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Factors associated with prolonged mechanical ventilation in children with pulmonary failure: Cohort study from the

Juan Sebastián Barajas-Romero1, Pablo Vásquez-Hoyos2, Rosalba Pardo3

  • 1Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Universidad Nacional de Colombia, Bogotá, Colombia.

Medicina Intensiva
|July 22, 2023
PubMed

Insights

Young children, bronchopulmonary dysplasia, and fungal infections increase the risk of prolonged mechanical ventilation (pMV) in pediatric intensive care units (PICUs). Asthma may reduce pMV risk. Factors like VAP and tracheostomy also prolong ventilation.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Infectious Diseases

Background:

  • Prolonged mechanical ventilation (pMV) is a significant concern in pediatric intensive care units (PICUs).
  • Identifying factors associated with pMV is crucial for optimizing patient outcomes and resource allocation.
  • Understanding these factors can inform clinical decision-making and targeted interventions.

Purpose of the Study:

  • To identify demographic, clinical, and treatment-related factors associated with prolonged mechanical ventilation (pMV) in pediatric patients.
  • To analyze factors contributing to extended mechanical ventilation duration in the PICU setting.

Main Methods:

  • Secondary analysis of a prospective cohort study conducted in PICUs within the LARed Network from April 2017 to January 2022.
  • Included 1698 pediatric patients requiring invasive mechanical ventilation (IMV) for respiratory causes, defining pMV as IMV duration exceeding the 75th percentile (9 days).
  • Collected data on demographics, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality.

Main Results:

  • Factors associated with pMV at admission included younger age (<6 months), bronchopulmonary dysplasia, and fungal infections. Asthma was associated with a lower risk of pMV.
  • During the PICU stay, pMV was linked to ventilation-associated pneumonia, need for tracheostomy, blood transfusions, neuromuscular blockade, and high-frequency ventilation.
  • Higher mean airway pressure (>13 cmH2O) and longer PICU length of stay were also associated with pMV.

Conclusions:

  • Several factors at admission and during the course of intensive care are associated with prolonged mechanical ventilation in pediatric patients.
  • These findings highlight the importance of early identification and management of risk factors to potentially reduce the duration of mechanical ventilation in critically ill children.
Abstract

Keywords:
Insuficiencia respiratoriaIntensive Care Units PediatricRespiración artificialRespiration artificialRespiratory insufficiencyUnidades de Cuidado Intensivo Pediátrico

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