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.