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Characteristics of children intubated and mechanically ventilated in 16 PICUs

Robinder G Khemani1, Barry P Markovitz1, Martha A Q Curley2

  • 1Department of Anesthesia and Critical Care Medicine, Childrens Hospital Los Angeles, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA.

Chest
|June 23, 2009
PubMed

Insights

Over 30% of children in US pediatric intensive care units (PICUs) require mechanical ventilation. Many with respiratory failure don't meet acute lung injury (ALI) criteria, impacting clinical trial design.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory physiology
  • Clinical trial methodology

Background:

  • Understanding the characteristics of pediatric patients requiring mechanical ventilation in PICUs is crucial for designing multicenter clinical trials.
  • A significant proportion of PICU admissions involve intubated and mechanically ventilated children.

Purpose of the Study:

  • To analyze the characteristics of children who received mechanical ventilation in US PICUs.
  • To inform the design and feasibility of future clinical trials focused on pediatric acute lung injury (ALI) and mechanical ventilation.

Main Methods:

  • Secondary analysis of a data set from 16 US PICUs.
  • Included 12,213 children (2 weeks to 18 years) who were intubated and mechanically ventilated.
  • Data included patient demographics, diagnoses, and ventilator support parameters.

Main Results:

  • 30% of PICU admissions involved intubated and mechanically ventilated children.
  • Common conditions included cyanotic congenital heart disease (22%) and respiratory failure without radiographic infiltrates (26%).
  • 12% of patients with available data met oxygenation criteria for ALI based on SpO2/FiO2 ratios, despite not always having an arterial line or requiring significant support.

Conclusions:

  • At least 30% of children in US PICUs receive endotracheal intubation.
  • A substantial portion of pediatric patients with respiratory failure in PICUs do not meet radiographic criteria for ALI.
  • Findings aid in sample size calculations and feasibility assessments for pediatric mechanical ventilation trials.
Abstract

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