Clinical outcomes in mechanically ventilated patients in pediatric intensive care: A cohort study

Introduction. Mechanical ventilation (MV) is a common intensive care intervention associated with increased resource use and a risk of complications. Therefore, this study aimed to characterize ventilated patients with acute hypoxemic respiratory failure (AHRF) and pediatric acute respiratory distress syndrome (PARDS). Population and Methods. We conducted a prospective cohort study in the pediatric intensive care unit of a high-complexity hospital between June 2021 and August 2022. The study analyzed the outcomes of patients with MV, the incidence of AHRF and PARDS, and their respective outcomes. Results. The study recorded 1354 admissions; 273 required mechanical ventilation (306 cycles). 19.4% had AHRF and 6.6% had PARDS. Morbidity upon discharge from the intensive care unit was 18.7%, and mortality was 12.1%. In-hospital mortality was 13.2%; 10.2% required a tracheostomy. In the univariate analysis, PIM-2, failed and unscheduled extubations, tracheostomy, days on mechanical ventilation and length of hospital stay, AHRF, and PARDS were associated with morbidity and mortality. In the multivariate analysis, PIM-2 and tracheostomy remained significant. Conclusion. One in five patients admitted to the pediatric intensive care unit required mechanical ventilation, and approximately seven out of ten ventilated patients survived without acquired morbidity. AHRF was associated with longer duration of mechanical ventilation and hospital stay, a higher likelihood of tracheostomy, and higher morbidity and mortality. The results for patients with PARDS show a trend toward more days on a ventilator, longer hospital stays, and higher mortality.