Browsing by Author "Kohne, Joseph G."

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    Epidemiology of Pediatric Critical Care Admissions in 43 United States Children’s Hospitals, 2014-2019
    (Wolters Kluwer, 2022-07) Heneghan, Julia A.; Rogerson , Colin; Goodman, Denise M.; Hall, Matt; Kohne, Joseph G.; Kane, Jason M.; Pediatrics, School of Medicine
    OBJECTIVES: To identify trends in the population of patients in PICUs over time. DESIGN: Cross-sectional, retrospective cohort study using the Pediatric Health Information System database. SETTING: Forty-three U.S. children’s hospitals. PATIENTS: All patients admitted to Pediatric Health Information System-participating hospitals from January 2014 to December 2019. Individuals greater than 65 years old and normal newborns were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: PICU care occurred in 13.8% of all pediatric hospital encounters and increased over the study period from 13.3% to 14.3%. Resource intensity, based on average Hospitalization Resource Intensity Scores for Kids score, increased significantly across epochs (6.5 in 2014–2015 vs 6.9 in 2018–2019; p < 0.001), although this was not consistently manifested as additional procedural exposure. Geometric mean PICU cost per patient encounter was stable. The two most common disease categories in PICU patients were respiratory failure and cardiac and circulatory congenital anomalies. Of all PICU encounters, 35.5% involved mechanical ventilation, and 25.9% involved vasoactive infusions. Hospital-level variation in the percentage of days spent in the PICU ranged from 15.1% to 63.5% across the participating sites. Of the total hospital costs for patients admitted to the PICU, 41.7% of costs were accrued during the patients’ PICU stay. CONCLUSIONS: The proportional use of PICU beds is increasing over time, although was variable across centers. Case-based resource use and complexity of pediatric patients are also increasing. Despite the higher use of PICU resources, the standardized costs of PICU care per patient encounter have remained stable. These data may help to inform current PICU resource allocation and future PICU capacity planning.
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    Tracheostomy Practices and Outcomes in Children during Respiratory ECMO
    (Wolters Kluwer, 2022-04) Kohne, Joseph G.; MacLaren, Graeme; Rider, Erica; Carr, Benjamin; Mallory, Palen; Gebremariam, Acham; Friedman, Matthew L.; Barbaro, Ryan P.; Pediatrics, School of Medicine
    Objectives: Children receiving prolonged extracorporeal membrane oxygenation (ECMO) support may benefit from tracheostomy during ECMO by facilitating rehabilitation; however the procedure carries risks, especially hemorrhagic complications. Knowledge of tracheostomy practices and outcomes of ECMO-supported children who undergo tracheostomy on ECMO may inform decision-making. Design: Retrospective cohort study Setting: ECMO centers contributing to the Extracorporeal Life Support Organization (ELSO) Registry Patients: Children birth to 18 years who received ECMO support for 7 days or greater for respiratory failure from January 1st 2015 to December 31st 2019. Interventions: None Measurements and Main Results: 3685 children received at least seven days of ECMO support for respiratory failure. The median duration of ECMO support was 13.0 days (IQR 9.3-19.9), and in-hospital mortality was 38.7% (1426/3685). A tracheostomy was placed during ECMO support in 94/3685 (2.6%). Of those who received a tracheostomy on ECMO, the procedure was performed at a median 13.2 days (IQR 6.3-25.9) after initiation of ECMO. Surgical site bleeding was documented in 26% of children who received a tracheostomy (12% after tracheostomy placement). Among children who received a tracheostomy, the median duration of ECMO support was 24.2 days (IQR 13.0-58.7); in-hospital mortality was 30/94 (32%). Those that received a tracheostomy before 14 days on ECMO were older (median age 15.8 years (IQR 4.7-15.5) versus 11.7 years (IQR 11.5-17.3); p-value=0.002) and more likely to have been supported on VV-ECMO (84% vs 52%, p=0.001). Twenty-two percent (11/50) of those who received a tracheostomy before 14 days died in the hospital, compared to 19/44 (43%) of those who received a tracheostomy at 14 days or later (p=0.03). Conclusions: Tracheostomies during ECMO were uncommon in children. One in four patients who received a tracheostomy on ECMO had surgical site bleeding. Children who had tracheostomies placed after 14 days were younger and had worse outcomes, potentially representing tracheostomy as a “secondary” strategy for prolonged ECMO support.