Skip to main content
Erschienen in: Intensive Care Medicine 5/2004

01.05.2004 | Neonatal and Pediatric Intensive Care

What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study

verfasst von: J. A. Farias, F. Frutos, A. Esteban, J. Casado Flores, A. Retta, A. Baltodano, I. Alía, T. Hatzis, F. Olazarri, A. Petros, M. Johnson

Erschienen in: Intensive Care Medicine | Ausgabe 5/2004

Einloggen, um Zugang zu erhalten

Abstract

Objective

To describe the daily practice of mechanical ventilation (MV), and secondarily, its outcome in pediatric intensive care units (PICUs).

Design

Prospective cohort of infants and children who received MV for at least 12 h.

Setting

Thirty-six medical surgical PICUs.

Patients

All consecutive patients admitted to the PICUs during 2-month period.

Measurements and main results

Of the 1893 patients admitted, 659 (35%) received MV for a median time of 4 days (25th percentile, 75%: 2, 6). Median of age was 13 months (25th percentile, 75%: 5, 48). Common indications for MV were acute respiratory failure (ARF) in 72% of the patients, altered mental status in 14% of the patients, and ARF on chronic pulmonary disease in 10% of the patients. Median length of stay in the PICUs was 8 days (25th percentile, 75%: 5, 13). Overall mortality rate in the PICUs was 15% (confidence interval 95%: 13–18) for the entire population, 50% (95% CI: 25–74) in patients who received MV because of acute respiratory distress syndrome, 24% (95% CI: 16–35) in patients who received MV for altered mental status and 16% (95% CI: 9–29) in patients who received MV for ARF on chronic pulmonary disease.

