Abstract P-003: ESCALATIONS TO VARIOUS CARDIORESPIRATORY SUPPORTS AFTER PEDIATRIC RAPID RESPONSE EVENTS ARE ASSOCIATED WITH UNIQUE PRECEDING PHYSIOLOGIC PATTERNS
Aims & Objectives:
Rapid response events (RRE) frequently result in unplanned admissions to ICU and may subsequently need various ICU interventions. We hypothesized that distinct preceding physiologic patterns are associated with escalation to individual types of cardio-respiratory supports post RRE. Such association can guide prediction tools, with potential utility in prognostication and resource allocation.
After institutional review board approval, we screened all RREs in a tertiary pediatric academic hospital to identify and review events with escalation of support within 24 hours post RRE. Support categories included: 1-Non-invasive ventilation, 2-Mechanical ventilation 3-Pressors and 4-Mixed. Controls were RREs with no escalation of support. We examined vital signs (VS): oxygen saturations, heart and respiratory rates recorded every 2 seconds by bedside monitors for four-hours prior to support escalation or after RRE (controls). We created VS histograms with Sickbay research platform and compared them pairwise with Kolmogorov-Smirnov test.
During a two-year period 1841 RREs and 236 (13%) escalation events occurred in our hospital. The median patient age was 2.29 years [IQR-0.5–10] for support escalation events, 62% were males and 26 (11%) died before discharge. Table depicts the characteristics and outcomes of various support categories. Figure shows VS histograms. [P value for each pair-wise comparison: <0.01]
Mortality is high among RREs that subsequently need cardio-respiratory support and preceding physiologic patterns are unique between individual types of supports and differ from non-support controls.Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies