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Prolonged mechanical ventilation as a consequence of acute illness
J Fraser1, T Henrichsen, Q Mok
1Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London.
Insights
Many critically ill children require prolonged mechanical ventilation, with a significant portion experiencing long-term dependence and severe health issues. This highlights critical challenges in pediatric intensive care and long-term management strategies.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Neurology
Background:
- Prolonged mechanical ventilation in children presents significant management challenges.
- Understanding the reasons for ventilator dependence is crucial for improving outcomes.
Purpose of the Study:
- To investigate the causes of prolonged mechanical ventilation in acutely ill children.
- To determine the outcomes for children requiring long-term mechanical ventilation.
Main Methods:
- Retrospective medical record review of pediatric patients (1 month to 16 years).
- Study period: 1983-1996, focusing on patients ventilated for over 28 days.
Main Results:
- Forty children required ventilation for 36-180 days.
- Causes included pulmonary (42%), neuromuscular (28%), spinal cord (20%), and central (10%) factors.
- Mortality was 40%, 25% remained ventilator-dependent, and 29% of survivors had severe neurological deficits.
Conclusions:
- Children surviving intensive care are increasingly ventilator-dependent with high comorbidity risks.
- Further research is needed on the management and care pathways for these vulnerable children.
Objective:
To determine why acutely ill children become dependent upon mechanical ventilation and what happens to them.
Methods:
A retrospective medical record study of all patients aged between 1 month and 16 years from 1983 to 1996 who required ventilation for more than 28 days.
Results:
Forty children were ventilated for between 36 and 180 days before discharge or death. Before their presenting illness, 13 (33%) were normal, 15 (37%) had documented predisposing conditions such as bronchopulmonary dysplasia, and the remaining 12 (30%) had diagnoses made after admission. The cause of respiratory failure was central in four patients (10%), spinal cord in eight (20%), neuromuscular in 11 (28%), and pulmonary in 17 (42%). Severe nosocomial infection requiring treatment with intravenous antibiotics occurred in 22. To date, 16 children (40%) have died, and 10 (25%) remain ventilator dependent. Of the 24 survivors, seven (29%) have severe residual neurological deficit.
Conclusions:
Increasingly, children are surviving intensive care only to remain ventilator dependent and at risk of significant comorbidity. This study should inform further debate on why such children remain ventilator dependent, and how and where they are managed.