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.

Download Full-text

Multicenter mortality and morbidity associated with pulmonary hypertension in the pediatric intensive care unit

Pulmonary Circulation ◽

10.1177/2045893217745785 ◽

2017 ◽

Vol 8 (1) ◽

pp. 204589321774578 ◽

Cited By ~ 6

Author(s):

Emily Morell Balkin ◽

Martina A. Steurer ◽

Elise A. Delagnes ◽

Matt S. Zinter ◽

Satish Rajagopal ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Pulmonary Hypertension ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Clinical Decision Making ◽

Invasive Mechanical Ventilation ◽

Pediatric Intensive Care ◽

Severity Scores

Despite advances in the diagnosis and management of pediatric pulmonary hypertension (PH), children with PH represent a growing inpatient population with significant morbidity and mortality. To date, no studies have described the clinical characteristics of children with PH in the pediatric intensive care unit (PICU). A retrospective multicenter cohort study of 153 centers in the Virtual PICU Systems database who submitted data between 1 January 2009 and 31 December 2015 was performed. A total of 14,880/670,098 admissions (2.2%) with a diagnosis of PH were identified. Of these, 2190 (14.7%) had primary PH and 12,690 (85.3%) had secondary PH. Mortality for PH admissions was 6.8% compared to 2.3% in those admitted without PH (odds ratio = 3.1; 95% confidence interval = 2.9–3.4). Compared to patients admitted to the PICU without PH, those with PH were younger, had longer length of stay, higher illness severity scores, were more likely to receive invasive mechanical ventilation, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, and more likely to have co-diagnoses of sepsis, heart failure, and respiratory failure. In a multivariate model, factors significantly associated with mortality for children with PH included age < 6 months or > 16 years, invasive mechanical ventilation, and co-diagnoses of heart failure, sepsis, hemoptysis, disseminated intravascular coagulation, stroke, and multi-organ dysfunction syndrome. Despite therapeutic advances, the disease burden and mortality of children with PH remains significant. Further investigation of the risk factors associated with clinical deterioration and mortality in this population could improve the ability to prognosticate and inform clinical decision-making.

Download Full-text

Non-Invasive Mechanical Ventilation Practice in Pediatric Intensive Care Unit: A Retrospective Study

Turkish Journal of Pediatric Emergency and Intensive Care Medicine ◽

10.4274/cayd.66376 ◽

2016 ◽

pp. 62-68

Author(s):

Özlem Temel Köksoy ◽

Muhammet Şükrü Paksu ◽

Nazik Yener ◽

Emine Malhun Kaplan

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Retrospective Study ◽

Pediatric Intensive Care Unit ◽

Invasive Mechanical Ventilation ◽

Pediatric Intensive Care ◽

Non Invasive

Download Full-text

1333: RISK FACTORS ASSOCIATED WITH UNPLANNED EXTUBATION IN A HIGH- VOLUME PEDIATRIC INTENSIVE CARE UNIT

Critical Care Medicine ◽

10.1097/01.ccm.0000529336.85843.89 ◽

2018 ◽

Vol 46 (1) ◽

pp. 650-650

Author(s):

Priyamvada Chaudhary ◽

Curtis Travers ◽

Barbara Smith ◽

Atul Vats ◽

Clara Hopkins

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

High Volume ◽

Unplanned Extubation ◽

Factors Associated

Download Full-text

Gross Motor Developmental Dysfunctional Outcomes in Infantile and Toddler Pediatric Intensive Care Unit Survivors

10.21203/rs.2.15247/v4 ◽

2019 ◽

Author(s):

Chun-Feng Yang ◽

Yang Xue ◽

Jun-Yan Feng ◽

Fei-Yong Jia ◽

Yu Zhang ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Motor Function ◽

Linear Regression Analysis ◽

Invasive Mechanical Ventilation ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Gross Motor

