PREVALENCE OF ADVERSE EVENTS IN PEDIATRIC INTENSIVE CARE UNITS IN THE UNITED STATES

Agarwal S, Classen DA, Coopes BJ, et al. Pediatr Crit Care Med. 2010;11(5):568-578.

This retrospective, cross-sectional, randomized review of records of 734 patients who were discharged from 15 US pediatric intensive care units (PICUs) between September and December 2005 sought to identify types and severity of adverse events (AEs) and adverse drug events (ADEs). Study objectives included the following: to determine the rates for AEs/ADEs, including types, severity, and preventability in PICU patients; to identify population characteristics associated with increased risk of AEs/ADEs; and to develop and test a PICU-specific trigger toll to facilitate identification of AEs/ADEs. The intervention was the testing of a PICU-focused trigger tool for AEs/ADEs.

Sixty-two percent of the PICU patients had at least 1 AE. There were a total of 1488 AEs, including 256 ADEs identified. This translated to a rate of 28.6 AEs and 4.9 ADEs per 100 patient-days. The most common identified AEs included catheter complications, uncontrolled pain, and endotracheal tube malposition. Ten percent were found to be life-threatening or permanent; 45% were classified as preventable. The adjusted cumulative risk of an AE per PICU day was 5.3% and 1.6 for an ADE. There was a 4% increase in adjusted ADEs rates for every year increase in age.

Study conclusions found that AEs and ADEs occur frequently in the PICU. Data found will help in strategies for evidence-based prevention.

EFFECT OF DEXMEDETOMIDINE ON PULMONARY ARTERY PRESSURE AFTER CONGENITAL CARDIAC SURGERY: A PILOT STUDY

Lazol JP, Lichtenstein SE, Jooste EH, et al. Pediatr Crit Care Med. 2010;11(5):589-592.

This prospective observational pilot study was conducted to examine the effects of dexmedetomidine on pulmonary artery pressure after congenital cardiac surgery from September 1, 2008, to November 30, 2008. Twenty-two patients were enrolled in the study at a university hospital. All patients had a thoracic central venous catheter in place as part of their routine care after surgery.

Patients had an echocardiogram preformed at 3 time points: baseline (T0), 6 minutes after dexmedetomidine loading (T1), and 1 hour after initiation of dexmedetomidine infusion (T2). Transthoracic echocardiography was used to estimate pulmonary artery pressure. All patients received a loading dose of 0.62 [mu]g/kg, followed by 0.5 [mu]g/kg per hour at T1, and 0.65 [mu]g/kg per hour at T2.

None of the patients had any increase in pulmonary artery pressure. The pulmonary artery pressure decreased from 30 mm Hg at T0 to 24 mm Hg (10) at T1 and 26 mm Hg (8) at T2. The authors found the administration of dexmedetomidine to be safe as a sedative and analgesic agent and, based on the results of this study, plan to design a larger, randomized controlled study.