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Vol 5 No 1.
Juni 2022 pISSN : 2654-5241 eISSN : 2722-7537 Artikel Penelitian Children Mortality in Pediatric Intensive Care Unit (PICU): An Overview Asma Danisa HasmuddinA.
Tuti SeniwatiA.
Titi Iswanti Afelya A Abstrak Latar Belakang: Pediatric Intensive Care Unit (PICU), merupakan bangsal perawatan yang dikhususkan bagi anak yang memiliki kondisi medis yang kritis.
Kondisi kritis yang dialami oleh anak yang dirawat di PICU tidak terlepas dari keadaan darurat dan dapat beresiko terjadinya kematian.
Meskipun angka kematian anak mengalami penurunan setiap tahun, namun kejadian mortalitas di ruang PICU masih menjadi kontributor besar kematian pada anak-anak untuk saat Tujuan Penelitian: Untuk mengidentifikasi karakteristik kematian pada anak di ruang PICU Rumah Sakit Dr.
Wahidin Sudirohusodo Makassar.
Metode: Penelitian ini merupakan survei analitik menggunakan desain cross-sectional dengan teknik purposive sampling.
Hasil: Penelitian terhadap 53 catatan medis anak menunjukkan rata-rata responden dengan usia 59 bulan (SD 69,.
mengalami kematian, rata-rata lama hari rawat responden yang mengalami kematian yakni 7,94 hari (SD 9,.
, rata-rata status neurologis pasien diawal masuk menunjukkan nilai 11,43 (SD 4,.
Pasien dengan diagnosis sepsis menunjukkan frekuensi kematian terbanyak pada penelitian ini.
Kesimpulan: Responden dengan kategori usia infant, kategori status neurologis ringan, pemakaian ventilator mekanik, memiliki frekuensi paling banyak mengalami kejadian mortalitas di ruang PICU.
Saran pada peneltian ini yaitu diharapkan bagi peneliti lain dapat meneliti variabel-variabel yang berhubungan dengan kematian anak di PICU untuk dapat diungkap secara keseluruhan.
Kata kunci: Mortalitas anak, karakteristik, anak, perawatan kritis.
PICU Abstract Introduction: Pediatric Intensive Care Unit (PICU), is unit of care spesifically for children who have critical medical Critical condition experienced by children treated at PICU are inseparable from emergencies and can be at risk of death.
Even though the child mortality rate has decreased every year, the incidence of mortality in the PICU is still a large contributor to the death of children at this time.
Objective: To identify characteristics of children mortality in the PICU hospital unit Dr.
Wahidin Sudirohusodo Makassar.
Method: This study was an analytic survey using a crosectional design with purposive sampling.
Results: The study of 53 children medical records showed that the average respondent aged 59 months (SD 69.
experienced death, length of stay of respondents who experienced death was 94 days (SD 9,.
, the neurological status of patients at the beginning of admission shows the value of 11.
43 (SD
Patients with a diagnosis of sepsis showed the highest mortality in this study.
Conclusion: Respondents with infant categories, mild neurological status at the admission of PICU, used mechanical ventilators as oxygen devices, have the highest frequency of mortality in PICU.
Hence, this study suggested to the other researcher to examine the variables that relate to child mortality in PICU for revealed as a whole.
Keywords: Children mortality, characteristics, critical care.
PICU Submitted : 12 Maret 2022 Revised : 26 Maret 2022 Affiliasi penulis : 1 Student of Nursing Study Program.
Faculty of Nursing.
Hasanuddin University.
Makassar.
2 Department of Pediatric Nursing.
Faculty of Nursing.
Hasanuddin University.
Makassar.
Department of Medical Surgical Nursing.
Faculty of Nursing.
Hasanuddin University.
Makassar.
3 Department of Medical Surgical Nursing.
Faculty of Medicine.
Cendrawasih University Korespondensi : AuTuti SeniwatiAy tutiseniwati@unhas.
