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Desempenho dos critérios de disfunção múltipla de órgãos : PODIUM e IPSCC 2005 numa unidade de cuidados intensivos pediátricos
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Introdução: Os critérios de disfunção múltipla de órgãos têm como finalidade a classificação e estratificação dos doentes internados em Unidades de Cuidados Intensivos Pediátricos (UCIP) com Síndrome de Disfunção Múltipla de Órgãos (MODS). São ferramentas importantes para a gestão de recursos, identificando doentes de maior risco, com necessidade de intervenções específicas e otimização de cuidados. Objetivos: O objetivo principal deste estudo foi comparar a aplicabilidade dos critérios contemporâneos de disfunção múltipla de órgãos PODIUM com os critérios da IPSCC 2005, utilizados atualmente na UCIPed; como objetivo secundário pretendeu-se encontrar uma correlação entre a MODS, o tempo de internamento e a mortalidade para cada conjunto de critérios. Métodos: Estudo observacional retrospetivo com revisão dos internamentos ocorridos entre 1 de janeiro de 2022 e 31 de dezembro de 2022 na UCIPed. Foram excluídos os internamentos planeados, de causa cirúrgica e/ou internamentos na unidade para vigilância ou monitorização após a realização de procedimentos eletivos e os internamentos de causa médica com duração inferior a 48h. Os critérios foram comparados por estatística descritiva, utilizando o programa Microsoft Excel 2024 (Microsoft Corporation). Resultados: Foram considerados 161 internamentos e a mortalidade da amostra foi de 4.3% (7 óbitos). Ambos os conjuntos de critérios demonstraram que as disfunções respiratória e cardiovascular tiveram maior incidência na população em estudo e uma menor mortalidade associada. Pela aplicação dos critérios PODIUM e da IPSCC 2005, a totalidade dos óbitos registados na amostra (n=7) cumpriram critérios para MODS. Conclusão: Dada a dimensão reduzida da amostra e o número de mortes considerado, não foi possível inferir acerca da capacidade dos critérios PODIUM de identificar os doentes de maior risco e/ou com maior probabilidade de morte. No entanto, ressalvamos a possibilidade de, em estudos futuros, a extensão da amostra poder obter resultados com significado estatístico.
Introduction: The purpose of the multiple organ dysfunction criteria is to classify and stratify patients admitted to Pediatric Intensive Care Units (PICUs) with Multiple Organ Dysfunction Syndrome (MODS). These criteria are important tools for managing resources, identifying patients at greater risk, identifying the need for specific interventions and optimizing the provision of care. Objectives: The main objective of this study was to compare the applicability of the contemporary PODIUM multiple organ dysfunction criteria with the 2005 IPSCC criteria currently used in the UCIPed; as a secondary objective we aimed to find a correlation between MODS, length of stay and mortality for each set of criteria. Methods: This was a retrospective observational study reviewing admissions to the UCIPed between 1st January 2022 and 31st December 2022. Planned admissions, admissions for surgery and/or admissions to the unit for surveillance or monitoring after elective procedures and admissions for medical reasons lasting less than 48 hours were excluded. The criteria were compared using descriptive statistics, using the Microsoft Excel 2024 programme (Microsoft Corporation). Results: One hundred and sixty-one admissions were taken into consideration and the mortality was 4.3% (7 deaths). Both sets of criteria showed that respiratory and cardiovascular dysfunctions had a higher incidence in the study population and a lower associated mortality. When applying the PODIUM and IPSCC 2005 criteria, all the deaths recorded in the sample (n=7) met the criteria for MODS. Conclusion: Given the small size of the sample and the number of deaths considered, it was not possible to infer about the ability of the PODIUM criteria to identify the patients most at risk and/or most likely to die. However, we emphasize the possibility that, in future studies, extending the sample could yield statistically significant results.
Introduction: The purpose of the multiple organ dysfunction criteria is to classify and stratify patients admitted to Pediatric Intensive Care Units (PICUs) with Multiple Organ Dysfunction Syndrome (MODS). These criteria are important tools for managing resources, identifying patients at greater risk, identifying the need for specific interventions and optimizing the provision of care. Objectives: The main objective of this study was to compare the applicability of the contemporary PODIUM multiple organ dysfunction criteria with the 2005 IPSCC criteria currently used in the UCIPed; as a secondary objective we aimed to find a correlation between MODS, length of stay and mortality for each set of criteria. Methods: This was a retrospective observational study reviewing admissions to the UCIPed between 1st January 2022 and 31st December 2022. Planned admissions, admissions for surgery and/or admissions to the unit for surveillance or monitoring after elective procedures and admissions for medical reasons lasting less than 48 hours were excluded. The criteria were compared using descriptive statistics, using the Microsoft Excel 2024 programme (Microsoft Corporation). Results: One hundred and sixty-one admissions were taken into consideration and the mortality was 4.3% (7 deaths). Both sets of criteria showed that respiratory and cardiovascular dysfunctions had a higher incidence in the study population and a lower associated mortality. When applying the PODIUM and IPSCC 2005 criteria, all the deaths recorded in the sample (n=7) met the criteria for MODS. Conclusion: Given the small size of the sample and the number of deaths considered, it was not possible to infer about the ability of the PODIUM criteria to identify the patients most at risk and/or most likely to die. However, we emphasize the possibility that, in future studies, extending the sample could yield statistically significant results.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Pediatric Organ Dysfunction Information Update Mandate (PODIUM) International Pediatric Sepsis Consensus Conference (IPSCC 2005) Síndrome de Disfunção Múltipla de Órgãos Cuidados intensivos pediátricos Critérios de diagnóstico Mortalidade Pediatria