Environmental factors
ETS – Samir et al. looked at the impact of ETS on outcomes in children at a PICU with severe acute asthma38. In this retrospective study, they found that children who were ETS-exposed had a significantly longer overall LOS at the PICU of 15% compared to children who were not exposed to ETS; moreover, these children deteriorated faster between the emergency department and the PICU. No differences were found in number of patients who received mechanical ventilation38.
Diet – In an attempt to evaluate the effect of zip code (coming from an area with lower median income) and diet on the PICU outcomes in infants with bronchiolitis, Leimanis Laurens et al. performed a retrospective chart review of infants (0-5 months of age) admitted to the PICU with a primary or secondary respiratory diagnosis, in which they divided the patients in formula fed, breastmilk fed or a mixed diet39. They found that significantly more infants from a lower household income were formula fed and had a public insurance. However, in the clinical outcomes, no differences were found in PICU LOS, overall LOS, mortality or the need for extra corporeal membrane oxygenation (ECMO)39. Swathi et al, described infants admitted with an acute respiratory infection and the association between infants who were exclusive breast fed until the age of six months old, and infants who were not, and found a significantly higher mortality rate of the infants in the latter group29.