Distributions and Behavior of Vital Signs in Critically Ill Children by Admission Diagnosis
Distributions and Behavior of Vital Signs in Critically Ill Children by Admission Diagnosis
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DOI：
10.1097/pcc.0000000000001395
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发表时间：
2018-02-01
影响因子：
4.1
通讯作者：
Laussen, Peter C.
中科院分区：
文献类型：
--
作者：
Eytan, Danny;Goodwin, Andrew J.;Laussen, Peter C.
目的：根据入院诊断确定儿童在ICU入院时的心率和动脉内血压分布，并检查入院后72小时内这些生理体征的趋势设计：对连续采集的信号进行回顾性分析。设置：一家四级和一级转诊儿童医院，设有普通PICU和心脏重症监护室。患者：分析了1289例18岁以下的患者。根据最初的入院诊断或外科手术将患者入院的数据分为19组。干预：无。测量和主要结果：入院时的分布依赖于患者的年龄和入院诊断（p < 10（-6））。心率随着时间的推移而降低，而动脉血压相对稳定，当按诊断组分析时，这些趋势的方向和幅度存在差异（p < 10（-6））。多元线性回归分析表明，患者年龄、诊断组和入院时的生理生命体征值解释了72小时（或出院时，如果更早）时观察到的生理信号变化的50-63%，其中入院值的影响最大。此外，无论是个别患者的心率或动脉血压的方差小于方差测量的水平组的患者具有相同的diagnosis.Conclusions：这是第一个研究报告的分布连续测量的生理变量和趋势，他们的行为根据入院诊断重症儿童。诊断组之间和诊断组内检测到的差异可能有助于早期识别离群值，并允许细化患者监测策略。
Objectives: Define the distributions of heart rate and intraarterial blood pressure in children at admission to an ICU based on admission diagnosis and examine trends in these physiologic signs over 72 hours from admission (or to discharge if earlier).Design: A retrospective analysis of continuously acquired signals.Setting: A quaternary and primary referral children's hospital with a general PICU and cardiac critical care unit.Patients: One thousand two hundred eighty-nine patients less than 18 years old were analyzed. Data from individual patient admissions were divided into 19 groups by primary admission diagnosis or surgical procedure.Interventions: None.Measurement and Main Results: Distributions at admission are dependent on patient age and admission diagnosis (p < 10(-6)). Heart rate decreases over time, whereas arterial blood pressure is relatively stable, with differences seen in the directions and magnitude of these trends when analyzed by diagnosis group (p < 10(-6)). Multiple linear regression analysis shows that patient age, diagnosis group, and physiologic vital sign value at admission explain 50-63% of the variation observed for that physiologic signal at 72 hours (or at discharge if earlier) with admission value having the greatest influence. Furthermore, the variance of either heart rate or arterial blood pressure for the individual patient is smaller than the variance measured at the level of the group of patients with the same diagnosis.Conclusions: This is the first study reporting distributions of continuously measured physiologic variables and trends in their behavior according to admission diagnosis in critically ill children. Differences detected between and within diagnostic groups may aid in earlier recognition of outliers as well as allowing refinement of patient monitoring strategies.