Clinical profile of children mechanically ventilated in a pediatric intensive care unit of a limited resource setting
DOI:
https://doi.org/10.18203/2349-3291.ijcp20161034Keywords:
Bronchopneumonia, Mechanical ventilation, Upper lobe atelectasis, Ventilator associated pneumoniaAbstract
Background: Mechanical ventilation, a lifesaving intervention in a critical care unit is under continuous evolution in modern era. Despite this, the management of children with invasive ventilation in developing countries with limited resources is challenging. The study analyses the clinical profile, indications, complications and duration of ventilator care in limited resource settings.
Methods: Retrospective study of critically ill children mechanically ventilated in an intensive care unit of a tertiary care government hospital.
Results: A total of 111 children required invasive ventilation during the study period of 1 year. Infants constituted the majority (68.5%), and males (59.5%) were marginally more than female children (40.5%). Respiratory failure was the most common indication for invasive ventilation (51.4%). The major underlying etiology for invasive ventilation was bronchopneumonia associated with septic shock (28.8%); and the same also required a prolonged duration of ventilation of > 72 hours (34.3%). Prolonged ventilator support of >72 hours predisposed to more complications as well as a prolonged hospital stay of >2 weeks and above, which was statistically significant. Upper lobe atelectasis (47.4%) and ventilator associated pneumonia (21.1%) were the major complications. The mortality rate of our study population was 36.9% as opposed to the overall mortality of 8.3%.
Conclusions: Our study highlights that critically ill children can be managed with mechanical ventilation even in limited resource settings. The child should be assessed clinically regarding the tolerance to extubation every day, to minimise the complications associated with prolonged ventilator support. A favourable outcome requires good nursing care and meticulous management by an intensivist.
References
Kendirli T, Kavaz A, Yalaki Z, Ozturk-Hismi B, Derelli E, İnce E. Mechanical ventilation in children. Turk J Pediatr. 2006;48(4):323.
Indumathy S. Pediatric emergency medicine course. second. Jaypee. 2013:5.
Kaushik J, Aamir M, Kaur G, Vinayak N, Mittal K. Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study. Indian J Crit Care Med. 2014;18(7):437.
Silva DCB da, Shibata ARO, Farias JA, Troster EJ. How is mechanical ventilation employed in a pediatric intensive care unit in Brazil? Clinics. 2009;64(12):1161-6.
Farias JA, Frutos F, Esteban A, Flores JC, Retta A, Baltodano A. What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study. Intensive Care Med. 2004;30(5):918-25.
Payen V, Jouvet P, Lacroix J, Ducruet T, Gauvin F. Risk factors associated with increased length of mechanical ventilation in children: Pediatr Crit Care Med. 2012;13(2):152-7.
Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR. A prospective study of ventilator-associated pneumonia in children. Pediatrics. 2009;123(4):1108-15.
Casado RJA, de Mello MJG, de Aragão RCF, de Albuquerque M de FPM, Correia JB. Incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit. Crit Care Med. 2011;39(8):1968-73.
Tullu MS, Deshmukh CT, Baveja SM. Bacterial nosocomial pneumonia in Paediatric Intensive Care Unit. J Postgrad Med. 2000;46(1):18-22.
Wang GC, Kao HA, Hwang FY, Ho MY, Hsu CH, Hung HY. Complications in the use of mechanical ventilator in newborns: one year’s experience. 1991;32(4):227-32.
Volakli E, Sdougka M, Tamiolaki M, Tsonidis C, Reizoglou M, Giala M. Demographic profile and outcome analysis of pediatric intensive care patients. Hippokratia. 2011;15(4):316.
Singhal D, Kumar N, Puliyel JM, Singh SK, Srinivas V. Prediction of mortality by application of PRISM score in intensive care unit. Indian Pediatr. 2001;38(7):714-9.
Jeena PM, Wesley AG, Coovadia HM. Admission patterns and outcomes in a paediatric intensive care unit in South Africa over a 25-year period (1971-1995). Intensive Care Med. 1999;25(1):88-94.
Tan GH, Tan TH, Goh DYT, Yap HK. Risk factors for predicting mortality in a paediatric intensive care unit. Ann-Acad Med Singap. 1998;27:813-8.