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[Mechanical ventilation on paediatric intensive care units in Czech Republic]
M Fedora1, L Kroupová, P Kosut
1Pädiatrische Intensivstation der Abteilung für Kinderanästhesie und Reanimation Universitätskrankenhaus Brno. mfedora@fnbrno.cz
Insights
Mechanically ventilated children represent 23% of pediatric intensive care unit admissions, with a 3.5% mortality rate. Severity of illness and length of stay were significantly elevated in these critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Clinical Research
Background:
- Mechanical ventilation is a critical intervention for critically ill children.
- Understanding the characteristics and outcomes of mechanically ventilated children is essential for optimizing care.
- Pediatric intensive care units (PICUs) manage a significant number of children requiring respiratory support.
Purpose of the Study:
- To determine the incidence of mechanical ventilation in PICUs.
- To analyze demographic data and clinical characteristics of ventilated children.
- To evaluate ventilator settings, outcomes, and mortality rates in this population.
Main Methods:
- A prospective, observational, multicenter study was conducted in seven Czech Republic PICUs.
- 144 children (1 month to 18 years) requiring mechanical ventilation were enrolled.
- Data collected included demographics, illness severity scores (PRISM, MOSF, LIS), respiratory failure origin, ventilation parameters, and outcomes.
Main Results:
- Mechanically ventilated children constituted 23% of all PICU admissions.
- The mean age was 70 months, mean weight 23 kg, with elevated PRISM scores and length of stay.
- Mortality was 3.5%, with no deaths attributed to hypoxia.
Conclusions:
- Mechanical ventilation is utilized in a substantial proportion of PICU patients.
- Ventilated children exhibit increased illness severity and prolonged hospital stays.
- The overall mortality rate is 3.5%, highlighting the critical nature of these patients.
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 ventilated children.
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.
Patients:
All children between 1 month and 18 years admitted to the participating paediatric intensive care units who required intubation and mechanical ventilation were enrolled.
Method:
Following parameters were recorded in all patients: demographic data (age, weight, gender), the origin of the admitting diagnosis, severity of illness (Pediatric Risk of Mortality Score - PRISM, Multiorgan System Failure - MOSF, Lung Injury Score - LIS), the origin of respiratory failure, presence of chronic disease and immunosuppression, length of ventilation, length of stay, ventilator setting, the use of unconventional ventilation, outcome (mortality), blood gas analyses and indices (alveoloarterial oxygen difference - AaDO (2), oxygenation index - OI, hypoxemia score - PaO (2)/FiO (2) and ventilation index - VI), deadspace to tidal volume ratio-Vd/Vt and dynamic respiratory system compliance (Cdyn).
Results:
One hundred and forty four children (42 % girls) were enrolled in total which represent 23 % of all admitted children. The mean age of the patients was 70 months and mean weight was 23 kg. PRISM score and the length of stay were twofold against mean values (11.7 vs. 5.7 and 10.4 vs. 4.8 days respectively). The mean length of ventilation was 117 hours, 66 % of the patients had an extrapulmonary origin of respiratory failure, 19 % of the patients were chronically ill, and 0,7 % had the evidence of immunosuppression. Pressure regulated volume controlled and Biphasic positive airway pressure were the most frequently used ventilator settings. Unconventional ventilation in all was used in 13 % of the patients. Mortality was 3.5 %.
Conclusion:
Children on mechanical ventilation create 23 % of all patients admitted to paediatric intensive care units. The severity of illness and length of stay were twofold against mean values. Mortality rate was 3.5 % and hypoxia was not a cause of death in any patient.
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