Prof. Dr. Reda Sanad Arafa Professor of Pediatrics Faculty of Medicine Benha University EGYPT Benha...

Prof. Dr. Reda Sanad Arafa Professor of Pediatrics

Faculty of Medicine Benha University

EGYPT

Benha Faculty Of Medicine - EGYPT

IMPORTANCE OF PICUIMPORTANCE OF PICU Pediatric intensive care unit (PICU) is an important component

of tertiary pediatric care services.

PICU aims at promoting qualified care for critically ill children .

These units are points of major technology transfer and constitute one of the main consumers of hospital budgets.

o Lakshmi (2008) reported that 15-20 % of hospital budgets are spent in ICUs

o Abdul-Monim B (2001) reported that ICUs consume :• 10% of hospital beds• 30% of acute care hospital cost• > 20% of hospital budgets


Critically ill child means a child who is in a clinical state which may result in respiratory or cardiac arrest or severe neurologic complication .

Risk for critical illness may be primary cardiovascular or respiratory or secondary to neurologic , infectious , metabolic disorder or serious injury .

Infection is the most common & septic shock is a catastrophic immune system reaction which produce organ failure .

( Emma W., 2009 )

(Qureshi et al.; 2007)


(Stormorken & Powell, 2004)

MULTIPLE ORGAN DYSFUNCTIONSYNDROME IN CHILDREN (MODS)

The simultaneous occurrence of at least two organ failure.

MODS is important because of its frequent occurrence and its association with high mortality in the pediatric intensive care unit

25% of the children admitted to PICU has MODS and that the mortality associated with it is up to 50%.

In fact, from 97% to 100% of the deaths in PICUs have been related to MODS.

( Marshall et al., 2003)


Estimation of disease severity and probability of death are important elements in determining the prognosis of patients in PICU.

A more accurate prognostic assessment can lead to more appropriate monitoring , proper management and family counseling.

ICU scoring systems are devised to determine probable outcome of the patients admitted to the ICU

( Marshall et al., 2003)


The most commonly measured PICU outcomes are mortality, length of stay, functional outcome, and organ dysfunction .

The 2 most commonly used scoring systems to predict ICU mortality are the Pediatric Risk of Mortality (PRISM) and the Pediatric Index of Mortality (PIM) .

Pediatric Logistic Organ Dysfunction (PELOD) has recently been validated with good discrimination.

(Qureshi et al., 2007)

Scoring systems in PICUScoring systems in PICU


The Clinical Classification System ( CCS ) and the Therapeutic Intervention System ( TISS ) are indirect measures of illness severity .

The CCS is a qualitative assessment of care requirements on admission and the TISS is a quantitative measure of therapeutic requirements.


The Physiologic Stability Index ( PSI ) is a more direct measure of illness severity but is time consuming , requiring the use of 34 variables.

The Pediatric Risk of Mortality ( PRISM ) was developed from the PSI to reduce the number of variables to 14 without losing its predictive power.

Pediatric Logistic Organ Dysfunction (PELOD) has recently been validated with good discrimination.

(Qureshi et al., 2007)


The PELOD score has developed to estimate disease

severity and probability of death for ICU patients .

It includes six key organ dysfunctions :

cardiovascular, respiratory, hematological, neurological,

renal, and hepatic. The maximum number of points for an

organ dysfunction is 20 and the maximum PELOD score is

71.

The total score gives us the percentage of probability of

death PELOD Score.htm Table.doc

THE PELOD SCORE


A case of Down syndrome , 15 months old , 7.8 kg , with C H D common A V canal , complicated by bronchopneumonia & referred to PICU by :

RD grade IV Shock Drowsiness


RD grade IV Tachypnea R R 78/min Nasal flare & retractions Cyanosis ( PaO2 58 mmHg )

Shock Tachycardia 200/min Hypotension 52/35 Cold extremities Oliguria ( S.creat. 1.8 mg/dl )


What is about ? Disease severity & outcome Family counselling Monitoring vital parameters Management strategy

What “ vital parameter” you are anxious from getting worse ?

HR RR Bl.Pressure Renal impairment Hepatic impairment


score.png


Severe critical illness score 30 Poor outcome Mortality 79.6% Monitor HR , BL.Pressure , PaO2 s.creat. Focus on BL.Pressure

Management strategy : Iv fluids Inotropics Antifailure

Ventilation Antibiotics


The ICU is an expensive treatment facility where patients of high mortality rates are treated.

Estimation of disease severity and probability of death are important elements in determining the prognosis of patients in PICU.

A more accurate prognostic assessment can lead to

more appropriate monitoring , proper management , and family counseling.

PELOD has recently been validated with good

discrimination.


PELOD scoring system is highly reliable and very

sensitive to measure severity of illness and determine the probability of death in PICU.

It is valid to be a valuable detector for PICU services and a sensitive director for appropriate monitoring , proper management & family counseling

It gives the priority to focus on vital parameters that affects total score number and the corresponding outcome for patients in PICU.


Prof. Dr. Reda Sanad Arafa Professor of Pediatrics Faculty of Medicine Benha University EGYPT Benha...

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