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Mechanical ventilation in pediatric intensive care units during the season for acute lower respiratory infection: a

Julio A Farias1, Analía Fernández, Ezequiel Monteverde

  • 1Hospital de Niños R Gutiérrez, CABA, Argentina. jufarias@intramed.net.ar

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|July 5, 2011
PubMed

Insights

During acute lower respiratory infection season, half of pediatric intensive care unit admissions need mechanical ventilation, primarily for acute respiratory failure. The spontaneous breathing trial is the preferred method for weaning patients off mechanical ventilation.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory medicine
  • Mechanical ventilation

Background:

  • The season of acute lower respiratory infections (ALRI) significantly impacts pediatric intensive care unit (PICU) admissions.
  • Mechanical ventilation (MV) is a critical intervention for critically ill children during ALRI season.

Purpose of the Study:

  • To characterize the use and outcomes of mechanical ventilation in PICUs during the ALRI season.
  • To identify the primary indications for MV and common liberation strategies.

Main Methods:

  • A prospective cohort study was conducted in 60 medical-surgical PICUs.
  • Consecutive infants and children requiring MV for at least 12 hours during a 28-day period were enrolled.

Main Results:

  • 55% of 2,156 PICU admissions received MV (median 5 days), with acute respiratory failure being the main indication (78%).
  • Overall PICU mortality was 13%, rising to 39% in patients with acute respiratory distress syndrome (ARDS).
  • The spontaneous breathing trial (SBT) was used in 62% of liberation attempts, while gradual ventilatory support reduction was used in 37%.

Conclusions:

  • Mechanical ventilation is frequently required for children admitted to PICUs during ALRI season, predominantly due to acute respiratory failure.
  • Mortality is significantly higher in pediatric patients with ARDS requiring MV.
  • The spontaneous breathing trial is the most prevalent method for weaning patients from mechanical ventilation.
Abstract

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