@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} } @article {1767, title = {Daily practice of mechanical ventilation in Italian pediatric intensive care units: a prospective survey.}, journal = {Pediatr Crit Care Med}, volume = {12}, year = {2011}, month = {2011 Mar}, pages = {141-6}, abstract = {

OBJECTIVES: To assess how children requiring endotracheal intubation are mechanically ventilated in Italian pediatric intensive care units (PICUs).

DESIGN: A prospective, national, observational, multicenter, 6-month study.

SETTING: Eighteen medical-surgical PICUs.

PATIENTS: A total of 1943 consecutive children, aged 0-16 yrs, admitted between November 1, 2006 and April 30, 2007.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Data on cause of respiratory failure, length of mechanical ventilation (MV), mode of ventilation, use of specific interventions were recorded for all children requiring endotracheal intubation for >24 hrs. Children were stratified for age, type of patient, and cause of respiratory failure. A total of 956 (49.2\%) patients required MV via an endotracheal tube; 673 (34.6\%) were ventilated for >24 hrs. The median length of MV was 4.5 days for all patients. If postoperative patients were excluded, the median time was 5 days. Bronchiolitis (6.7\%), pneumonia (6.7\%), and upper airway obstruction (5.3\%) were the most frequent causes of acute respiratory failure, and altered mental status (9.2\%) was the most frequent reason for MV. The overall mortality was 6.7\% with highest rates for heart disease (nonoperative), sepsis, and acute respiratory distress syndrome (26.1\%, 22.2\%, and 16.7\% respectively). Length of stay, associated chronic disease, severity score on admission, and PICU mortality were significantly higher in children who received MV (p < .05) than in children who did not. Controlled MV and pressure support ventilation + synchronized intermittent mandatory ventilation were the most frequently used modes of ventilatory assistance during PICU stay.

CONCLUSIONS: Mechanical ventilation is frequently used in Italian PICUs with almost one child of two requiring endotracheal intubation. Children treated with MV represent a more severe category of patients than children who are breathing spontaneously. Describing the standard care and how MV is performed in children can be useful for future clinical studies.

}, keywords = {Adolescent, Child, Child, Preschool, Clinical Protocols, Female, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Intubation, Intratracheal, Italy, Male, Prospective Studies, Respiration, Artificial, Respiratory Insufficiency}, issn = {1529-7535}, doi = {10.1097/PCC.0b013e3181dbaeb3}, author = {Wolfler, Andrea and Calderoni, Edoardo and Ottonello, Giancarlo and Conti, Giorgio and Baroncini, Simonetta and Santuz, Pierantonio and Vitale, Pasquale and Salvo, Ida} }