Perfil epidemiológico de uma UTI pediátrica no sul do Brasil

• Autor(a) principal: Corullón, Juliana Lebsa
• Data de Publicação: 2007
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional PUCRS
• Texto Completo: http://hdl.handle.net/10923/4633
• topic: PEDIATRIA; UNIDADES DE TERAPIA INTENSIVA PEDIÁTRICA; EPIDEMIOLOGIA; DESNUTRIÇÃO; MORTALIDADE

Objective: To trace the Epidemiology profile of patients interned in the Pediatric ITU at São Lucas Hospital - PUCRS with emphasis in the influence of nutricional state and of organic failure in mortality. Methods: Contemporary coorte study was carried out through the Pediatrics ITU at São Lucas Hospital - PUCRS from May 2005 to April 2006. Demographic variables were studied, the type of bedstead, origin, acute or chronic illnesses, clinical or surgical status, main organic dysfunction (OD) and nutrition degree. For the diagnosis in the admission main OD was used. The definitions of OD was adapted from Wilkinson et al in 1986. For the evaluation of the nutrition, data related to gender, weight for age and stature for age and weight for stature has been compared to the curve of the NCHS. A Z score lesser than two standarts derivations (Z<_2) was used to define three types of desnutrition: low weight-for-age, low weight-for-stature or low stature-for-age. The outcome variables have been: reason for discharge (discharge or death). For the discharge diagnosis, multiple occurrences of organic dysfunctions register was used. For statistics evaluation, average or median were used, the Qui-square test, and relative risk, the T test, ANOVA and logistic regression and its respective reason of possibility (OR). Differences findings Findings were considered statistically significant at a p value <0. 05. The study was approved by an Ethics Committee of the institution. Results: There were 432 internments and 31 deaths (7. 2%) in this period. Median age 31 months (IIQ 9-88). 222 (51. 4%) patients derived from hospital itsef. The internments’ median was 4 days (IIQ 2-7,5). Until the seventh day 75% of patients were interned. The average weight was of 15,9±11,4 kg and the average stature was of 94,2±31. Patients’ characteristics associated to mortality were: physician patient 247 (57. 2%), deaths 25 (10%) and mechanics ventilation use in 182 (42. 1%), deaths 28 (15. 4%). All types of desnutrition had significant association with mortality (p<0,05). The low stature-for-age 127 (29. 4%) deaths 14 (45. 2%). The low weight-for-age 115 (26. 6%) deaths 15 (48. 4%). The low weight-for-stature 74 patients (17. 1%) deaths 13 (41. 9%). During internment 22 patients (5. 1%) did not present OD. The following ODs had significant associations with mortality (p<0,05): respiratory dysfunction in 288 (66. 7%), deaths 30 (10. 4%); neurological in 136 (31. 5%) deaths 15 (11. 0%); cardiac in 97 (22. 5%) deaths 18 (18. 6%); hematological 54 (12. 5%) deaths 16 (29. 6%), renal 48 (11. 1%) deaths 11 (22. 9%); hepatic 20 (4. 6%) deaths 6 (30. 0%). The gastrointestinal dysfunction 81 (18,7) deaths 7 (8. 6%) did not present relation to mortality p=0,571. In a multivaried analysis there was observed that five ODs: Respiratory, Neurological, Cardiac, Hematolological, Hepatic; Clinical patient and low weight-forstature (Z <-2) were independenty related to mortality (p<0,05).Conclusions: The presence of clinical patients, with Respiratory, Neurological, Cardiac, Hematological, Hepatic dysfunctions and low weight-for-stature (Z<-2) represents a decisive and independent factor in Pediatric ITU outcome, significantly increasing mortality.