Ricardo García-De Jesús

Pediatric Risk, Injury, Failure, Loss, End-Stage renal disease score identifies acute kidney injury and predicts mortality in critically ill children: a prospective study.

Objectives: To determine whether Pediatric Risk, Injury, Failure, Loss, End-Stage renal disease (pRIFLE) criteria serve to characterize the pattern of acute kidney injury in critically ill pediatric patients. To identify if pRIFLE score will predict morbidity and mortality in our patient’s cohort. Design: Prospective cohort. Setting: Multidisciplinary, tertiary care, ten-bed PICU. Patients: A total of 266 patients admitted to PICU from November 2009 to November 2010. Interventions: None. Measurements and Main Results: The incidence of acute kidney injury in the PICU was 27.4%, of which 83.5% presented within 72 hours of admission to the PICU. Patients with acute kidney injury were younger; weighed less; were more likely to be on fluid overload greater than or equal to 10%; and were more likely to be on inotropic support, diuretics, or aminoglycosides. No difference in gender, use of other nephrotoxins, or mechanical ventilation was observed. Fluid overload greater than or equal to 10% was an independent predictor of morbidity and mortality. In multivariate analysis, acute kidney injury and failure categories, as defined by pRIFLE, predicted mortality, hospital length of stay, and PICU length of stay. Conclusions: In this cohort of critically ill pediatric patients, acute kidney injury identified by pRIFLE and fluid overload greater than or equal to 10% predicted increased morbidity and mortality. Implementation of pRIFLE scoring and close monitoring of fluid overload upon admission may help develop early interventions to prevent and treat acute kidney injury in critically ill children.

114: PRISM III VS. RACHS-1 AS PREDICTORS OF MORTALITY IN CHILDREN WHO UNDERWENT CARDIAC SURGERY

Crit Care Med 2015 • Volume 43 • Number 12 (Suppl.) PCICU within 7 days of initial discharge. Methods: We retrospectively reviewed an emergency response database that records all acute decompensations outside ICU, at a tertiary care academic pediatric hospital over a three-year period. All patients who were in PCICU, 7 or fewer days before the acute decompensation and readmitted to ICU were included in this study. Results: Fifty-six readmissions after acute decompensation in 50 patients were studied. Median age at readmission was 4.9 mo. 21(38%) events occurred in patients with single ventricle (SV) physiology, 24(42%) with biventricular physiology (BV) and 11(20%) with acquired heart disease (AHD). Hypoplastic left heart syndrome (post Norwood and systemic to pulmonary shunt) comprised more than half of SV cases; common atrioventricular canal or repaired anomalous pulmonary venous return were more than half of the BV cases, and dilated cardiomyopathy was the most likely AHD case. Cardiac surgery had occurred within 30 days of the readmission in 37(66%) cases. Echocardiographic and chest radiographic signs of worsening were present in 30% and 46% cases at readmission respectively. Interventions needed within 72 hr of ICU admission were: 1) ventilation (SV:28%, BV:33%, AHD:54%), 2) Hemodynamic support (SV:29%, BV:12.5%, AHD:27%). Mortality within 30 days of the readmission was 34% (SV: 43%, BV: 16%, AHD: 37%). Conclusions: Congenital heart disease patients are more likely to have ICU readmission after acute decompensation. Patients with single ventricle physiology and acquired heart disease are more likely to need ventilation and hemodynamic support after readmission and have higher 30-day mortality.