Conclusion

One in every 3 patients admitted to the PICUs requires ventilatory support.. The ARF was the most common reason for MV, and survival of unselected infants and children receiving MV for more than 12 h was 85%.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Salyer J (1996) Outcomes of pediatric mechanical ventilation. Resp Care Clin North Am 2:471–485 Salyer J (1996) Outcomes of pediatric mechanical ventilation. Resp Care Clin North Am 2:471–485
2.
Zurück zum Zitat Martinot A, Leteutre S, Grandbastein B, Duhamel A, Leclerc F et le groupe francophone de Réanimation et urgences pédiatriques (1997) Caractéristiques des patients et utilisation des ressources dans les services de réanimation pédiatrique français. Arch Pediatr 4:730–736CrossRefPubMed Martinot A, Leteutre S, Grandbastein B, Duhamel A, Leclerc F et le groupe francophone de Réanimation et urgences pédiatriques (1997) Caractéristiques des patients et utilisation des ressources dans les services de réanimation pédiatrique français. Arch Pediatr 4:730–736CrossRefPubMed
3.
Zurück zum Zitat Earle M, Natera O, Zaslavsky A, Quiñones E, Carrillo H, Gonzalez Garcia E, Torres A, Marquez M, Garcia Montes J, Zavala I, Garcia Davila R, Todres D (1997) Outcome of pediatric intensive care at six centers in Mexico and Ecuador. Crit Care Med 25:1462–1467CrossRefPubMed Earle M, Natera O, Zaslavsky A, Quiñones E, Carrillo H, Gonzalez Garcia E, Torres A, Marquez M, Garcia Montes J, Zavala I, Garcia Davila R, Todres D (1997) Outcome of pediatric intensive care at six centers in Mexico and Ecuador. Crit Care Med 25:1462–1467CrossRefPubMed
4.
Zurück zum Zitat Lopez-Herce J, Sancho L, Martinón JM and the Spanish Society of Pediatric Intensive Care (2000) Study of paediatric intensive care units in Spain. Intensive Care Med 26:62–68CrossRefPubMed Lopez-Herce J, Sancho L, Martinón JM and the Spanish Society of Pediatric Intensive Care (2000) Study of paediatric intensive care units in Spain. Intensive Care Med 26:62–68CrossRefPubMed
5.
Zurück zum Zitat Harel Y, Niranjan V, Evans B, Newark NJ (1998) The current practice patterns of mechanical ventilation for respiratory failure in pediatric patients. Heart Lung 27:238–244PubMed Harel Y, Niranjan V, Evans B, Newark NJ (1998) The current practice patterns of mechanical ventilation for respiratory failure in pediatric patients. Heart Lung 27:238–244PubMed
6.
Zurück zum Zitat American College of Chest Physicians (1993) Consensus Conference Mechanical Ventilation. Chest 104:1833–1859PubMed American College of Chest Physicians (1993) Consensus Conference Mechanical Ventilation. Chest 104:1833–1859PubMed
7.
Zurück zum Zitat Task Force on guidelines, Society of Critical Care Medicine (1991) Guidelines for standards of care for patients with acute respiratory failure on mechanical ventilatory support. Crit Care Med 19:275–278PubMed Task Force on guidelines, Society of Critical Care Medicine (1991) Guidelines for standards of care for patients with acute respiratory failure on mechanical ventilatory support. Crit Care Med 19:275–278PubMed
8.
Zurück zum Zitat Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, Cide D, Goldwaser R, Soto L, Bugedo G, Rodrigo C, Pimentel J, Raimondi G, Tobin M for the mechanical ventilation international group (2000) How is mechanical ventilation employed in the intensive care unit? An international review. Am J Respir Crit Care Med 161:1450–1458 Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, Cide D, Goldwaser R, Soto L, Bugedo G, Rodrigo C, Pimentel J, Raimondi G, Tobin M for the mechanical ventilation international group (2000) How is mechanical ventilation employed in the intensive care unit? An international review. Am J Respir Crit Care Med 161:1450–1458
9.
Zurück zum Zitat Pollack M, Patel K, Ruttimann U (1988) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116PubMed Pollack M, Patel K, Ruttimann U (1988) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116PubMed
10.
Zurück zum Zitat Lebel MH, Gauthier M, Lacroix J, Rousseau E, Buithieu M (1989) Respiratory failure and mechanical ventilation in severe bronchiolitis. Arch Dis Child 64:1431–1437PubMed Lebel MH, Gauthier M, Lacroix J, Rousseau E, Buithieu M (1989) Respiratory failure and mechanical ventilation in severe bronchiolitis. Arch Dis Child 64:1431–1437PubMed
11.
Zurück zum Zitat Proulx F, Fayon M, Farrel C, Lacroix J, Gauthier M (1996) Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest 109:1033–1037PubMed Proulx F, Fayon M, Farrel C, Lacroix J, Gauthier M (1996) Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest 109:1033–1037PubMed
12.
Zurück zum Zitat Bernard GR, Artigas A, Brigham KL (1994) The American–European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMed Bernard GR, Artigas A, Brigham KL (1994) The American–European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMed
13.
