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Chronic respiratory failure in infants with prolonged ventilator dependency
M S Schreiner1, J J Downes, R G Kettrick
1Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, PA 19104.
JAMA
|December 18, 1987
Summary
This study shows that over 70% of infants with chronic respiratory failure (CRF) requiring prolonged mechanical ventilation can survive. A strategy emphasizing necessary ventilatory support, rather than rapid weaning, improved outcomes for these critically ill infants.
Area of Science:
- Pediatrics
- Critical Care Medicine
- Neonatology
Background:
- Chronic respiratory failure (CRF) in infancy necessitates prolonged mechanical ventilation.
- Infants with CRF often have underlying conditions like bronchopulmonary dysplasia, congenital anomalies, or neuromuscular disorders.
- Outcomes for infants with prolonged ventilator dependency have historically been poor.
Purpose of the Study:
- To evaluate the feasibility and outcomes of providing prolonged mechanical ventilatory support for infants with severe chronic respiratory failure.
- To assess survival rates and successful weaning from mechanical ventilation in this patient population.
- To identify causes of mortality in infants with prolonged ventilator dependency.
Main Methods:
- Retrospective analysis of 101 infants with CRF requiring mechanical ventilation for >28 days.
- Data collected on underlying diagnoses, duration of ventilation, survival, and weaning status.
- Review of causes of death in non-survivors.
Main Results:
- 71 out of 101 infants (70.3%) survived.
- 53 out of 71 survivors (75%) were successfully weaned from mechanical ventilation.
- Mean duration of mechanical ventilation was 12.3 months.
- Pulmonary insufficiency and cardiac failure were primary causes of death within the first two years; ventilator-related accidents occurred later.
Conclusions:
- Prolonged mechanical ventilatory support, when provided to maintain normal physiological parameters, is a feasible strategy for improving survival in infants with severe CRF.
- A significant majority of infants with prolonged ventilator dependency can survive and be weaned.
- This approach challenges the paradigm of rapid weaning and demonstrates potential for better long-term outcomes.