Adverse Events Related to Mechanical Ventilation in a Pediatric Intensive Care Unit

Abstract

Objective: To identify the prevalence and factors associated with adverse events (AE) related to invasive mechanical ventilation in patients admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary public hospital. Methods: This is a cross-sectional study from July 2016 to June 2018, with data collected throughout patients’ routine care in the unit by the care team. Demographic, clinical and ventilatory characteristics and adverse events were analysed. The logistic regression model was used for multivariate analysis regarding the factors associated with AE. Results: Three hundred and six patients were included, with a total ventilation time of 2,155 days. Adverse events occurred in 66 patients (21.6%), and in 11 of those (16.7%) two AE occurred, totalling 77 events (36 AE per 1000 days of ventilation). The most common AE was post-extubation stridor (25.9%), followed by unplanned extubation (16.9%). Episodes occurred predominantly in the afternoon shift (49.3%) and associated with mild damage (54.6%). Multivariate analysis showed a higher occurrence of AE associated with length of stay of 7 days or more (Odds Ratio [OR]=2.6; 95% confidence interval [95%CI] 1.49-4.66; p=0.001). Conclusions: The results of the present study show a significant number of preventable adverse events, especially stridor after extubation and accidental extubation. The higher frequency of these events is associated with longer hospitalization.

Indications and Safety of High Flow Nasal Cannula in Pediatric Intensive Care Unit: Retrospective Single Center Experience in Saudi Arabia

“…However, invasive ventilation frequently has a high risk for subsequent complications, such as ventilator-associated pneumonia, airway stenosis, sepsis, acute respiratory distress syndrome, atelectasis, or pulmonary edema. [16][17][18] However, HFNC has recently gained rapid global adoption and became well documented in intensive and emergency health-care settings. 19,20 Several studies have indicated that HFNC is a simple, well-tolerated noninvasive respiratory support.…”

Complications during mechanical ventilation—A pediatric intensive care perspective

“…Prolonged invasive mechanical ventilation may lead to laryngeal damage as pressure from the endotracheal tube is thought to cause ischemia and consequently erosion of the laryngeal mucosa. Young age, increased duration of endotracheal intubation and the use of cuffed tubes are associated with an increased risk of post-extubation stridor ( 30 , 31 ). Studies have not shown an association between the occurrence of stridor and the absence of an air leak prior to extubation, however, frequent endotracheal suctioning prior to extubation has shown to be a predictor for post-extubation stridor ( 32 ).…”

Reducing paediatric unintended extubation: A standardized bundle approach

“…Unintended extubation (UE) is defined as any unintentional or unplanned dislodgement of an endotracheal tube (ETT) from the trachea (Table 1). 1,2 UE is the most common adverse event related to use of an artificial airway and can lead to complications including: hypoxemia and hypercarbia, hemodynamic compromise and arrest, need for emergent re‐intubation, and in rare cases death 3–5 . While reintubation in children does not carry the same mortality risks as adults, children who require reintubation have longer durations of mechanical ventilation and hospital stays, increasing their risk for nosocomial infections 6,7 .…”

“…1,2 UE is the most common adverse event related to use of an artificial airway and can lead to complications including: hypoxemia and hypercarbia, hemodynamic compromise and arrest, need for emergent re-intubation, and in rare cases death. [3][4][5] While reintubation in children does not carry the same mortality risks as adults, children who require reintubation have longer durations of mechanical ventilation and hospital stays, increasing their risk for nosocomial infections. 6,7 On average each paediatric UE increases total hospital cost by $36 000, and increases ICU and hospital length of stay by 5.5 and 6.5 days respectively, across age groups and diagnoses.…”

“…6,7 On average each paediatric UE increases total hospital cost by $36 000, and increases ICU and hospital length of stay by 5.5 and 6.5 days respectively, across age groups and diagnoses. 5,7,8 Current paediatric reported rates of UE range from 0.44 to 3.5 per 100 ventilator days (Table 1). 4 The target arbitrary benchmark for UE worldwide identified in the literature is <1 per 100 ventilator days, excluding tracheostomy and non-invasive ventilator days.…”