Zurück zum Zitat Farias JA, Retta A, Alía I, Olazarri F, Esteban A, Golubicki A, Allende D, Maliarchuk O, Peltzer C, Ratto ME, Zalazar R, Garea M, Moreno EG (2001) A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients. Intensive Care Med 27:1649–1654PubMed Farias JA, Retta A, Alía I, Olazarri F, Esteban A, Golubicki A, Allende D, Maliarchuk O, Peltzer C, Ratto ME, Zalazar R, Garea M, Moreno EG (2001) A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients. Intensive Care Med 27:1649–1654PubMed
14.
Zurück zum Zitat Farias JA, Alía I, Retta A, Olazarri F, Fernández A, Esteban A, Palacios K, Nunzio L di, Fernández G, Bordón A, Berrondo C, Sheehan G (2002) An evaluation of extubation failure predictors in mechanically ventilated infants and children. Intensive Care Med 28:752–757CrossRef Farias JA, Alía I, Retta A, Olazarri F, Fernández A, Esteban A, Palacios K, Nunzio L di, Fernández G, Bordón A, Berrondo C, Sheehan G (2002) An evaluation of extubation failure predictors in mechanically ventilated infants and children. Intensive Care Med 28:752–757CrossRef
15.
Zurück zum Zitat Thiagarajan RR, Bratton SL, Martin LD, Brogan TV, Taylor D (1999) Predictors of successful extubation in children. Am J Respir Crit Care Med 160:1562–1566PubMed Thiagarajan RR, Bratton SL, Martin LD, Brogan TV, Taylor D (1999) Predictors of successful extubation in children. Am J Respir Crit Care Med 160:1562–1566PubMed
16.
Zurück zum Zitat Knaus WA, Sun X, Hakim R, Wagner DP (1994) Evaluation of definitions for adult respiratory distress syndrome. Am J Respir Crit Care Med 150:311–317PubMed Knaus WA, Sun X, Hakim R, Wagner DP (1994) Evaluation of definitions for adult respiratory distress syndrome. Am J Respir Crit Care Med 150:311–317PubMed
17.
Zurück zum Zitat Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. J Am Med Assoc 287:345–355CrossRef Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. J Am Med Assoc 287:345–355CrossRef
18.
Zurück zum Zitat Timmons OD, Dean JM, Vernon DD (1991) Mortality rates and prognostic variables in children with adult respiratory distress syndrome. J Pediatr 119:896–899PubMed Timmons OD, Dean JM, Vernon DD (1991) Mortality rates and prognostic variables in children with adult respiratory distress syndrome. J Pediatr 119:896–899PubMed
19.
Zurück zum Zitat De Bruin W, Notterman D, Magid M, Godwin T, Johnston S (1992) Acute hypoxemic respiratory failure in infants and children: clinical and pathologic characteristics. Crit Care Med 20:1223–1234PubMed De Bruin W, Notterman D, Magid M, Godwin T, Johnston S (1992) Acute hypoxemic respiratory failure in infants and children: clinical and pathologic characteristics. Crit Care Med 20:1223–1234PubMed
20.
Zurück zum Zitat Davis SL, Furman DP, Costarino AT (1993) Adult respiratory syndrome in children: associated disease, clinical course, and predictors of death. J Pediatr 123:35–45PubMed Davis SL, Furman DP, Costarino AT (1993) Adult respiratory syndrome in children: associated disease, clinical course, and predictors of death. J Pediatr 123:35–45PubMed
21.
Zurück zum Zitat Lodha R, Kabra SK, Pandey RM (2001) Acute respiratory distress syndrome: experience at a tertiary care hospital. Indian Pediatr 38:1154–1159PubMed Lodha R, Kabra SK, Pandey RM (2001) Acute respiratory distress syndrome: experience at a tertiary care hospital. Indian Pediatr 38:1154–1159PubMed
22.
Zurück zum Zitat Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, Gasparetto A, Lemaire F (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150:896–903PubMed Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, Gasparetto A, Lemaire F (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150:896–903PubMed
23.
Zurück zum Zitat Esteban A, Frutos F, Tobin M, Alía I, Solsona JF, Valverde I, Fernández R, Cal MA de la, Benito S, Tomas R, Carriedo D, Macias S, Blanco J (1995) A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 332:345–350PubMed Esteban A, Frutos F, Tobin M, Alía I, Solsona JF, Valverde I, Fernández R, Cal MA de la, Benito S, Tomas R, Carriedo D, Macias S, Blanco J (1995) A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 332:345–350PubMed
24.
Zurück zum Zitat Randolph AG, Wypij D, Venkataram ST, Hanson JH, Gedeit R, Meert K, Luckett P, Forbes P, Lilley M, Thompson J, Cheifetz I, Hibberd P, Wetzel R, Cox P, Arnold J (2002) Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. J Am Med Assoc 288:2561–2568CrossRef Randolph AG, Wypij D, Venkataram ST, Hanson JH, Gedeit R, Meert K, Luckett P, Forbes P, Lilley M, Thompson J, Cheifetz I, Hibberd P, Wetzel R, Cox P, Arnold J (2002) Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. J Am Med Assoc 288:2561–2568CrossRef
25.
Zurück zum Zitat Farias JA, Alía I, Esteban A, Golubicki AN, Olazarri FA (1998) Weaning from mechanical ventilation in pediatric intensive care patients. Intensive Care Med 24:1070–1075PubMed Farias JA, Alía I, Esteban A, Golubicki AN, Olazarri FA (1998) Weaning from mechanical ventilation in pediatric intensive care patients. Intensive Care Med 24:1070–1075PubMed
26.
