Barajas-Romero JS, Vásquez-Hoyos P, Pardo R, Jaramillo-Bustamante JC, Grigolli R, Monteverde-Fernández N, Gonzalez-Dambrauskas S, Jabornisky R, Cruces P, Wegner A, Díaz F, Pietroboni P. Factors associated with prolonged mechanical ventilation in children with pulmonary failure: Cohort study from the LARed Network registry.
Med Intensiva 2024;
48:23-36. [PMID:
37481458 DOI:
10.1016/j.medine.2023.07.001]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/15/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES
To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs).
DESIGN
Secondary analysis of a prospective cohort.
SETTING
PICUs in centers that are part of the LARed Network between April 2017 and January 2022.
PARTICIPANTS
Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort.
INTERVENTIONS
None.
MAIN VARIABLES OF INTEREST
Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality.
RESULTS
1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21).
CONCLUSIONS
Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay.
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