Telp: 6281354915399
INTRODUCTION
Pediatric intensive care unit (PICU) is a ward of care specifically for children who have chronic and complex medical conditions The purpose of this intensive care unit is to prevent death in children by intensively caring and monitoring patients with critical conditions that have unstable airway, inability to oxygenate (O2 Sat less than 90% on Fakultas Kedokteran Universitas Mulawarman Accepted: 19 Mei 2022 oxygen requirements> 50%, inability to ventilate with increased PCO2.
Scale Scores Glasgow Coma (GCS) <8 or score suddenly dropped> 2 points, the critical value of the vital sign paramete.
2and at risk of death3.
Based data from the World Health Organization(WHO)4, child mortality were grouped into three age groups including, children aged O 5 years with the number of deaths reaching 5.
4 million in 2017, children aged 5-14 years with the number of deaths reaching 18% of the age mortality of O 5 years, and children aged 16 -18 which is categorized as a teenager with 1.
8 million deaths in 2017.
From 1999 to 2017 the child mortality rate has decreased significantly Jurnal Kesehatan Pasak Bumi Kalimantan.
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4 million occurrences of child deaths in the world5.
In line with these data, the child mortality rate in Indonesia has also decreased in recent years.
The latest data obtained from 2000 to 2017 the mortality rate for children under 5 years decreased by 40% per 1000 births with a total of children who died for 2017 as many as 125,213, while for birth rates aged 5-14 years were 5 % per 1000 birth rates with an overall total death toll estimated at 23,974 cases6.
Although the prevalence of child mortality every year has decreased, the mortality rate is still a problem in some countries in the world including in developing countries like Indonesia.
About half of deaths among children in the United States aged one to nineteen occur in hospitals, and the majority of deaths in hospitals occur in the intensive care section7.
The PICU mortality rate in United States is estimated to be around 20% of patients per year .
in 5 or the equivalent of 500,000 children treated at PICU per yea.
Based on researcher observation, in Indonesia, there is no specific data related to mortality in critical ill patients.
The data available is only general child mortality.
Therefore, it is very important to know the characteristics of children mortality while being treated at PICU to assist nurses in providing appropriate treatment at the beginning of care.
METHOD
This study used a descriptive method, with a cross-sectional study.
The population was all children who died in the PICU of Dr.
Wahidin Sudirohusodo hospital from January 2017 to December 2018.
The sampling technique used purposive sampling and total sample of 53 respondents was obtained from the medical record.
The inclusion criteria were children who died in PICU room.
Samples collected were only 53 respondents' medical record data, due to some data not included in the inclusion criteria such as data obtained showing respondents who had recovered and respondents who were not treated at PICU but were only treated on the ward, as well as some medical records that were not present at the time research.
Data collection was performed using secondary data recap sheets containing variables that would be examined including age, sex, length of stay, type of surgical or non-surgical illness suffered by the patient.
Fakultas Kedokteran Universitas Mulawarman oxygenation equipment used, duration of use of the ventilator and assessment of the child's neurological status by using GCS and FOUR Score.
This sheet has been created by the authors, which is preceded by patient demographic data, and assessment of research variables.
The variables studied have several objective criteria that have been determined by researchers based on previous research, and observe preliminary data in hospital management before the study Objective criteria in this study, including the age categories of infants, toddlers, preschools, schools, and teen, variable type of disease including surgical and non-surgical, previous studies have shown causes of death that occur in PICU differ from surgical or nonsurgical types9, variable final diagnosis based on observations that have been obtained by researchers, the disease most suffered by PICU patients is in the case of sepsis.
In this case the neurological status can be determined by using the Glasgow Coma
Scale
(GCS)
Full Outline Unresponsiveness (FOUR) score which is a scale used to determine the patient's neurological status when first treated in the PICU room which is listed in the medical record with objective criteria include severe neurological status, if the GCS score is O 8 and the FOUR score is O 7, moderate neurological status, if the GCS score is 9-13 and the FOUR score is 8-14, mild neurological status, if the GCS score is 141510 and FOUR Score is 15-1611.
