Mechanical Ventilation at Paediatric Intensive Care Units

Overview

Objective:
The aims of this study were to evaluate the incidence of mechanically ventilated children in participating units,to find out the demographic data of the patients, to evaluate ventilator settings and to assess the mortality of ventilatedchildren.Design: Prospective observational multicenter study between 1. 2. 2002 and 30. 4. 2002.Setting: Seven paediatric intensive care units in tertiary hospitals in the Czech Republic.Material and Method: All children between 0 and 18 years admitted to the participating paediatric intensive care units whorequired intubation and mechanical ventilation were enrolled. Following parameters were recorded in all patients: demographicdata (age, weight, gender), the origin of the admitting diagnosis, severity of illness (Paediatric Risk of MortalityScore – PRISM, Multiorgan System Failure – MOSF, Lung Injury Score – LIS), the origin of respiratory failure, presence ofchronic disease and immunosuppression, length of ventilation, length of stay, ventilator setting, the use of unconventionalventilation, outcome (mortality), blood gas analyses and indices (alveoloarterial oxygen difference – AaDO2, oxygenationindex – OI, hypoxemia score – PaO2/FiO2 and ventilation index – VI) and dynamic respiratory system compliance (Cdyn).Results: One hundred and forty four children (42% girls) were enrolled in total, which represented 23% of all admittedchildren. The mean age of the patients was 70 months and mean weight was 23 kg. PRISM score and the length of stay weretwofold compared to mean values (11.7 vs. 5.7 and 10.4 vs. 4.8 days respectively). The mean length of ventilation was 117hours, 66 % of the patients had an extrapulmonary origin of respiratory failure, 19% of the patients were chronically ill, and0.7 % had the evidence of immunosuppression. The pressure regulated volume controlled and biphasic positive airwaypressure were the most frequently used ventilator settings. Both permissive hypercapnia and prone position were used in8% of the patients and unconventional ventilation in all was used in 13% of the patients. The mortality was 3.5%.Conclusion: Children on mechanical ventilation represent 23% of all patients admitted to paediatric intensive care units.The severity of illness and length of stay were twofold compared to mean values and 66% of the patients had an extrapulmonaryorigin of respiratory failure.The pressure regulated volumecontrolled and biphasic positive airway pressurewere the most frequently used ventilator settings and unconventional ventilation was used in 13% of the patients. Themortality rate was 3.5% and hypoxia was not a cause of death in any patient.

Key words:
mechanical ventilation – intensive care – children