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Mechanical ventilation in children
Tanil Kendirli1, Asli Kavaz, Zahide Yalaki
1Pediatric Intensive Care Unit, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey.
Insights
Mechanical ventilation in pediatric intensive care units (PICU) is linked to significant complications and a high mortality rate, exceeding 58% in treated children. This highlights a critical need for more research on pediatric mechanical ventilation outcomes.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Intensive care unit management
Background:
- Mechanical ventilation is essential for critically ill children but associated with substantial complications.
- Prolonged ventilatory support increases the risk of adverse events in pediatric intensive care units (PICUs).
Purpose of the Study:
- To retrospectively evaluate the incidence, indications, complications, and mortality associated with mechanical ventilation in a PICU.
- To provide epidemiological data on the outcomes of mechanically ventilated children.
Main Methods:
- Retrospective review of medical records from 407 pediatric patients admitted to the PICU.
- Analysis of data for 91 patients (22.3%) who received mechanical ventilation between January 2002 and May 2005.
- Categorization of indications, complications, and mortality rates.
Main Results:
- The primary indications for mechanical ventilation were respiratory failure (64.8%), cardiovascular failure (19.7%), and central nervous system disease (9.8%).
- The complication rate among mechanically ventilated children was 42.8%, with atelectasis (26.3%) and ventilator-associated pneumonia (17.5%) being most common.
- The mortality rate for mechanically ventilated patients was 58.3%, significantly higher than the overall PICU mortality rate of 12.2%.
Conclusions:
- Mechanical ventilation in children is associated with a high complication and mortality rate.
- There is a lack of comprehensive epidemiological data regarding the long-term follow-up and mortality of infants and children requiring mechanical ventilation.
Abstract:
Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between January 2002-May 2005. Medical records of 407 patients were reviewed. Ninety-one patients (22.3%) were treated with mechanical ventilation. Ages of all patients were between 1-180 (median: 8) months. The mechanical ventilation time was 18.8 +/- 14.1 days. Indication of mechanical ventilation could be divided into four groups as respiratory failure (64.8%), cardiovascular failure (19.7%), central nervous system disease (9.8%) and safety airway (5.4%). Tracheostomy was performed in four patients. The complication ratio of mechanically ventilated children was 42.8%, and diversity of complications was as follows: 26.3% atelectasia, 17.5% ventilator-associated pneumonia, 13.1% pneumothorax, 5.4% bleeding, 4.3% tracheal edema, and 2.1% chronic lung disease. The mortality rate of mechanically ventilated patients was 58.3%, but the overall mortality rate in the PICU was 12.2%. In conclusion, there are few published epidemiological data on the follow-up results and mortality in infants and children who are mechanically ventilated.
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