Mechanical ventilation practice in Egyptian pediatric intensive care units

Abstract

IntroductionMechanical ventilation is one of the indispensable tools in pediatric intensive care units. Few studies addressed the epidemiology of pediatric patients on mechanical ventilation and the frequently used modes of ventilation. This is the first study to describe the practice of mechanical ventilation (MV) in Egyptian pediatric intensive care units (PICUs).MethodsThis prospective observational study was conducted from January 2014 to December 2014 in two pediatric intensive care units at Cairo University Pediatric Hospital. The study included all children who were intubated and mechanically ventilated for more than 12 hours of admission. Pre-coded data was entered into the SPSS version 21 for data analysis. Comparison between groups was performed using Mann Whitney test for quantitative variables and Chi square with Fisher’s exact test for qualitative ones. Multivariate logistic regression model was conducted to explore the significant predictors for PICU mortality.ResultsIn total, 893 children were admitted and 293 were mechanically ventilated. The incidence of utilizing MV in children was 32.8%. Neurologic causes were the most common reasons for initiation of MV, with 114 (38.9%) cases. The most commonly preferred mode for initiation of MV is SIMV with PS. Complication occurred in 117 (39.9%) of the cases. The most commonly preferred method of weaning was PS with CPAP in 115/154 (74.7%) cases. Mortality occurred in 134/293 (45.7%) of patients. Duration of mechanical ventilation was significantly longer with neuromuscular diseases, and with the occurrence of complications (p<0.001). There was a significant relationship between mortality and higher PRISM III score, cardiovascular cases, sepsis, multiple organ dysfunction syndrome (MODS), ventilator-associated pneumonia (VAP), and with barotrauma.ConclusionsIn our practice, MV is used oftentimes with almost a third of admissions requiring intubation for different reasons. Most children are ventilated due to neurologic causes. This study paves the way for improving our knowledge of MV with avoiding the fatal complications.

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

“…In the present study, a prevalence of 21.6% of AE was observed (36 AE per thousand days of MV), which is lower than the studies by Kendirli et al 12 (42.8%), Meligy et al 13 (39.9% or 29.5 AE per thousand days of MV), De Jesus et al 3 (51.3%) and Principi et al (40% or 114 AE per thousand days of MV). 15 We also found that 16.6% of patients suffered two AE, similar to the study by Meligy et al, 13 in which 11.9% suffered more than one AE. The variation in prevalence found can be influenced by the selection made by each author regarding which events to analyze.…”

“…11 Studies in the pediatric age range are still restricted, with a limited number of cases describing VAP more commonly, reinforcing the purpose and relevance of this study to assess the prevalence, types of events, and factors associated with the occurrence of AE related to MV in children and adolescents. 3,[11][12][13][14][15][16][17] The results of the present study showed a significant number of AEs that can be prevented, identifying the length of hospital stay as a risk factor to be monitored and evaluated regarding the prevention of these occurrences.…”

“…Regarding the sample size, based on the literature findings that showed AE ranging from 40 to 51.3%, 3,[11][12][13][14][15] the sample calculation should have had an "n" between 260 and 664 patients. In this study, considering the presence of AE around 20%, with a confidence interval amplitude of 0.10 and a confidence level of 95%, the minimum "n" so that statistical objectivity would not be impaired, was 246 children.…”

An epidemiological study of ventilator-associated pneumonia (VAP) and ventilator-associated events (VAE) surveillance and preventative strategies in critically ill children

“…The present study found lower VAP rates compared to a recent six-month prospective study in 16 PICUs in the USA, which found 7.1 per 1000 ventilator days (Gupta et al, 2014). These differences may be due to the demographic variations in respective PICUs, institutional preventative strategies, and varying treatment options (Awasthi et al, 2013;Bassant Salah, Sally, & Seham Awad El, 2017;Srinivasan et al, 2009).…”

Gamma Glutamyl Transferase and Uric Acid Levels Can Be Associated with the Prognosis of Patients in the Pediatric Intensive Care Unit

“…It is well-documented that IMV is an independent risk factor in the prognosis of children in PICU [ 11 , 12 , 13 ]. In this study, GGT was significantly higher in patients with IMV use, and the ROC curves showed that the GGT score covered an AUC of 0.609 for a cutoff value of 30.6 IU.…”