 2017 to 2022, the proportion of PCCI in PICU diseases showed an increasing trend year by year (P<0.05). Among the 321 children with PCCI, there were 148 infants and young children (46.1%), 57 preschool children (17.8%), 54 school-aged children (16.8%), and 62 adolescents (19.3%), with the highest proportion in the infant and young children group (P<0.05). The in-hospital mortality rates of the four age groups were 14.9% (22/148), 8.8% (5/57), 5.6% (3/54), and 8.1% (5/62), respectively. The infant and young children group had the highest mortality rate, but there was no statistically significant difference among the four groups (P>0.05). Conclusions The proportion of PCCI in PICU diseases is increasing, and the main causes are infection and unintentional injury. The most common cause of death in children with PCCI is infection. The PCCI patient population is mainly infants and young children, and the in-hospital mortality rate of infant and young children with PCCI is relatively high.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	TAN Zi-Feng
	LI En-Si
	ZHONG Wei-Bin
	YANG Dong-Ru
	MA Ke-Ze
	LAI Zhi-Jun
	CHEN Su-Jun
	ZHENG Man

Key words： Pediatric chronic critical illness Pediatric intensive care unit Etiology Prognosis Child

Received: 09 February 2023

Corresponding Authors: (Ma K-Z, Email:azema2005@163.com) E-mail: azema2005@163.com

Cite this article:

TAN Zi-Feng,LI En-Si,ZHONG Wei-Bin et al. Etiology composition and prognosis of pediatric chronic critical illness in a pediatric intensive care unit[J]. CJCP, 2023, 25(8): 843-848.

URL:

http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2302053 OR http://www.zgddek.com/EN/Y2023/V25/I8/843

