Long-stay patients in pediatric intensive care units. Five-years, 2-points, cross-sectional study

Abstract

Objectives: To explore the changing patterns of long-stay patients (LSP) to improve the utilization of pediatric intensive care units (PICUs) resources.

Methods: This is a 2-points cross-sectional study (5 years apart; 2014-2019) conducted among PICUs and SCICUs in Riyadh, Saudi Arabia. Children who have stayed in PICU for more than 21 days were included.

Results: Out of the 11 units approached, 10 (90%) agreed to participate. The prevalence of LSP in all these hospitals decreased from 32% (48/150) in 2014 to 23.4% (35/149) in 2019. The length of stay ranged from 22 days to 13.5 years. The majority of LSP had a neuromuscular or cardiac disease and were admitted with respiratory compromise. Ventilator-associated pneumonia was the most prevalent complication (37.5%). The most commonly used resources were mechanical ventilation (93.8%), antibiotics (60.4%), and blood-products transfusions (35.4%). The most common reason for the extended stay was medical reasons (51.1%), followed by a lack of family resources (26.5%) or lack of referral to long-term care facilities (22.4%).

Conclusion: A long-stay is associated with significant critical care bed occupancy, complications, and utilization of resources that could be otherwise utilized as surge capacity for critical care services. Decreasing occupancy in this multicenter study deserves further engagement of the healthcare leaders and families to maximize the utilization of resources.

Figure 1

Pediatric intensive care units (PICU) versus pediatric surgical cardiac intensive care units (SCICU) changes in the long stay bed occupancy (2014-2019) *p= 0.0112

Figure 2

Medical reasons for the long stay in the pediatric intensive care units (PICU)/pediatric surgical cardiac intensive care units (SCICU) . Others: tracheostomy care, fluctuating blood sugar levels, and the need for frequent suctioning of respiratory secretions.