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Author Notes:

Correspondence: amanda.ruth@choa.org

AR performed background research, designed and contributed to concept of the study, guided data extraction, directed analysis, and prepared and revised the final manuscript as submitted.

CM assisted in the study methodology, carried out the initial statistical analyses, developed the figures and tables, and reviewed and revised the manuscript.

JF carried out the initial analyses, prepared the manuscript, and reviewed and revised the manuscript and figures.

KH conceptualized and designed the study, carried out the initial analyses, prepared the manuscript, and reviewed and revised the manuscript and figures.

All authors read and approved the final manuscript.

Matthew Hall is the biostatistician for Children’s Hospital Association and assisted in the initial data extraction and subsequent data pulls.

Emory and Children’s Healthcare of Atlanta Pediatric Research Center Biostatistics Core provided invaluable statistical support.

The authors declare that they have no competing interests.

Subjects:

Extracorporeal therapies in pediatric severe sepsis: findings from the pediatric health-care information system.

Tools:

Journal Title:

Critical Care

Volume:

Volume 19

Publisher:

, Pages 397-397

Type of Work:

Article | Final Publisher PDF

Abstract:

INTRODUCTION: Pediatric severe sepsis (PSS) continues to be a major health problem. Extracorporeal therapies (ETs), defined as extracorporeal membrane oxygenation (ECMO) and RRenal replacement therapyenal replacement therapy (RRT), are becoming more available for utilization in a variety of health conditions. We aim to describe (1) rates of utilization of ET in PSS, (2) outcomes for PSS patients receiving ET, and (3) epidemiologic characteristics of patients receiving ET. METHODS: We conducted a retrospective review of a prospectively collected database. Data from the Pediatric Health Information System (PHIS) database collected by the Children's Hospital Association (CHA) from 2004-2012 from 43 US children's hospitals' pediatric intensive care units (PICUs) were used. Patients with PSS were defined by (1) International Classification of Diseases, 9th Revision (ICD-9) codes reflecting severe sepsis and septic shock and (2) ICD-9 codes of infection and organ dysfunction as defined by updated Angus criteria. Among the patients with PSS, those with a PHIS flag of ECMO or RRT were identified further as our main cohort. RESULTS: From 2004 to 2012, 636,842 patients were identified from 43 hospitals, and PSS prevalence was 7.7 % (49,153 patients). Nine point eight percent (4795 patients) received at least one form of ET, and the associated mortality rate was 39 %. Mortality rates were 47.8 % for those who received ECMO, 32.3 % in RRT, and 58.0 % in RRT + ECMO. Underlying co-morbidities were found in 3745 patients (78.1 %) who received ET (81 % for ECMO, 77.9 % in RRT, and 71.2 % in those who received both). There was a statistically significant increase in ECMO utilization in patients with at least three organ dysfunctions from 2004 to 2012 (6.9 % versus 10.3 %, P < 0.001) while RRT use declined (24.5 % versus 13.2 %, P < 0.001). After 2009, there was a significant increase in ECMO utilization (3.6 % in 2004-2008 versus 4.0 % in 2009-2012, P = 0.004). ECMO and RRT were used simultaneously in only 500 patients with PSS (1 %). CONCLUSIONS: ETs were used in a significant portion of PSS patients with multiple organ dysfunction syndrome (MODS) during this time period. Mortality was significant and increased with increasing organ failure. ECMO use in PSS patients with MODS increased from 2004 to 2012. Further evaluation of ET use in PSS is warranted.

Copyright information:

© Ruth et al. 2015

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).

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