Morbidity and Mortality in Critically Ill Children. II. A Qualitative Patient-Level Analysis of Pathophysiologies and Potential Therapeutic Solutions

Crit Care Med, 2020 · DOI: 10.1097/CCM.0000000000004332 · Published: June 1, 2020

Simple Explanation

This study looks at why critically ill children in pediatric intensive care units (PICUs) experience new health problems or death. The study identifies common underlying medical issues and suggests new treatments that could improve outcomes. Researchers analyzed medical records to understand the specific processes leading to these outcomes. They focused on identifying areas where new therapies or improvements in existing treatments could make a difference. The goal is to create a research plan that targets the most critical issues affecting these children. By addressing these issues, the hope is to reduce the number of children who develop new health problems or die while in intensive care.

Study Duration

December 4, 2011 and April 7, 2013

Participants

292 critically ill children

Evidence Level

Not specified

Key Findings

1
The most common problems were related to poor delivery of essential substances like oxygen to the body, inflammation, and direct injury to tissues, especially the brain.
2
Many children had chronic conditions that worsened their outcomes. Common chronic conditions included congenital heart disease, neuromuscular disorders, and malignancies.
3
The most frequently proposed therapeutic advances were new or improved drugs, cell regeneration techniques (especially for brain injuries), and better ways to control the immune system and inflammation.

Research Summary

This study identified the major causes of morbidity and mortality in critically ill children using detailed assessments of individual patients. Low cardiac output and cardiac arrest, inflammation-related organ failures, and central nervous system trauma were the most common pathophysiologic processes. Chronic illness was found to contribute to poor outcomes in over half of the cases. Intensivists suggested that advances in drug therapies, cell regeneration, and immune and inflammatory modulation are needed. The findings can inform a research agenda for pediatric intensive care focused on improving patient outcomes. A research agenda based on patient-level data may have high potential to directly impact patient outcomes.

Practical Implications

Targeted Research

Focus research efforts on improving substrate delivery, managing inflammation, and treating traumatic brain injuries in pediatric ICU patients.

Chronic Illness Management

Develop specialized care plans and interventions for critically ill children with pre-existing chronic conditions, such as congenital heart disease and neuromuscular disorders.

Therapeutic Development

Prioritize the development of new drugs, cell regeneration therapies, and immune modulation techniques to address the identified pathophysiologies.

Study Limitations

1
The study was restricted to CPCCRN sites, all of which are in the United States.
2
Use of predefined categories in the structured medical record review may have constrained reviewers.
3
The pathophysiologies and therapies may have been limited by the pre-existing concepts, experience, and imagination of the reviewers

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