Prof. Dr. Reda Sanad Arafa
Professor of Pediatrics
Faculty of Medicine
Benha University
EGYPT
Benha Faculty Of Medicine - EGYPT
Benha Faculty Of Medicine - EGYPT
IMPORTANCE OF PICU

Pediatric intensive care unit (PICU) is an important component
of tertiary pediatric care services.

PICU aims at promoting qualified care for critically ill children .

These units are points of major technology transfer and constitute
one of the main consumers of hospital budgets.
o Lakshmi (2008) reported that 15-20 % of hospital budgets are spent in ICUs
o Abdul-Monim B (2001) reported that ICUs consume :
•
•
•
10% of hospital beds
30% of acute care hospital cost
> 20% of hospital budgets
Benha Faculty Of Medicine - EGYPT
Benha Faculty Of Medicine - EGYPT

Critically ill child means a child who is in a clinical
state which may result in respiratory or cardiac arrest or
severe neurologic complication .

Risk for critical illness may be primary cardiovascular
or respiratory or secondary to neurologic , infectious ,
metabolic disorder or serious injury .
Infection is the most common & septic shock is a
catastrophic immune system reaction which produce
organ failure .

( Emma W., 2009 )

Benha Faculty Of Medicine - EGYPT
(Stormorken & Powell, 2004)
MULTIPLE ORGAN DYSFUNCTION
SYNDROME IN CHILDREN (MODS)

The simultaneous occurrence of at least two organ failure.

MODS is important because of its frequent occurrence and its
association with high mortality in the pediatric intensive care unit

25% of the children admitted to PICU has MODS and that the
mortality associated with it is up to 50%.

In fact, from 97% to 100% of the deaths in PICUs have been
related to MODS.
( Marshall et al., 2003)
Benha Faculty Of Medicine - EGYPT
Benha Faculty Of Medicine - EGYPT
 Estimation
of disease severity and probability of
death are important elements in determining the
prognosis of patients in PICU.
A
more accurate prognostic assessment can lead to
more appropriate monitoring , proper management
and family counseling.
 ICU
scoring systems are devised to determine
probable outcome of the patients admitted to the ICU
( Marshall et al., 2003)
Benha Faculty Of Medicine - EGYPT

The most commonly measured PICU outcomes are
mortality, length of stay, functional outcome, and organ
dysfunction .

The 2 most commonly used scoring systems to predict
ICU mortality are the Pediatric Risk of Mortality
(PRISM) and the Pediatric Index of Mortality (PIM) .

Pediatric Logistic Organ Dysfunction (PELOD) has
recently been validated with good discrimination.
(Qureshi et al., 2007)
Scoring systems in PICU
Measure illness
severity
Assess
therapeutic
requirements
& efficacy
Determine
prognosis
Benha Faculty Of Medicine - EGYPT

The Clinical Classification System ( CCS ) and the
Therapeutic Intervention System ( TISS ) are indirect
measures of illness severity .

The CCS is a qualitative assessment of care requirements
on admission and the TISS is a quantitative measure of
therapeutic requirements.
Benha Faculty Of Medicine - EGYPT

The Physiologic Stability Index ( PSI ) is a more direct
measure of illness severity but is time consuming , requiring
the use of 34 variables.

The Pediatric Risk of Mortality ( PRISM ) was developed
from the PSI to reduce the number of variables to 14 without
losing its predictive power.

Pediatric Logistic Organ Dysfunction (PELOD) has recently
been validated with good discrimination.
(Qureshi et al., 2007)
Benha Faculty Of Medicine - EGYPT
THE PELOD SCORE

The PELOD score has developed to estimate disease severity
and probability of death for ICU patients .

It includes six key organ dysfunctions :
cardiovascular, respiratory, hematological, neurological, renal,
and hepatic. The maximum number of points for an organ
dysfunction is 20 and the maximum PELOD score is 71.
The total score gives us the percentage of probability of death
PELOD Score.htm
Table.doc
Benha Faculty Of Medicine - EGYPT

A case of Down syndrome , 15 months old ,
7.8 kg , with C H D common A V canal ,
complicated by bronchopneumonia & referred
to PICU by :



RD grade IV
Shock
Drowsiness
Benha Faculty Of Medicine - EGYPT


RD grade IV
Tachypnea R R 78/min
Nasal flare & retractions
Cyanosis ( PaO2 58 mmHg )
Shock
Tachycardia 200/min
Hypotension 52/35
Cold extremities
Oliguria ( S.creat. 1.8 mg/dl )
Benha Faculty Of Medicine - EGYPT
What is about ?




Disease severity & outcome
Family counselling
Monitoring vital parameters
Management strategy
What “ vital parameter” you are
anxious from getting worse ?
HR
RR
Bl.Pressure
Renal impairment
Hepatic impairment
Benha Faculty Of Medicine - EGYPT
score.png
Benha Faculty Of Medicine - EGYPT





Severe critical illness
score 30
Poor outcome
Mortality 79.6%
Monitor HR , BL.Pressure , PaO2 s.creat.
Focus on BL.Pressure
Management strategy :
Iv fluids
Inotropics
Ventilation
Antibiotics
Antifailure
Benha Faculty Of Medicine - EGYPT
Benha Faculty Of Medicine - EGYPT
 The
ICU is an expensive treatment facility where patients of
high mortality rates are treated.
of disease severity and probability of death
are important elements in determining the prognosis of
patients in PICU.
 Estimation
more accurate prognostic assessment can lead to more
appropriate monitoring , proper management , and family
counseling.
A
 PELOD
has recently been validated with good discrimination.
Benha Faculty Of Medicine - EGYPT

PELOD scoring system is highly reliable and very
sensitive to measure severity of illness and determine the
probability of death in PICU.

It is valid to be a valuable detector for PICU services
and a sensitive director for appropriate monitoring , proper
management & family counseling

It gives the priority to focus on vital parameters that
affects total score number and the corresponding outcome
for patients in PICU.
Benha Faculty Of Medicine - EGYPT