>Year 2007, Issue 1
Laue NML, Risco CRE, López AMA, Galicia TJ
Development of a pediatric multiple organ dysfunction outcome score (EPPDOM).
Rev Asoc Mex Med Crit y Ter Int 2007; 21 (1)
PDF: 69.35 Kb.
Introduction: The multiorganic dysfunction is frequently observed in critical care and his mortality is high.
Objective: To design a score for the evaluation of the multiple organ dysfunction in children.
Material and methods: Prospective cohort study, consist in the search of organic failure in patients which interned in the service, selection of variables and construction of 4 models applicable in the initial, days 3, 5 and critic.
Statistic tests: Relative risk of dead, t of Student, Mantel-Haenszel, Wilcoxon and Logistic regression.
Results: 559 patients evaluated, 171 with multiorganic dysfunction. The EPPDOM models predict mortality in 73-76% in the 4 moments of evaluation. The association of failures cardiovascular-respiratory-renal was observed in 60% of the patients which die, with rr = 1.6. The sequential evaluation showed what in 81% of patients the 4 predictions was accurate or exist only one error.
Discussion and conclusions: The intestine, the sepsis and the two-hits are important in the pathogenesis of the multiple organ dysfunction syndrome, nevertheless the majority of the scores not evaluate this conditions.
Conclusions: The EPPDOM score satisfactory predict mortality and survive in 4 important moments of the evaluation of this disease, value 7 organic systems and include epidemiological variables.
||Multiorganic failure, prognostic score, children.
Domínguez TE, Pertnoy JD. Multiple organ dysfunction score, logistic organ dysfunction or sequential organ failure assessment. Crit Care Med 2002;30(8):1913-4.
Berenholtz SM, Dorman T. Component multiple organ dysfunction score: are we any closer to an ideal system? Crit Care Med 2001;29(11):2223-4.
Huerta TJ, Casas TE, Cañada LM. Escala de disfunción orgánica múltiple: correlación con una escala modificada. Rev Asoc Mex Med Crit Ter Int 2002;XVI(5):159-64.
Marshall JC, Cook DJ, Christov NV et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995;23:1638-52.
Laue NL, López AM, Risco CR et al. Morbimortalidad por disfunción orgánica múltiple en niños gravemente enfermos. Rev Asoc Mex Med Crit Ter Int 2002;XVI(1):5-10.
Moore F, Sauria A, Moore E et al. Postinjury multiple organ failure: a bimodal phenomenum. J Trauma 1996; 40(4):501-12.
Opal SM. Concept of PIRO as a new conceptual framework to understand sepsis. Pediatr Crit Care Med 20025;6(3):555-60.
Kutko M, Calario MP, Flaherty MB et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Ped Crit Care Med 2003;4(3):333-7.
Krafte JB, Pollack MM. Multiple organ system failure in children. Crit Care Med 1994;22(6):903-4.
Carcillo AJ, Cunnion RE. Common issues in pediatric and adult critical care. Crit Care Clin 1997;13(3):553-74.
Bone RC. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med 1996;24:163-72.
Oberholzer A, Keel M, Zellweger R et al. Incidence of septic complications and multiple organ failure in severely injured patients is sex specific. J Trauma 2000;48(5): 932-7.
Evans T, Smitkies M. ABC of the critical care: organ dysfunction. BMJ 1999;318(7198):1606-9.
Crouser ED, Dorinsky PM. Gastrointestinal tract physiology and interaction with acute lung injury in adult respiratory distress syndrome/multiple organ dysfunction syndrome. New Horizons 1994;2(4):476-87.
Demling RH. The clinical relevance of defining the mechanism for altered gut permeability in a two-hit model of injury and infection. Crit Care Med 2004;32(11):2356-7.
Krafte JB, Brilli R. Increased circulating thrombomodulin in children with septic shock. Crit Care Med 1998;26(5): 933-8.
Bone RC, Grodzin ChJ, Balk RA. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest 1997;112:235-43.
Carcillo J, Fields A, Task Force Committee Members. Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002;30(6):1365-78.
Wilkinson JD, Pollack MM, Glass NL et al. Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit. J Pediatr 1987;111:324-8.
Balk RA. Pathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock. Crit Care Clin 2000;16(2):337-52.
Deitch EA, Goodman ER. Trauma care in the millennium: prevention of multiple organ failure. Surg Clin North Am 1999;79(6):1471-87.
Remick DG. Do not get sick when you are sick: the impact of comorbid condition. Crit Care Med 2004;32(10): 2147-8.
Looney MR, Grepper MA, Matthay MA. Transfusion-relate acute lung injury. Crit Care Review Chest 2004;126 (1):249-58.
>Year 2007, Issue 1