Early childhood critical illness: Medication Exposure, Related Acute adverse events, Later educational outcomes and Death
Overview
Survival of over 97% after each ICU admission has created growing populations of children living after treatment of a previously fatal disease, with chronic disease and with technology dependence. 97% survival has lead to growing numbers of technology dependent children. Survivors of previously fatal diseases, living with chronic disease.
Healthcare associated harm is common in paediatric ICUs.
Critically ill children are metabolically complex and experience consequences of their ICU stay that can persist long after hospital discharge.
Neurodevelopmental outcome after paediatric critical illness is now highly patient-relevant, but is rarely evaluated.
Objective
Evaluating relationships between patient risk factors and ICU exposures with acute and delayed mortality, and formal neurodevelopmental, functional and population-level educational assessments in children after ICU admission.
Projects
Acute Inter-facility Transport. This Ontario-wide study described an increasing rate of inter-facility transfers to a paediatric ICU over the 8-years studied. ICU Mortality was 5.7% at ICU discharge and was 7.6% at 6 months. Lower PICU mortality was independently associated with prior acute care contact and availability of paediatric expertise at the referral hospital (Tijssen, PCH 2019).
Unplanned extubation in PICU. This 11-year case-series, showed declining rates of unplanned extubation in this cohort of 11,310 PICU patient-admissions. The 458 unplanned extubation events (0.61 events/100 intubation-days) in 410 (3.39%) patients, had consequences in 245 (53.5%) including cardiac arrest in 9 (2%) (Al-Abdwani, JCC 2018).
Acute Kidney Injury in PICU. Study of 3,865 PICU patients found 915 (23.7%) developed acute kidney injury. Rish factors for AKI were nephrotoxic medications, urgent ICU admission, respiratory dysfunction and treatment with extracorporeal membrane oxygenation.
Ongoing Work
Establishing the EMERALD cohort (C Maratta)
Describing the frequency and nature of PICU follow up clinics (A Shevell)
Describing a framework to support operational decisions about post ICU follow up (J Nicoll)
