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Survival and functional outcome of children requiring mechanical ventilation during therapy for acute bacterial
E T Madagame1, P L Havens, J M Bresnahan
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Insights
Mechanical ventilation for pediatric acute bacterial meningitis can lead to death or severe functional deficits in half of patients. Early indicators like PRISM score and vital signs predict outcomes for these critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Neurology
Background:
- Acute bacterial meningitis is a severe infection in children, often requiring intensive care.
- Mechanical ventilation is a critical intervention for respiratory failure in severe pediatric meningitis.
- Predicting survival and functional outcomes is crucial for managing these complex cases.
Purpose of the Study:
- To identify predictors of survival in pediatric patients with acute bacterial meningitis requiring mechanical ventilation.
- To determine factors influencing functional outcomes (locomotion, self-care, communication) post-treatment.
- To analyze the long-term functional status of survivors.
Main Methods:
- Retrospective case series of 32 pediatric patients treated between 1985 and 1990.
- Analysis of clinical data including vital signs, Pediatric Risk of Mortality (PRISM) score, and Glasgow Coma Score within 24 hours of admission.
- Functional status assessment at hospital discharge and long-term follow-up (median 41.5 months).
Main Results:
- Ten in-hospital deaths occurred; 22 patients survived.
- Admission PRISM score was the best predictor of death and long-term functional status.
- Hypotension and tachycardia within 24 hours of pediatric ICU admission were associated with poor outcomes.
- At follow-up, 4/8 patients with initial mild/moderate deficits showed no disability, while 6/7 with severe deficits remained dependent.
Conclusions:
- Approximately half of pediatric patients requiring mechanical ventilation for acute bacterial meningitis either died or had severe functional deficits.
- Children with mild to moderate functional impairments at discharge demonstrated improvement over time.
- Early risk assessment using PRISM scores and vital signs is vital for predicting outcomes in pediatric meningitis patients requiring mechanical ventilation.
Objective:
To determine predictors of survival and functional outcome of pediatric patients requiring mechanical ventilation during therapy for acute bacterial meningitis.
Design:
Retrospective case series.
Setting:
Pediatric intensive care unit (ICU) at a midwestern tertiary care children's hospital.
Patients:
Consecutive sample of 32 patients (median age 9.8 months; range 9 days to 12 yrs) from 1985 to 1990 with acute bacterial meningitis severe enough to require mechanical ventilation during therapy. Of these patients, 59% were female and 59% were white.
Interventions:
None.
Measurements And Main Results:
Data were analyzed to identify predictors of survival and functional status after hospital discharge. Variables included were vital signs, Pediatric Risk of Mortality (PRISM) score within the first 24 hrs of hospitalization, Glasgow Coma Score, and course of illness. Functional status was assessed at hospital discharge and at follow-up (median follow-up: 41.5 months, range 7 to 77) in the areas of locomotion, self-care, and communication. There were ten inhospital deaths. The 22 survivors formed three groups. At hospital discharge, seven children showed no functional disability. Seven patients were dependent in all three areas of function at discharge, with six still dependent at follow-up evaluation. Eight patients showed mild to moderate impairment in at least one area of function at hospital discharge. At follow-up, four of these eight patients demonstrated no functional disability, one had improved status, two were unchanged, and one was lost to follow-up. The best predictor of death and functional status at follow-up was the admission PRISM score. Hypotension and tachycardia within the first 24 hrs after pediatric ICU admission were strongly associated with poor outcome.
Conclusions:
After bacterial meningitis in children whose care included mechanical ventilation, half of the patients died or survived with severe functional deficits. Patients with mild or moderate functional deficits at hospital discharge improved with time.