Risk Factors for Acquiring Functional and Cognitive Disabilities During Admission to a PICU
Risk Factors for Acquiring Functional and Cognitive Disabilities During Admission to a PICU
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DOI：
10.1097/pcc.0000000000000199
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发表时间：
2014-09-01
影响因子：
4.1
通讯作者：
Goodman, Denise M.
中科院分区：
文献类型：
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作者：
Bone, Meredith F.;Feinglass, Joseph M.;Goodman, Denise M.
目的：描述在进入PICU期间获得功能或认知障碍的风险因素。设计：多中心PICU数据库的回顾性分析。设置：2009年1月1日至2010年12月31日期间，虚拟PICU性能系统网络中的24个PICU。患者：1个月至18岁存活至出院的连续性患者。干预措施：无。测量和主要结果：主要结果是在进入PICU期间获得性整体功能障碍和认知障碍，分别通过儿科总体性能类别或儿科大脑性能类别评分的变化来测量。主要分析队列包括24个虚拟PICU性能系统站点的29，352例住院患者，这些站点收集了主要结局变量。分别有10.3%和3.4%的队列获得了整体功能或认知障碍。创伤诊断（比值比，4.50; 95% CI，3.83-5.29;比值比，3.91; 95% CI，3.07-4.98），计划外入住PICU（比值比，2.67; 95% CI，2.27-3.12;比值比，1.52; 95% CI，1.16-2.00），死亡风险最高类别（比值比，1.19; 95% CI，1.02-1.39;比值比，2.70; 95% CI，2.15-3.40），肿瘤学初步诊断（比值比，5.61; 95% CI，4.56-6.91;比值比，4.30; 95% CI，2.97-6.24），和神经系统原发性诊断（比值比，2.04，95%CI，1.70-2.44;比值比，4.29，95%CI，3.18-5.78）与获得功能和认知残疾独立相关。获得功能和认知障碍的干预风险因素包括有创机械通气（比值比，1.79; 95% CI，1.60-2.00;比值比，2.83; 95% CI，2.36-3.39），肾脏替代治疗（比值比，2.43; 95% CI，1.73-3.42;比值比，1.76，95% CI，1.08-2.85），心肺复苏（比值比，1.91; 95% CI，1.24-2.95;比值比，1.81; 95% CI，1.02-3.23），体外膜肺氧合（比值比，7.40，95%CI，4.10-13.36;比值比，14.04，95%CI，7.51-26.26）。结论：我们确定了一部分患者，他们在入住PICU期间出现全面功能和认知障碍的可能性很高。这一人群可能受益于可以减轻这种风险的干预措施，以及从PICU出院后的重点随访。
Objective: To describe the risk factors for acquiring functional or cognitive disabilities during admission to a PICU.Design: Retrospective analysis of a multicenter PICU database.Setting: Twenty-four PICUs in the Virtual PICU Performance System network from January 1, 2009, through December 31, 2010.Patients: Consecutive patients, who are 1 month to 18 years old, who survived to discharge.Interventions: None.Measurements and Main Results: Primary outcomes were acquired global functional disability and cognitive disability during admission to a PICU, measured by change in Pediatric Overall Performance Category or in Pediatric Cerebral Performance Category scores, respectively. The primary analysis cohort consisted of 29,352 admissions to the 24 Virtual PICU Performance System sites which collected the main outcome variables. Respectively, 10.3% and 3.4% of the cohort acquired global functional or cognitive disability. Trauma diagnosis (odds ratio, 4.50; 95% CI, 3.83-5.29; odds ratio, 3.91; 95% CI, 3.07-4.98), unscheduled admission to the PICU (odds ratio, 2.67; 95% CI, 2.27-3.12; odds ratio, 1.52; 95% CI, 1.16-2.00), highest risk of mortality category (odds ratio, 1.19; 95% CI, 1.02-1.39; odds ratio, 2.70; 95% CI, 2.15-3.40), oncologic primary diagnoses (odds ratio, 5.61; 95% CI, 4.56-6.91; odds ratio, 4.30; 95% CI, 2.97-6.24), and neurologic primary diagnoses (odds ratio, 2.04, 95% CI, 1.70-2.44; odds ratio, 4.29, 95% CI, 3.18-5.78) were independently associated with acquiring both functional and cognitive disability. Intervention risk factors for acquiring both functional and cognitive disability included invasive mechanical ventilation (odds ratio, 1.79; 95% CI, 1.60-2.00; odds ratio, 2.83; 95% CI, 2.36-3.39), renal replacement therapy (odds ratio, 2.43; 95% CI, 1.73-3.42; odds ratio, 1.76, 95% CI, 1.08-2.85), cardiopulmonary resuscitation (odds ratio, 1.91; 95% CI, 1.24-2.95; odds ratio, 1.81; 95% CI, 1.02-3.23), and extracorporeal membrane oxygenation (odds ratio, 7.40, 95% CI, 4.10-13.36; odds ratio, 14.04, 95% CI, 7.51-26.26).Conclusions: We identified a subset of patients whose potential for acquiring global functional and cognitive disability during admission to the PICU is high. This population may benefit from interventions that could mitigate this risk and from focused follow-up after discharge from the PICU.