What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study

J A Farias, F Frutos, A Esteban, J Casado Flores, A Retta, A Baltodano, I Alía, T Hatzis, F Olazarri, A Petros, M Johnson, J A Farias, F Frutos, A Esteban, J Casado Flores, A Retta, A Baltodano, I Alía, T Hatzis, F Olazarri, A Petros, M Johnson

Abstract

Objective: To describe the daily practice of mechanical ventilation (MV), and secondarily, its outcome in pediatric intensive care units (PICUs).

Design: Prospective cohort of infants and children who received MV for at least 12 h.

Setting: Thirty-six medical surgical PICUs.

Patients: All consecutive patients admitted to the PICUs during 2-month period.

Measurements and main results: Of the 1893 patients admitted, 659 (35%) received MV for a median time of 4 days (25th percentile, 75%: 2, 6). Median of age was 13 months (25th percentile, 75%: 5, 48). Common indications for MV were acute respiratory failure (ARF) in 72% of the patients, altered mental status in 14% of the patients, and ARF on chronic pulmonary disease in 10% of the patients. Median length of stay in the PICUs was 8 days (25th percentile, 75%: 5, 13). Overall mortality rate in the PICUs was 15% (confidence interval 95%: 13-18) for the entire population, 50% (95% CI: 25-74) in patients who received MV because of acute respiratory distress syndrome, 24% (95% CI: 16-35) in patients who received MV for altered mental status and 16% (95% CI: 9-29) in patients who received MV for ARF on chronic pulmonary disease.

Conclusion: One in every 3 patients admitted to the PICUs requires ventilatory support. The ARF was the most common reason for MV, and survival of unselected infants and children receiving MV for more than 12 h was 85%.

Figures

Fig. 1
Fig. 1
Modes of mechanical ventilation used during study period. VLV-A/C volume limited ventilation—assist/control, SIMV synchronized intermittent mandatory ventilation, PCV pressure control ventilation, PSV pressure support ventilation, SIMV+PSV synchronized intermittent mandatory plus pressure support ventilation, HFOV high-frequency oscillatory ventilation
Fig. 2
Fig. 2
Modes of weaning used in 590 attempts. SIMV synchronized intermittent mandatory ventilation, PSV pressure support ventilation, SIMV+PSV synchronized intermittent mandatory plus pressure support ventilation, CPAP continuous positive airway pressure

References

    1. Salyer Resp Care Clin North Am. 1996;2:471.
    1. Martinot Arch Pediatr. 1997;4:730. doi: 10.1016/S0929-693X(97)83410-0.
    1. Earle Crit Care Med. 1997;25:1462. doi: 10.1097/00003246-199709000-00011.
    1. Lopez-Herce Intensive Care Med. 2000;26:62. doi: 10.1007/s001340050013.
    1. Harel Heart Lung. 1998;27:238.
    1. American Chest. 1993;104:1833.
    1. Task Crit Care Med. 1991;19:275.
    1. Esteban Am J Respir Crit Care Med. 2000;161:1450.
    1. Pollack Crit Care Med. 1988;16:1110.
    1. Lebel Arch Dis Child. 1989;64:1431.
    1. Proulx Chest. 1996;109:1033.
    1. Bernard Am J Respir Crit Care Med. 1994;149:818.
    1. Farias Intensive Care Med. 2001;27:1649.
    1. Farias Intensive Care Med. 2002;28:752. doi: 10.1007/s00134-002-1306-6.
    1. Thiagarajan Am J Respir Crit Care Med. 1999;160:1562.
    1. Knaus Am J Respir Crit Care Med. 1994;150:311.
    1. Esteban J Am Med Assoc. 2002;287:345. doi: 10.1001/jama.287.3.345.
    1. Timmons J Pediatr. 1991;119:896.
    1. De Crit Care Med. 1992;20:1223.
    1. Davis J Pediatr. 1993;123:35.
    1. Lodha Indian Pediatr. 2001;38:1154.
    1. Brochard Am J Respir Crit Care Med. 1994;150:896.
    1. Esteban N Engl J Med. 1995;332:345.
    1. Randolph J Am Med Assoc. 2002;288:2561. doi: 10.1001/jama.288.20.2561.
    1. Farias Intensive Care Med. 1998;24:1070.
    1. Orlowski Crit Care Med. 1980;8:324.
    1. Scott PH, Eigen H, Moye LA, Georgitis J, Laughlin J. Predictability and consequences of spontaneous extubation in a pediatric ICU. Crit Care Med. 1985;13:228–232.
    1. Little Crit Care Med. 1990;18:163.
    1. Betbese Crit Care Med. 1998;26:1180.
    1. Epstein Am J Respir Crit Care Med. 2000;161:1912.
    1. Venkataraman Crit Care Med. 2000;28:2991.
    1. Epstein Chest. 1997;112:186.
    1. Esteban Am J Respir Crit Care Med. 1997;156:459.
    1. Timmons Chest. 1995;108:789.
    1. Arnold Crit Care Med. 1994;22:1530.
    1. The N Engl J Med. 2000;342:1301.
    1. Estenssoro Crit Care Med. 2002;30:2450.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