RESULTS
Based on table 1 shows that most of the pediatric patients who died in the PICU room were male, 32 respondents .
4%), the most age category was children aged 0-1 years around 28 respondents .
8%) with mean of respondent aged was 1 year.
Type of disease with the non-surgical category has the highest frequency of 52 respondents.
Sepsis shows the final diagnosis which mostly affect patients who died at PICU.
For neurological status variables, the average GCS / FOUR score of patients at the initial admission PICU showed 11, with mild neurological status with GCS values 14-15 and FOUR scores 15-16 having the most frequencies of 27 The type of oxygenation device most widely used at the beginning of Jurnal Kesehatan Pasak Bumi Kalimantan.
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Table 1.
Characteristic of respondents Characteristics of Respondents Frequency .
Percentage (%) Age .
Ages 0-1 Years Ages 1-3 Years Ages 3-6 Years Ages 6-12 Years Ages 12-18 Years Gender Boys Girls Types of diseases Surgical Non-Surgical Final Diagnosis Sepsis Non- Sepsis Neurological Status enters PICU Mild Neurological Status Moderate Neurological Status Severe Neurological Status The type of oxygenation device enters PICU Mechanical Ventilator O2 Face Mask O2 Nasal Not Using Table 2 shows that the distribution of respondents based on the incidence of mortality reported that most of them died > 48 hours as many as 43 respondents with a percentage of 81.
Table 2.
The distribution of respondents based on time of death in PICU Time of death Frequency .
Percentage (%) < 48 hours > 48 hours Table 3 shows that the average length of stay of patients until they die is 7.
94 days (SD .
, and the average length of use of ventilators in the PICU room is 51.
80 hours (SD 45.
Fakultas Kedokteran Universitas Mulawarman Mean Min-Max Table 3.
The distribution of respondents based on length of stay and length of use mechanical ventilator Variable Mean Length Of stay (Da.
Length of use ventilator (Hou.
MinMax
DISCUSSION
This study showed that the age of patients 0-1 years has a higher incidence of The previous studies have shown that patients aged around 0-5 years are higher population death than 5-18 years, although statistical values do not show a significant This is due to several factors, one of which is growth and development factors in The physiological immaturity of the Jurnal Kesehatan Pasak Bumi Kalimantan.
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Juni 2022 pISSN : 2654-5241 eISSN : 2722-7537 body's systems in younger children can increase the risk of infection and spread of the Early-life infection is a significant cause of global morbidity and mortality.
Distinct immune function in infants is a significant contributor to infection risk14.
The result of this study indicates that male respondents had the highest frequency of death.
This statement was in line with research Mcevoy & Shander15 which states patients with male sex show a higher population experiencing death in the intensive care room.
One study showed that sex would differentiate immune responses, male subjects could often experience more severe disease conditions due to an increase in pro-inflammatory mediators was TNF.
IL-6.
IL-10, and female subjects were found many anti-inflammatory mediators 16.
Patients with non-surgical diseases experienced higher mortality than the types of surgical diseases.
The results of this study are supported by previous studies conducted9 which states that there was a significant correlation between types of disease, with the incidence of mortality, patients with nonsurgical diseases have seven times higher risk of death.
After that, the severity of the disease greatly affects death in patients and had significant correlation with mortality of Meanwhile, the age group of infants is the most age group with a diagnosis of sepsis, which is 70.
6% 17.
However, the incidence of sepsis will reportedly decrease with increasing age of the child18.
This is due to the physiological maturity especially the immune system in children that age is still immature so that during the disease process occurs, it can attack complex tissues, the immune system, and endothelial cells and disorders in the microcirculation that can cause organ dysfunction or even failure that causes death high in these patients16.
