COMPLICATIONS OF CARE IN A PEDIATRIC INTENSIVE-CARE UNIT - A PROSPECTIVE-STUDY

Objectives: (a) To examine the frequency, type, and severity of compli cations occurring in a pediatric intensive care unit; (b) to identify populations at risk and (c) to study the impact of complications on mo rbidity and mortality. Design: Prospective survey. Setting: Pediatric intensive care unit (PICU) of a university-affiliated hospital. Patien ts: 1035 consecutive admissions over an 18-month period. Results: 115 complications occurred during 83 (8.0%) admissions, for 2.7 complicati ons per 100 PICU-days 48 (42%) complications were major, 45 (39% moder ate, and 22 (19%) minor, Sixty complications (52%) were ventilator-rel ated, ii! were drug-related, 13 procedure-related, 24 infectious, and 32 involved invasive devices 118 vascular catheters), Human error was involved in 41 (36%) cases, 21 of which were major (18%). Treatments i ncluded reintubation < 24 b (28), intravenous antimicrobials (24), and invasive bedside procedures (14). Carcliopulmonary resuscitation was required in 6 patients. Thirteen patients with complications died (15. 7%); 2 deaths were directly due to complications. Patients with compli cations were younger, had longer lengths of stay, and had a higher mor tality. Length Of stay was a positive risk factor for complication ris k (odds ratio =1.09, 95% confidence interval: 1.05 to 1.13; p = 0.0001 ); other patient characteristics had no predictive effect. Kaplan-Meie r estimates showed that the most severe complications occurred early i n the PICU slav. The best indicators of patient mortality were number of complications (odds ratio = 2.96, 95% confidence interval 1.72 to 5 .08; p = 0.0001), and mortality risk derived ii-om the Pediatric Risk of Mortality Score (odds ratio = 1.08, 95% confidence interval 1.06 to 1.10; p = 0.0001), Mortality was correlated with increasing severity of complications, Conclusion: Complications have a significant impact on patient care. Patients may be at increased risk earlier in their PI CU course, when the number of interventions may be greatest. Complicat ions may increase patient mortality and predict patient death better t han other patient variables.