@article {10490, title = {Withdrawal Assessment Tool-1 Monitoring in PICU: A Multicenter Study on Iatrogenic Withdrawal Syndrome.}, journal = {Pediatr Crit Care Med}, volume = {18}, year = {2017}, month = {2017 02}, pages = {e86-e91}, abstract = {

OBJECTIVES: Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17\% and 57\% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients{\textquoteright} outcome between patients with and without withdrawal syndrome.

DESIGN: Observational multicenter prospective study.

SETTING: Eight Italian PICUs belonging to the national PICU network Italian PICU network.

PATIENTS: One hundred thirteen patients, less than 18 years old, mechanically ventilated and treated with analgesic and sedative therapy for five or more days. They were admitted in PICU from November 2012 to May 2014.

INTERVENTIONS: Symptoms of withdrawal syndrome were monitored with Withdrawal Assessment Tool-1 scale.

MEASUREMENTS AND MAIN RESULTS: The occurrence rate of withdrawal syndrome was 64.6\%. The following variables were significantly different between the patients who developed withdrawal syndrome and those who did not: type, duration, and cumulative dose of analgesic therapy; duration and cumulative dose of sedative therapy; clinical team judgment about analgesia and sedation{\textquoteright}s difficulty; and duration of analgesic weaning, mechanical ventilation, and PICU stay. Multivariate logistic regression analysis revealed that patients receiving morphine as their primary analgesic were 83\% less likely to develop withdrawal syndrome than those receiving fentanyl or remifentanil.

CONCLUSIONS: Withdrawal syndrome was frequent in PICU patients, and patients with withdrawal syndrome had prolonged hospital treatment. We suggest adopting the lowest effective dose of analgesic and sedative drugs and frequent reevaluation of the need for continued use. Further studies are necessary to define common preventive and therapeutic strategies.

}, keywords = {Adolescent, Analgesics, Child, Child, Preschool, Critical Care, Female, Humans, Hypnotics and Sedatives, Iatrogenic Disease, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Italy, Logistic Models, Male, Prospective Studies, Respiration, Artificial, Substance Withdrawal Syndrome}, issn = {1529-7535}, doi = {10.1097/PCC.0000000000001054}, author = {Amigoni, Angela and Mondardini, Maria Cristina and Vittadello, Ilaria and Zaglia, Federico and Rossetti, Emanuele and Vitale, Francesca and Ferrario, Stefania and Savron, Fabio and Coffaro, Giancarlo and Brugnaro, Luca and Amato, Roberta and Wolfler, Andrea and Franck, Linda S} } @article {8301, title = {The Importance of Mortality Risk Assessment: Validation of the Pediatric Index of Mortality 3 Score.}, journal = {Pediatr Crit Care Med}, volume = {17}, year = {2016}, month = {2016 Mar}, pages = {251-6}, abstract = {

OBJECTIVE: To evaluate the performance of the newest version of the Pediatric Index of Mortality 3 score and compare it with the Pediatric Index of Mortality 2 in a multicenter national cohort of children admitted to PICU.

DESIGN: Retrospective, prospective cohort study.

SETTING: Seventeen Italian PICUs.

PATIENTS: All children 0 to 15 years old admitted in PICU from January 2010 to October 2014.

INTERVENTIONS: None.

MEASUREMENT AND MAIN RESULTS: Eleven thousand one hundred nine children were enrolled in the study. The mean Pediatric Index of Mortality 2 and 3 values of 4.9 and 3.9, respectively, differed significantly (p < 0.05). Overall mortality rate was 3.9\%, and the standardized mortality ratio was 0.80 for Pediatric Index of Mortality 2 and 0.98 for Pediatric Index of Mortality 3 (p < 0.05). The area under the curve of the receiver operating characteristic curves was similar for Pediatric Index of Mortality 2 and Pediatric Index of Mortality 3. The Hosmer-Lemeshow test was not significant for Pediatric Index of Mortality 3 (p = 0.21) but was highly significant for Pediatric Index of Mortality 2 (p < 0.001), which overestimated death mainly in high-risk categories.

CONCLUSIONS: Mortality indices require validation in each country where it is used. The new Pediatric Index of Mortality 3 score performed well in an Italian population. Both calibration and discrimination were appropriate, and the score more accurately predicted the mortality risk than Pediatric Index of Mortality 2.

}, issn = {1529-7535}, doi = {10.1097/PCC.0000000000000657}, author = {Wolfler, Andrea and Osello, Raffaella and Gualino, Jenny and Calderini, Edoardo and Vigna, Gianluca and Santuz, Pierantonio and Amigoni, Angela and Savron, Fabio and Caramelli, Fabio and Rossetti, Emanuele and Cecchetti, Corrado and Corbari, Maurizio and Piastra, Marco and Testa, Raffaele and Coffaro, Giancarlo and Stancanelli, Giusi and Gitto, Eloisa and Amato, Roberta and Prinelli, Federica and Salvo, Ida} }