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Risk factors for air leakage during invasive mechanical ventilation in pediatric intensive care units

Ling Ma1, Miao Yin2, Xi-Lun Yang1

  • 1Department of Anesthesiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.

European Journal of Medical Research
|October 29, 2022
PubMed

Insights

Air leakage during invasive mechanical ventilation (IMV) in pediatric intensive care units (PICU) affects ventilation duration and hospitalization. Acute respiratory distress syndrome (ARDS), higher pediatric critical illness scores (PCIS), and higher peak inspiratory pressure (PIP) increase air leakage risk.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory physiology
  • Mechanical ventilation

Background:

  • Air leakage is a common complication during invasive mechanical ventilation (IMV) in pediatric intensive care units (PICU).
  • Understanding risk factors for air leakage is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To investigate the incidence of air leakage during IMV in a PICU.
  • To identify risk factors associated with air leakage in pediatric patients.
  • To explore factors influencing patient outcomes in the context of air leakage.

Main Methods:

  • Retrospective cohort study of 548 children undergoing IMV in a single-center PICU.
  • Analysis of air leakage risk factors and factors associated with improved outcomes.
  • Multivariate logistic regression was used to identify significant predictors.

Main Results:

  • Air leakage occurred in 7.5% of cases, increasing IMV duration and hospitalization.
  • Higher risk of air leakage was associated with acute respiratory distress syndrome (ARDS) (OR=4.38), higher pediatric critical illness score (PCIS) (OR=1.08), and higher peak inspiratory pressure (PIP) (OR=1.08).
  • Lower risk was observed in patients with central respiratory failure (OR=0.14). The predictive model showed excellent power (AUC=0.883).

Conclusions:

  • Patients with ARDS, higher PCIS, or higher PIP are at increased risk of air leakage during IMV.
  • Factors like measles, pneumonia, low PEEP, and high PaO2/FiO2 ratio were linked to better outcomes in younger children (1-6 years).
  • Central respiratory failure and congenital heart disease were associated with less favorable outcomes.
Abstract

Keywords:
Air leakChildrenInvasive mechanical ventilationPneumomediastinumPneumothoraxSubcutaneous emphysema

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