Comparison of Pediatric Severe Sepsis Managed in US and European ICUs
Por:
Giuliano, JS, Markovitz, BP, Brierley, J, Levin, R, Williams, G, Lum, LCS, Dorofaeff, T, Cruces, P, Bush, JL, Keele, L, Nadkarni, VM, Thomas, NJ, Fitzgerald, JC, Weiss, SL, Sanagustin S., Bushell, T.
Publicada:
1 jun 2016
Resumen:
Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies.
Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality.
Setting: European and U.S. PICUs.
Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study.
Interventions: None.
Measurements and Main Results: European PICUs had fewer beds ( median, 11 vs 24; p < 0.001). European patients were younger ( median, 1 vs 6 yr; p < 0.001), had higher severity of illness ( median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward ( 37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients ( 85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U. S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days.
Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.
Filiaciones:
Giuliano, JS:
Yale Univ, Sch Med, Dept Pediat, Div Crit Care Med, New Haven, CT 06510 USA
Markovitz, BP:
Univ So Calif, Keck Sch Med, Childrens Hosp Los Angeles, Dept Pediat,Div Pediat Crit Care, Los Angeles, CA 90033 USA
Univ So Calif, Keck Sch Med, Childrens Hosp Los Angeles, Dept Anesthesiol Crit Care Med,Div Pediat Crit Ca, Los Angeles, CA 90033 USA
Brierley, J:
Great Ormond St Hosp NHS Trust, Dept Crit Care & Bioeth, London, England
Levin, R:
Royal Hosp Children, Dept Pediat, Glasgow, Lanark, Scotland
Williams, G:
Sydney Childrens Hosp, Dept Intens Care, Randwick, NSW, Australia
Lum, LCS:
Univ Malaya, Med Ctr, Dept Pediat, Kuala Lumpur, Malaysia
Dorofaeff, T:
Lady Cilento Childrens Hosp, Dept Pediat, Div Paediat Crit Care, Pediat Intens Care Unit, Brisbane, Qld, Australia
Cruces, P:
Univ Andres Bello, Hosp El Carmen de Maipu, Dept Pediat Intens Care, Santiago, Chile
Bush, JL:
Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Dept Anesthesia & Crit Care,Div Crit Care Med, Philadelphia, PA 19104 USA
Keele, L:
Penn State Univ, Dept Polit Sci, University Pk, PA 16802 USA
Nadkarni, VM:
Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Dept Anesthesia & Crit Care,Div Crit Care Med, Philadelphia, PA 19104 USA
Thomas, NJ:
Penn State Univ, Coll Med, Penn State Hershey Childrens Hosp, Dept Pediat,Div Pediat Crit Care Med, Hershey, PA USA
Fitzgerald, JC:
Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Dept Anesthesia & Crit Care,Div Crit Care Med, Philadelphia, PA 19104 USA
Weiss, SL:
Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Dept Anesthesia & Crit Care,Div Crit Care Med, Philadelphia, PA 19104 USA
Sanagustin S.:
Hospital de la Sant Creu Sant Pau, Spain
Bushell, T. :
Starship Children's Hospital, New Zealand
Green Accepted, Green Published
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