The average length of stay of patients who died in this study was indicated on the 7th day.
This research was in line with other studies that have shown an average length of stay of 7 days with the lowest quartile lasting less than 5 days and the longest quartile lasting for 20 to 394 days19.
The effect of length of stay on mortality has a high degree of association in critical pediatric patients who has a chronic disease as comorbid20.
Length of stay was used as a measure to assess the level of morbidity or mortality in the treatment room.
Fakultas Kedokteran Universitas Mulawarman The longer days of treatment show the severity of the condition of the patients being The largest population death in this study were patients with mild neurological status, with GCS and FOUR> 8.
Most of the patients who entered at the beginning in PICU had not experienced a decrease in consciousness.
By contrast on other research 21 showed the highest number of patients admitted to intensive care has decreased consciousness.
This could be due to the assessment of the patient's neurological status in this study only taken at the beginning of the treatment, but at the end of the treatment not taken, it could have been shown to decrease the value of neurological status from mild to severe.
Conditions of decreased consciousness can occur quickly .
or slowly22.
Oxygenated patients at the beginning of treatment at PICU had a high mortality rate especially in the use of mechanical The use of oxygenation devices has a significant relation with mortality in the PICU room with a value of p = 0.
002, in previous studies, the use of ventilators has more mortality than the use of other oxygenation devices13.
It is also suitable in this study which shows the use of ventilator devices has a high mortality rate, although in this study the use of oxygenation devices with the type of ventilator-associated with mortality did not have a significant relation.
Mangku et .
revealed improper administration of oxygen will cause disease severity including respiratory acidosis, organ failure, coma, and even death23.
And in this study found about 80% of patients who died using oxygenation devices.
There are several types of mechanical ventilators used in this study including Assist/Control (A/C), pressure-controlled Ventilation (PCV).
Synchronized Intermitten Mandatory Ventilation (SIMV).
Contionous Positive Airway Pressure (CPAP), and Bilateral Positive Non-Invasive (BiPAP).
However, the use of ventilators with pressurecontrolled Ventilation (PCV) mode that is most used by respondents.
Several studies have shown that.
Neurally Adjusted Ventilatory Assist (NAVA) has been recently proposed as an alternative to PCV or PSV24.
NAVA are safe, feasible, and have equivalent a spontaneous breathing trial (SBT) success rates when compared to PSV25.
In this study.
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Juni 2022 pISSN : 2654-5241 eISSN : 2722-7537 the average FiO2 setting in the use of mechanical ventilators was given as much as The lowest value is around 43% and the highest is 100%.
The use of FiO2 with high concentrations (Ou50%) and in the long term .
ore than 24 hour.
showed can be at risk of experiencing oxygen toxicity and can also be at risk of life-threatening on ventilator Variable length of ventilator use showed a significant length of stay of patients treated in intensive care and the risk of death in The statement was in line with other research 28 showed the median on the third day of use of a mechanical ventilator showed an association between the outcomes of patients who died with a p-value <0.
The risk posed by the duration of the use of a mechanical ventilator is based on the clinical care provided.
A study of the operational risks of mechanical ventilators shows that the effects are quite numerous and affect several systems in the body.
This is related to clinical care which consists of endotracheal intubation, administration of sedative drugs, a setting of the ventilator mode, and humidification system.
CONCLUSION
It can be concluded that the characteristics of children mortality in the PICU is largely dominated by patients under the age of 5 years associated with immaturity of the immune system which can accelerate the process of spread and severity of the In addition.
Oxygenated patients at the beginning of treatment at PICU had a high mortality rate especially in the use of mechanical ventilators.
Assessment of the patient's neurological status in this study only taken at the beginning of the treatment, but at the end of the treatment not taken, it could have been shown to decrease the value of neurological status from mild to severe.
Hence, this study suggested to the other researcher to examine the variables that relate to child mortality in PICU for revealed as a whole.
REFERENCES