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Blackwood, B., Tume, L.N., Morris, K.P., Clarke, M., McDowell, C., Hemming, K., Peters, M.J., McIlmurray, L., Jordan, J., Agus, A., Murray, M., Parslow, R., Walsh, T.S., Macrae, D., Easter, C., Feltbower, R.G. and McAuley, D.F. (2021) Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units: A Randomized Clinical Trial. JAMA, 326, 401-410.
https://doi.org/10.1001/jama.2021.10296

has been cited by the following article:

• TITLE: Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

  AUTHORS: Arnildo Linck Junior, Flávia Lopes Gabani, Edmarlon Girotto, Ana Maria Rigo Silva, Selma Maffei Andrade

  KEYWORDS: Pediatric Intensive Care Units, Outcomes Assessment, In-Hospital Mortality, Hospital Stay, Mechanical Ventilation, Catheter-Related Infections

  JOURNAL NAME: Open Journal of Pediatrics, Vol.13 No.5, September 25, 2023

  ABSTRACT: Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54; CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75; CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54; CI 95%: 0.39 - 0.74) were observed. Conclusion: The results indicate the benefits of care measures for children admitted to the PICU in terms of a reduction in adverse events and expansion of access.