Abstract:
OBJECTIVES:To describe the timing of onset of organ system failure, multiple organ system failure diagnosis, and the subsequent death in children admitted to a pediatric intensive care unit (ICU). Second, to identify independent risk markers of death in pediatric patients with multiple organ system failure. DESIGN:Review of a database. SETTING:Pediatric ICU within a tertiary care center. PATIENTS:We analyzed the pediatric ICU course of 777 consecutive patients aged < 18 yrs. MEASUREMENTS AND MAIN RESULTS:Eighty-five (10.9%) of 777 children had multiple organ system failure, defined as the simultaneous occurrence of at least two organ system failures. Of 85 children, 37 (43.5%) were postoperative cardiac surgery patients and 48 (56.5%) patients were in the ICU for other reasons. The diagnostic criteria for multiple organ system failure were met on the day of admission by 73 (86%) of 85 patients. The maximum number of organ system failures occurred within 72 hrs in 74 (87%) children. The mortality rate for all patients with multiple organ system failure was 50.6%. Thirty-eight (88.4%) of deaths occurred within 7 days after the diagnosis of multiple organ system failure. Survival analysis was comparable for both postoperative cardiac surgery patients and patients with other diagnoses. Multivariate analysis identified three factors as independent risk markers of death in pediatric patients with multiple organ system failure: maximum number of simultaneous organ system failures during the pediatric ICU stay: odds ratio, 55.9 (95% confidence interval, 7.9 to 396.1); age < or = 12 months: odds ratio, 17.1 (95% confidence interval, 1.8 to 158.7); and the Pediatric Risk of Mortality (PRISM) score on the day of admission: odds ratio, 1.25 (95% confidence interval, 1.1 to 1.5). CONCLUSIONS:The mortality rate associated with multiple organ system failure in pediatric patients is high. The maximum number of simultaneous organ system failures during pediatric ICU stay, age < or = 12 months, and the PRISM score on the day of admission are independent risk markers of death. Diagnosis of multiple organ system failures, development of maximum number of organ system failures, and deaths occur remarkably early after pediatric ICU admission; the rationale for using prophylactic therapy under such circumstances is unclear.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Proulx F,Gauthier M,Nadeau D,Lacroix J,Farrell CAdoi
10.1097/00003246-199406000-00023subject
Has Abstractpub_date
1994-06-01 00:00:00pages
1025-31issue
6eissn
0090-3493issn
1530-0293journal_volume
22pub_type
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更新日期:2005-10-01 00:00:00
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pub_type: 杂志文章,多中心研究
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journal_title:Critical care medicine
pub_type: 杂志文章
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更新日期:2006-09-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1989-10-01 00:00:00
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更新日期:2000-03-01 00:00:00
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更新日期:2003-02-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1991-10-01 00:00:00
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更新日期:2008-05-01 00:00:00
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更新日期:2004-05-01 00:00:00
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更新日期:1999-12-01 00:00:00
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更新日期:1986-01-01 00:00:00
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更新日期:2010-02-01 00:00:00
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更新日期:2003-10-01 00:00:00
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pub_type: 杂志文章
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更新日期:1989-01-01 00:00:00
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更新日期:1998-01-01 00:00:00
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更新日期:1996-09-01 00:00:00
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更新日期:2017-08-01 00:00:00
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更新日期:1990-07-01 00:00:00