Predictors of prolonged stay in the pediatric intensive care unit

Main Article Content

Yudha Fadhol Arafah
Indah Kartika Murni
Desy Rusmawatiningtyas

Abstract

Background Prolonged stay in the pediatric intensive care unit (PICU) reflects not only disease severity and patient health status, but also the performance and quality of patient care.


Objective To to determine whether surgical procedure, severe malnourishment, cardiovascular condition, sepsis, and ventilator use were the predictors of prolonged PICU stay.


Methods This nested, case-control study was conducted with secondary data from medical records of pediatric inpatients at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. We included pediatric patients aged 1 month-18 years treated in the PICU between 1 January - 31 December 2018. Predictors of prolonged stay were identified including surgical procedures, severe malnourishment, cardiovascular conditions, sepsis, and ventilator use. Logistic regression was used to identify independent predictors.


Results Subjects’ overall median age was 3.12 (IQR 0.76-18.8) years and the male to female ratio was 1:1. Median duration of ventilator use was 4 (IQR 1-21) days. The most common diagnosis was neurological disease (26.7%). Multivariate analysis showed that surgical procedure (OR 5.75; 95%CI 2.06 to 14.61) was statistically significant as an independent predictor of prolonged PICU stay.


Conclusion Surgical procedure is  the significant predictor of prolonged stay in PICU.

Article Details

How to Cite
1.
Arafah Y, Murni I, Rusmawatiningtyas D. Predictors of prolonged stay in the pediatric intensive care unit. PI [Internet]. 18Feb.2020 [cited 28Nov.2020];60(1):37-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2220
Section
Emergency & Pediatric Intensive Care
Author Biographies

Indah Kartika Murni, Gadjah Mada University

Departement of Child Health, FKKMK UGM/RSUP Dr. Sardjito, Yogyakarta

Desy Rusmawatiningtyas, Gadjah Mada University

Departement of Child Health, FKKMK UGM/RSUP Dr. Sardjito, Yogyakarta

Received 2019-06-21
Accepted 2020-02-18
Published 2020-02-18

References

. Ikatan Dokter Anak Indonesia. Buku Panduan Pelayanan Emergensi, Rawat Intermediet dan Rawat Intensif Anak. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia; 2016. p. 3-4.
2. Athale UH, Brown RC., Furman WL. Immunomodulation: clinical management of infections in immunocompromised infants and children. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 584-615.
3. Ruttimann UE, Pollack MM. Variability in duration of stay in pediatric intensive care units: a multiinstitutional study. J Pediatr. 1996;128:35-44. DOI:
10.1016/s0022-3476(96)70425-0.
4. Namachivayam P, Taylor A, Montague T, Moran K, Barrie J, Delzoppo C, Butt W. Long-stay children in intensive care: long-term functional outcome and quality of life from a 20-year institutional study. Pediatr Crit Care Med. 2012;13:520-8. DOI: 10.1097/PCC.0b013e31824fb989.
5. Nupen TL, Argent AC, Morrow B. Characteristics and outcome of long-stay patients in a paediatric intensive care unit in Cape Town, South Africa. S Afr Med J. 2016;107:70-5. DOI: 10.7196/SAMJ.2017.v107i1.11279.
6. Brown KL, Ridout DA, Goldman AP, Hoskote A, Penny DJ. Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med. 2003;31:28-33. DOI: 10.1097/00003246-200301000-00004.
7. Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, Moll JJ. Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg. 2011;40:179-84. DOI: 10.1016/j.ejcts.2010.11.038.
8. Leteurtre S, Duhamel A, Salleron J, Grandbastien B, Lacroix J, Leclerc F; Groupe Francophone de Reanimation et d’Urgences Pediatriques (GFRUP). PELOD-2: an update of the Pediatric logistic organ dysfunction score. Crit Care Med 2013;41:1761-73. DOI: 10.1097/CCM.0b013e31828a2bbd.
9. Rusmawatiningtyas D, Nurnaningsih. Mortality rates in pediatric septic shock. Paedietr Indones. 2017;56:304-10. DOI: 10.14238/pi56.5.2016.304-10.
10. Abelha FJ, Castro MA, Landeiro NM, Neves AM, Santos CC. Mortality and length of stay in a surgical intensive care unit. Rev Bras Anestesiol. 2006;56:34-45.
11. Sudarmadji S, Wati DK, Sidhiartha L. Faktor risiko pada lama rawat dan luaran pasien perawatan di unit perawatan intensif anak RSUP Sanglah Denpasar. Sari Pediatri 2016;17:455-2. DOI: 10.14238/sp17.6.2016.455-62.
12. Nangalu R, Pooni PA, Bhargav S, Bains HS. Impact of malnutrition on pediatric risk of mortality score and outcome in pediatric intensive care unit. Indian J Crit Care Med. 2016;20:385-90. DOI: 10.4103/0972-5229.186218.
13. Tabib A, Abrishami SE, Mahdavi M, Mortezaeian H, Totonchi Z. Predictors of prolonged mechanical ventilation in pediatric patients after cardiac surgery for congenital heart disease. Res Cardiovasc Med. 2016;5:e30391-9. DOI: 10.5812/cardiovascmed.30391.