	Girard K, Raffin TA. The chronically critically ill: to save or let die?[J]. Respir Care, 1985, 30(5): 339-347. PMID: 10315661.
	Voiriot G, Oualha M, Pierre A, et al. Chronic critical illness and post-intensive care syndrome: from pathophysiology to clinical challenges[J]. Ann Intensive Care, 2022, 12(1): 58. PMID: 35779142. PMCID: PMC9250584. DOI: 10.1186/s13613-022-01038-0.
	Parker MM, Thompson AE, Lumb P, et al. Co-evolutions of pediatric and adult critical care[J]. Crit Care Med, 2021, 49(2): 188-200. PMID: 33438971. DOI: 10.1097/CCM.0000000000004803.
	Zorko D, McNally JD, Rochwerg B, et al. Pediatric chronic critical illness: protocol for a scoping review[J]. JMIR Res Protoc, 2021, 10(10): e30582. PMID: 34596576. PMCID: PMC8520133. DOI: 10.2196/30582.
	Zorko DJ, McNally JD, Rochwerg B, et al. Defining pediatric chronic critical illness: a scoping review[J]. Pediatr Crit Care Med, 2023, 24(2): e91-e103. PMID: 36661428. DOI: 10.1097/PCC.0000000000003125.
	Iwashyna TJ, Hodgson CL, Pilcher D, et al. Timing of onset and burden of persistent critical illness in Australia and New Zealand: a retrospective, population-based, observational study[J]. Lancet Respir Med, 2016, 4(7): 566-573. PMID: 27155770. DOI: 10.1016/S2213-2600(16)30098-4.
	Gardner AK, Ghita GL, Wang Z, et al. The development of chronic critical illness determines physical function, quality of life, and long-term survival among early survivors of sepsis in surgical ICUs[J]. Crit Care Med, 2019, 47(4): 566-573. PMID: 30664526. PMCID: PMC6422682. DOI: 10.1097/CCM.0000000000003655.
	Miles AH, Rushton CH, Wise BM, et al. Pediatric chronic critical illness, prolonged ICU admissions, and clinician distress[J]. J Pediatr Intensive Care, 2021, 11(4): 275-281. PMID: 36388074. PMCID: PMC9649284. DOI: 10.1055/s-0041-1724098.
	Shapiro MC, Henderson CM, Hutton N, et al. Defining pediatric chronic critical illness for clinical care, research, and policy[J]. Hosp Pediatr, 2017, 7(4): 236-244. PMID: 28351944. DOI: 10.1542/hpeds.2016-0107.
	Shappley RKH, Noles DL, Spentzas T. Pediatric chronic critical illness: validation, prevalence, and impact in a children's hospital[J]. Pediatr Crit Care Med, 2021, 22(12): e636-e639. PMID: 34261947. DOI: 10.1097/PCC.0000000000002802.
	Troch R, Schwartz J, Boss R. Slow and steady: a systematic review of ICU care models relevant to pediatric chronic critical illness[J]. J Pediatr Intensive Care, 2020, 9(4): 233-240. PMID: 33133737. PMCID: PMC7588297. DOI: 10.1055/s-0040-1713160.
	12 李思澄. 慢性危重症发病机制理论的建立[J]. 肠外与肠内营养, 2019, 26(1): 22-23. DOI: 10.16151/j.1007-810x.2019.01.010.
	Mira JC, Gentile LF, Mathias BJ, et al. Sepsis pathophysiology, chronic critical illness, and persistent inflammation-immunosuppression and catabolism syndrome[J]. Crit Care Med, 2017, 45(2): 253-262. PMID: 27632674. PMCID: PMC5243156. DOI: 10.1097/CCM.0000000000002074.
	14 李辉凤, 王铭, 潘险峰. 持续炎症-免疫抑制-分解代谢综合征研究新进展[J]. 临床急诊杂志, 2022, 23(3): 219-224. DOI: 10.13201/j.issn.1009-5918.2022.03.012.
	Mira JC, Brakenridge SC, Moldawer LL, et al. Persistent inflammation, immunosuppression and catabolism syndrome[J]. Crit Care Clin, 2017, 33(2): 245-258. PMID: 28284293. PMCID: PMC5351769. DOI: 10.1016/j.ccc.2016.12.001.
	Hawkins RB, Raymond SL, Stortz JA, et al. Chronic critical illness and the persistent inflammation, immunosuppression, and catabolism syndrome[J]. Front Immunol, 2018, 9: 1511. PMID: 30013565. PMCID: PMC6036179. DOI: 10.3389/fimmu.2018.01511.
	17 陈辉, 杨毅. 持续性炎症-免疫抑制-分解代谢综合征: 重症感染的真凶?[J]. 中华内科杂志, 2015, 54(8): 670-671. DOI: 10.3760/cma.j.issn.0578-1426.2015.08.003.
	Donohue PK, Williams EP, Wright-Sexton L, et al. "It's relentless": providers' experience of pediatric chronic critical illness[J]. J Palliat Med, 2018, 21(7): 940-946. PMID: 29570427. DOI: 10.1089/jpm.2017.0397.
	Demirkiran H, Kilic M, Tomak Y, et al. Evaluation of the incidence, characteristics, and outcomes of pediatric chronic critical illness[J]. PLoS One, 2021, 16(5): e0248883. PMID: 34048449. PMCID: PMC8162636. DOI: 10.1371/journal.pone.0248883.
	Namachivayam SP, Alexander J, Slater A, et al. Five-year survival of children with chronic critical illness in Australia and New Zealand[J]. Crit Care Med, 2015, 43(9): 1978-1985. PMID: 25962079. DOI: 10.1097/CCM.0000000000001076.
	Murphy Salem S, Graham RJ. Chronic illness in pediatric critical care[J]. Front Pediatr, 2021, 9: 686206. PMID: 34055702. PMCID: PMC8160444. DOI: 10.3389/fped.2021.686206.
	Lamas D. Chronic critical illness[J]. N Engl J Med, 2014, 370(2): 175-177. PMID: 24401058. DOI: 10.1056/NEJMms1310675.
	Madrigal VN, Walter JK. Pediatric chronic critical illness: let us focus on the big picture[J]. Pediatr Crit Care Med, 2019, 20(12): 1206-1207. PMID: 31804446. PMCID: PMC6901103. DOI: 10.1097/PCC.0000000000002154.
	Hirschfeld RS, Barone S, Johnson E, et al. Pediatric chronic critical illness: gaps in inpatient intrateam communication[J]. Pediatr Crit Care Med, 2019, 20(12): e546-e555. PMID: 31634307. DOI: 10.1097/PCC.0000000000002150.
	Boss RD, Hirschfeld RS, Barone S, et al. Pediatric chronic critical illness: training teams to address the communication challenges of patients with repeated and prolonged hospitalizations[J]. J Pain Symptom Manage, 2020, 60(5): 959-967. PMID: 32540469. DOI: 10.1016/j.jpainsymman.2020.06.005.
	Boss RD, Williams EP, Henderson CM, et al. Pediatric chronic critical illness: reducing excess hospitalizations[J]. Hosp Pediatr, 2017, 7(8): 460-470. PMID: 28751491. DOI: 10.1542/hpeds.2016-0185.