Zurück zum Zitat Orlowski JP, Ellis NG, Amin NP, Crumrine RS (1980) Complications of airway intrusion in 100 consecutive cases in a pediatric ICU. Crit Care Med 8:324–331PubMed Orlowski JP, Ellis NG, Amin NP, Crumrine RS (1980) Complications of airway intrusion in 100 consecutive cases in a pediatric ICU. Crit Care Med 8:324–331PubMed
27.
Zurück zum Zitat Scott PH, Eigen H, Moye LA, Georgitis J, Laughlin J (1985) Predictability and consequences of spontaneous extubation in a pediatric ICU. Crit Care Med:13:228–232 Scott PH, Eigen H, Moye LA, Georgitis J, Laughlin J (1985) Predictability and consequences of spontaneous extubation in a pediatric ICU. Crit Care Med:13:228–232
28.
Zurück zum Zitat Little LA, Koening JC, Newth CJL (1990) Factors affecting accidental extubations in neonatal and pediatric intensive care patients. Crit Care Med 18:163–165PubMed Little LA, Koening JC, Newth CJL (1990) Factors affecting accidental extubations in neonatal and pediatric intensive care patients. Crit Care Med 18:163–165PubMed
29.
Zurück zum Zitat Betbese AJ, Perez M, Bak E, Rialp G, Mancebo J (1998) A prospective study of unplanned endotracheal extubation in intensive care unit patients. Crit Care Med 26:1180–1186PubMed Betbese AJ, Perez M, Bak E, Rialp G, Mancebo J (1998) A prospective study of unplanned endotracheal extubation in intensive care unit patients. Crit Care Med 26:1180–1186PubMed
30.
Zurück zum Zitat Epstein SK, Nevins ML, Chung J (2000) Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med 161:1912–1916PubMed Epstein SK, Nevins ML, Chung J (2000) Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med 161:1912–1916PubMed
31.
Zurück zum Zitat Venkataraman ST, Khan N, Brown A (2000) Validation of predictors of extubation success and failure in mechanically ventilated infants and children. Crit Care Med 28:2991–2996PubMed Venkataraman ST, Khan N, Brown A (2000) Validation of predictors of extubation success and failure in mechanically ventilated infants and children. Crit Care Med 28:2991–2996PubMed
32.
Zurück zum Zitat Epstein SK, Ciubotaru RL, Wong JB (1997) Effect of failed extubation on the outcome of mechanical ventilation. Chest 112:186–192PubMed Epstein SK, Ciubotaru RL, Wong JB (1997) Effect of failed extubation on the outcome of mechanical ventilation. Chest 112:186–192PubMed
33.
Zurück zum Zitat Esteban A, Alía I, Gordo F, Fernández R, Solsona JF, Vallverdú I, Macías S, Allegue J, Blanco J, Carriedo D, León M, Cal M de La, Taboada F, Gonzalez de Velasco J, Palazón E, Carrizosa F, Tomás R, Suarez J, Goldwaser R (1997) Extubation outcome after a trial spontaneous breathing with T-tube or pressure support ventilation. Am J Respir Crit Care Med 156:459–465PubMed Esteban A, Alía I, Gordo F, Fernández R, Solsona JF, Vallverdú I, Macías S, Allegue J, Blanco J, Carriedo D, León M, Cal M de La, Taboada F, Gonzalez de Velasco J, Palazón E, Carrizosa F, Tomás R, Suarez J, Goldwaser R (1997) Extubation outcome after a trial spontaneous breathing with T-tube or pressure support ventilation. Am J Respir Crit Care Med 156:459–465PubMed
34.
Zurück zum Zitat Timmons OD, Havens PL, Fackler JC (1995) Predicting death in pediatric patients with acute respiratory failure. Chest 108:789PubMed Timmons OD, Havens PL, Fackler JC (1995) Predicting death in pediatric patients with acute respiratory failure. Chest 108:789PubMed
35.
Zurück zum Zitat Arnold JH, Hanson JH, Toro-Figueroa LO, Gutierrez J, Berens RJ, Anglin DL (1994) Prospective, randomized comparison of high frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med 22:1530–1539PubMed Arnold JH, Hanson JH, Toro-Figueroa LO, Gutierrez J, Berens RJ, Anglin DL (1994) Prospective, randomized comparison of high frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med 22:1530–1539PubMed
36.
Zurück zum Zitat The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volume as compared with traditional tidal volume for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308PubMed The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volume as compared with traditional tidal volume for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308PubMed
37.
Zurück zum Zitat Estenssoro E, Dubin A, Laffaire E, Canales H, Saenz G, Moseinco M, Pozo M, Gomez A, Baredes N, Jannello G, Osatnik J (2002) Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med 30:2450–2456 Estenssoro E, Dubin A, Laffaire E, Canales H, Saenz G, Moseinco M, Pozo M, Gomez A, Baredes N, Jannello G, Osatnik J (2002) Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med 30:2450–2456
Metadaten
Titel
What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study
verfasst von
J. A. Farias
F. Frutos
A. Esteban
J. Casado Flores
A. Retta
A. Baltodano
I. Alía
T. Hatzis
F. Olazarri
A. Petros
M. Johnson
Publikationsdatum
01.05.2004
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 5/2004
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2225-5

Weitere Artikel der Ausgabe 5/2004

Intensive Care Medicine 5/2004 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.