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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.
Insights
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.
Abstract:
One hundred one infants with chronic respiratory failure (CRF) who required prolonged mechanical ventilation were cared for in the pediatric intensive care unit at The Children's Hospital of Philadelphia between January 1967 and December 1984. Chronic respiratory failure of infancy is a condition that requires mechanical ventilation for more than 28 days in the first year of life. Thirty-six children had severe bronchopulmonary dysplasia, 50 had congenital anomalies, and 15 had neuromuscular disorders. The mean duration of mechanical ventilation for the 101 patients was 12.3 months. Seventy-one children were alive, and 53 (75%) of the 71 had been weaned from mechanical ventilation as of Dec 31, 1984. Pulmonary insufficiency and cardiac failure were the predominant causes of death in 17 of 22 infants in the first two years after the onset of CRF; four of eight deaths that occurred beyond two years were caused by airway- and ventilator-related accidents. Mechanical ventilatory support was emphasized for as long as necessary to provide normal blood gas tensions, nutrition, growth, and development rather than weaning as rapidly as possible. This clinical experience demonstrates that it is feasible to save over 70% of infants with the severest forms of CRF and prolonged ventilator dependency.