To Study the Profile of Children Admitted in Pediatriaic Intensive Care Unit of a Rural Medical College, Hospital

According to the World Health Organization, the major causes of death in under-five-year-old children in developing countries (Thorburn, et. al., 2001) are preventable and curable. Improving outcome is possible by well-equipped and well-staffed intensive care units, since dramatic decreases in mortality and morbidity have been documented by such measures. (Tilford, et. al., 1998. Downes, 2009) Intensive care could reduce mortality rates by 15% to 60% (Pollack, et. al., 1997) and many studies have demonstrated its unquestionable benefit (Gemke and Bonsel, 1995). Well-equipped intensive care units staffed with intensivists have shown better outcomes (Pearson, et. al., 1997. Tilford, et. al., 2000) The development of pediatric intensive care has contributed to improved survival rates in children with critical illnesses (Bellomo, et. al., 2000). The goal of PICU is the surveillance and support of vital organ function in critically ill or injured children who are at risk for organ dysfunction (Filler, 2001). There are references that support better outcome of PICU patients in tertiary centres, which led to the development of a centralized system of PICUs worldwide. Collection, analysis, and interpretation of relevant objective data on the utilization of ICU beds will help plan for reducing the length of ICU stay and facilitate covering more patients who require this care. The establishment of PICU has tremendously improved the success rate in saving critical patients. In a hospital containing PICU patients and those who have potential to deteriorate into critical conditions will be sent to PICU for intensive treatment and monitoring. Hence this study will

The goal of PICU is the surveillance and support of vital organ function in critically-ill or injured children who are at risk for organ dysfunction.

Sample Size: 305 Duration of Study: 1ST August 2016 to 31st July 2017

This study shall be conducted at Pediatric Intensive Care Unit, Department of Pediatrics Avbrh Wardha from August 2016 to July 2017. Inclusion criteria: • All the children admitted in the PICU

• There shall be no exclusion criteria.

In this study, out of 305 patients, 201 (65.9%) were below 4 years, 50 patients (16.3%) were in the age

OUT of the total cases, there were more number of males 162(53.1%) and the females were 143 (46.8%).

Out of all the cases, 54 patients (17.7%) had cardiovascular system involvement, and majority of the patients 108 (35.4%) had central nervous system involvement, 81 patients (26.5%) had involvement of gastro intestinal system involved, 49 patients (16.06%) had involvement of respiratory system, only 11 patients (3.6%) were from oral surgery and the least number of patients that is only 2 patients (0.6%) had involvement of skin.

(83.61%).

In our study, a total of 305 patients were admitted out of which 277(90.8%) patients were discharged and 28 patients died (9.18%). The causes of death were as follows: 1. Bronchopneumonia 2. Pulmonary hemorrhage, sepsis 3. Intractable seizures 4. Septicemia, DIC 5. Septicemia, nephritic syndrome 6. Septic shock, chonic kidney disease 7. Tubercular meningitis 8. Renal failure, DIC, sepsis 9. Meningitis

10. DIC

11. Cardiogenic shock

In this study, the profile and the outcome of tertiary sector PICU patients, illness severity and treatment characteristics and the investigation of relative mortality risk and possible outcome prediction factors were observed.

This study had the maximum patients in the age groups of 0 to 4 years (65.9%). Haque at. el., 2009). also showed a close mean age range of 24 months (Haque and Bano, 2009). The preponderance of male sex was higher (53.1%) than that of the female sex (46.8%).This value was close to male sex value of 66% reported by (Haque and Bano, 2009). (Einloft, et. al., 2002) (56%) and Batista, et. al., 2015) (58%). also showed more number of males constituting to 63% of the admission. A study by Bagga et al. showed similar percent of males (69.2%), (Kapil and Bagga, 1993).

Out of all the admitted patients in the picu during this study, the maximum number of patients were admitted for 8- 10 days. (31.9%). Whereas a few patients had less than 1 day of stay (5.9%). A study by Pollock et al also showed longer duration of stay in the PICU (7.1%) (Pollack, et. al., 1987). It was also quite similar to a study by Khan et al where the average length of stay was 9.7 days. On the contrary (Khan, et. al., 2006), a study by Earan et. al. showed mean duration of stay to be 2.21 days.

PICU setup in this study had most of the patients being admitted due to central nervous system causes (35.4%) followed by gastro intestinal etiologies (26.5%)and then due to cardiovascular and respiratory problems. There were also patients of post operative maxillofacial surgery but their length of stay and number was very less. This was similar to a study by Earan et. al. in which respiratory and central nervous system involvement was more 40.2%

Ventilatory support, mainly invasive ventilation is one of the major life saving interventions in PICU. Like, in this study, 16.39% of the children received invasive ventilator support. But, a study by Begum et. al., showed a total of 23% of the patients requiring invasive ventilation (Begum and Kumar, 2016) this difference might be due to the time period which was different in both the studies. Study on PICU patients by Rukmani J. Kumar N., also showed 20.68% of the patiets requiring mechanical ventilation which was almost similar to our study (Rukmani and Kumar, 2017).

The mortality rate in our PICU is 9.18 %. The rest of the patients were discharged after their stay in

A very low mortality rate was shown by Earn et. al., in their study The mortality rates were also quite different from the study of Bagga et al, showing a mortality of 9.8% among long stay patients and 24.1% among short stay patients. . These results were also quite the opposite of the results by Pollock et al who showed 46% mortality of the chronic patients. These differences were arising because of the different specialist care at different PICU set ups. There is also difference between the management of different PICU in different set ups. Patient getting admitted have different underlying diagnosis. The mortality rate is also greatly dependent on the level of care and the expertise of the concerned specialist.

The major cause of deaths in the PICU was sepsis followed by shock, renal failure and DIC. Severe bronchopneumonia also was one of the leading causes of deaths in the PICU. Among the other causes of deaths were seizures, meningitis. This result was different from the study of Earan et. al, leading to maximum number of deaths due to respiratory causes. But the study by Bagga et. al again showed a similar result leading to septicemia as the as the major cause of death

• This study analyses the clinical profile, management and outcome of all the patient were admitted in the PICU of AVBRH, HOSPITAL between 2016 to 2017. This can serve as the basis for developing dedicated and new protocols for the caregivers in an effort to improve the outcome of critical illness.

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