Abstract Background: Increasing studies have focused on motor function/dysfunction in PICU survivors; however, most studies have focused on adults and older children. This study investigated gross motor developmental function outcomes in infantile and toddler pediatric intensive care unit (PICU) survivors and the factors associated with gross motor developmental functions. Methods: This observational study was conducted in the PICU of the First Hospital of Jilin University between January 2019 and March 2019. Thirty-five eligible patients were divided into the dysfunctional (n=24) or non-dysfunctional (n=11) group according to the results of the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Baseline gross motor function for all participants before PICU admission was measured via the Age and Stages Questionnaires, Third Edition (ASQ-3). The PDMS-2 was used to evaluate gross motor development function before PICU discharge. Results: The gross motor developmental dysfunction incidence was 68.6%. Linear correlation analysis showed that the gross motor quotient (GMQ) was positively correlated with the pediatric critical illness score (PCIS, r=0.621, P<0.001), and negatively correlated with length of PICU stay (r=-0.556, P=0.001), days sedated (r=-0.602, P<0.001), days on invasive mechanical ventilation (IMV; r=-0.686, P<0.001), and days on continuous renal replacement therapy (CRRT; r=-0.538, P=0.001). Linear regression analysis showed that IMV days (β=-0.736, P=0.001), sepsis (β=-18.111, P=0.003) and PCIS (β=0.550, P=0.021) were independent risk factors for gross motor developmental dysfunction Conclusions: Gross motor developmental dysfunction in infantile and toddler PICU survivors is more common and may be exacerbated by experiences associated with longer IMV days and increasing illness severity combined with sepsis. Trial Registration: The trial ‘Early rehabilitation intervention for critically ill children’ has been registered at http://www.chictr.org.cn/showproj.aspx?proj=23132. Registration number: ChiCTR1800020196. Keywords: Gross Motor Developmental Function; Sepsis; Mechanical Ventilation; Pediatric Intensive Care Unit; Infant; Toddler

Download Full-text

Use of recombinant human deoxyribonuclease in pediatric intensive care unit – a single-center experience

Revista Paulista de Pediatria ◽

10.1590/1984-0462/2022/40/2020169 ◽

2022 ◽

Vol 40 ◽

Author(s):

Daniel Meireles ◽

Sofia Ribeiro Fernandes ◽

Alzira Sarmento ◽

Telma Barbosa ◽

Manuel Ferreira Magalhães ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Invasive Mechanical Ventilation ◽

Pediatric Intensive Care ◽

Convulsive Status Epilepticus ◽

Single Center Experience ◽

Radiologic Findings ◽

Clinical Complications

ABSTRACT Objective: Dornase alfa (rhDNase) reduces the viscosity of purulent sputum in the lungs. The use in patients with cystic fibrosis (CF) is proven. However, the evidence of its applicability to other conditions is limited. This study aims to present the authors’ experience with the use of rhDNase in non-CF patients admitted to the Pediatric Intensive Care Unit (PICU). At the study center, rhDNase was used during flexible bronchoscopies in 24 cases, of which 20 (83%) had atelectasis and seven (29%) were admitted to PICU. Four patients (57%) were on invasive mechanical ventilation (MV). Case description: Two cases of daily rhDNase administration at PICU are presented: patient A was an 8-year-old boy admitted with septic shock and acute respiratory distress syndrome (ARDS). The patient required mechanical ventilation with aggressive settings and experienced several clinical complications. On D50, he started rhDNase treatment with an improvement in FiO2, PaCO2 and PaO2/FiO2 ratio according to radiologic findings. He was extubated on D23 of treatment. Patient B was a 17-month-old girl admitted with a convulsive status epilepticus who experienced respiratory complications (infectious and barotrauma) with ARDS, requiring aggressive ventilation. She initiated rhDNase treatment on D60. During the treatment an improvement in FiO2, PaO2/FiO2 ratio and a tendency of PaCO2 decrease were found. She had radiological improvement. No complications were described. Comments: RhDNase may be a helpful and safe tool to use in PICU prolonged intubated patients with ventilator-induced lung injury. Further studies are needed to assess and propose valid indications.

Download Full-text

Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

Global Pediatric Health ◽

10.1177/2333794x21991531 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2199153

Author(s):

Ameer Al-Hadidi ◽

Morta Lapkus ◽

Patrick Karabon ◽

Begum Akay ◽

Paras Khandhar

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Noninvasive Positive Pressure Ventilation ◽

Pediatric Intensive Care ◽

Nasal Cannula ◽

Respiratory Support ◽

Positive Pressure ◽

P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

Download Full-text

Revisiting unplanned extubation in the pediatric intensive care unit: What's new?

Heart & Lung ◽

10.1016/j.hrtlng.2017.08.006 ◽

2017 ◽

Vol 46 (6) ◽

pp. 444-451 ◽

Cited By ~ 4

Author(s):

Paulo Sérgio Lucas da Silva ◽

Daniela Farah ◽

Marcelo Cunio Machado Fonseca

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Unplanned Extubation

Download Full-text

Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

Children ◽

10.3390/children8111035 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1035

Author(s):

Rachel K. Marlow ◽

Sydney Brouillette ◽

Vannessa Williams ◽

Ariann Lenihan ◽

Nichole Nemec ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Medical Center ◽

Invasive Mechanical Ventilation ◽

Severity Of Illness ◽

Pediatric Intensive Care ◽

Respiratory Support ◽

Non Invasive ◽

Lengths Of Stay

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.

Download Full-text