Abstract

Introduction

The burden of critical illness in low- and middle-income countries (LMICs) is high; however, there is a paucity of data describing pediatric critical care outcomes in this setting.

Methods

We performed a prospective observational study of the pediatric (≤18 years) intensive care population in Malawi, from August 2016 to May 2018. Data collected include patient demographics and clinical data, admission criteria and outcome. A multivariate Poisson regression was performed to determine risk factors for mortality.

Results

Over the study period, 499 patients were admitted to the intensive care unit (ICU) and 105 (21.0%) were children. The average age was 10.6 ± 5.4 years. Primary indications for ICU admission were sepsis (n = 30, 30.3%) and traumatic brain injury (TBI, n = 23, 23.2%). Of those who died, sepsis (n = 18, 32.7%), acute respiratory failure (n = 11, 20.0%) and TBI (n = 11, 20.0%) were the primary admission diagnoses. Overall, ICU mortality was 54.3% (n = 57). Multivariate regression for increased ICU mortality revealed: age ≤5 years [risk ratio (RR) 1.96, 95% CI 1.10–2.26, p < 0.001], hemoglobin < 10 g/dl (RR 1.58, 95% CI 1.08—2.01, p = 0.01) and shock requiring epinephrine support (RR 2.76, 95% CI 1.80–4.23, p < 0.001).

Conclusions

Pediatric ICU mortality is high. Predictors of mortality were age ≤5 years, anemia at ICU admission and the need for epinephrine support. Training of pediatric intensive care specialists and increased blood product availability may attenuate the high mortality for critically ill children in Malawi.

中文翻译：

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马拉维儿科重症监护病房入院后的结果。

摘要

介绍

低收入和中等收入国家的重病负担很重；但是，在这种情况下，很少有数据描述了儿科重症监护的结局。

方法

我们对2016年8月至2018年5月在马拉维的儿科（≤18岁）重症监护人群进行了一项前瞻性观察研究。收集的数据包括患者的人口统计学和临床​​数据，入院标准和结局。进行多元Poisson回归以确定死亡率的危险因素。

结果

在研究期间，有499名患者被送入重症监护病房（ICU），其中有105名儿童（21.0％）是儿童。平均年龄为10.6±5.4岁。ICU入院的主要指征是败血症（n  = 30，30.3％）和脑外伤（TBI，n  = 23，23.2％）。在死者中，败血症（n  = 18，32.7％），急性呼吸衰竭（n  = 11，20.0％）和TBI（n  = 11，20.0％）是主要的入院诊断。总体而言，ICU死亡率为54.3％（n  = 57）。多变量回归显示ICU死亡率增加：年龄≤5岁[风险比（RR）1.96，95％CI 1.10–2.26，p  <0.001]，血红蛋白<10 g / dl（RR 1.58，95％CI 1.08-2.01，p = 0.01）和需要肾上腺素支持的电击（RR 2.76，95％CI 1.80–4.23，p  <0.001）。

结论

小儿ICU死亡率高。死亡率的预测因素是≤5岁，ICU入院时贫血以及需要肾上腺素支持。培训儿科重症监护专家和增加血液制品的利用率可能会减轻马拉维危重儿童的高死亡率。