Mechanical Ventilation in Children on Venovenous ECMO (original) (raw)
Related papers
Journal of Pediatric Surgery, 2010
We aimed to examine outcomes of extracorporeal membrane oxygenation (ECMO) therapy in the pediatric population and identify pre-ECMO and on-ECMO characteristics that are associated with survival. Methods: We retrospectively reviewed the ECMO records at our institution between 1999 and 2008 and selected pediatric patients who were cannulated for respiratory failure or hemodynamic instability resistant to conventional interventions. We recorded details of pre-ECMO clinical characteristics, including blood gas variables and mechanical ventilatory support, and details of ECMO therapy including survival off ECMO and to hospital discharge. Predictors of survival were analyzed using logistic regression modeling and a prediction algorithm was developed. Results: Of the 445 ECMO runs, data from 58 consecutive patients were analyzed: 57% were successfully decannulated, and 48% survived to discharge from the hospital. The cohort included 32 (55%) female patients, 22 postoperative patients (38%), and 15 (26%) with an immunosuppressive condition, with a median age of 5 years and weight 19.5 kg, The mean duration of pre-ECMO respiratory support was 3 days, in the form of high-frequency oscillatory ventilation (n = 28, 48%) and conventional mechanical ventilation (n = 13, 22%). The median duration (interquartile range) of ECMO support was 142 hours (60, 321) or 5.9 days. Pre-ECMO pH above 7.2 (P b .001) and oxygenation index below 35 (P = .021) were associated with the highest survival rates. Pre-ECMO PaCO 2 and duration of mechanical ventilation were not associated with survival. Conclusions: Based on our results, ECMO therapy should be considered early in children with oxygenation index greater than 35 with worsening metabolic status. The restriction of ECMO based on ventilator days alone needs to be revisited in this era of lung protective ventilation.
Characterization of pediatric patients receiving prolonged mechanical ventilation
Pediatric Critical Care Medicine, 2011
To describe the characteristics and risk factors of pediatric patients who receive prolonged mechanical ventilation, defined as ventilatory support for >21 days. Design: Prospective cohort. Setting: Four medical-surgical pediatric intensive care units in four university-affiliated hospitals in Argentina. Patients: All consecutive patients from 1 month to 15 yrs old admitted to participating pediatric intensive care units from June 1, 2007, to August 31, 2007, who received mechanical ventilation (invasive or noninvasive) for >12 hrs. Interventions: None. Measurements and Main Results: Demographic and physiologic data on admission to the pediatric intensive care units, drugs and events during the study period, and outcomes were prospectively recorded. A total of 256 patients were included. Of these, 23 (9%) required mechanical ventilation for >21 days and were assigned to the prolonged mechanical ventilation group. Patients requiring prolonged mechanical ventilation had higher mortality (43% vs. 21%, p < .05) and longer pediatric intensive care unit stay: 35 days [28-64 days] vs. 10 days [6-14]). There was no difference between the groups in age and gender distribution, reasons for admission, incidence of immunodeficiencies, or Paediatric Index of Mortality 2 score. The only difference at admission was a higher rate of genetic diseases in prolonged mechanical ventilation patients (26% vs. 9%, p < .05). There was a higher incidence of septic shock (87% vs. 34%, p < .01), acute respiratory distress syndrome (43% vs. 20%, p < .01), and ventilator-associated pneumonia (35% vs. 8%, p < .01) and higher utilization of dopamine (78% vs. 42%, p < .01), norepinephrine (61% vs. 15%, p < .01), multiple antibiotics (83% vs. 20%, p < .01), and blood transfusions (52% vs. 14%, p < .01). The proportion of extubation failure was higher in the prolonged mechanical ventilation group with similar rates of unplanned extubations in both groups. Variables remaining significantly associated with prolonged mechanical ventilation after multivariate analysis were treatment with multiple antibiotics, septic shock, ventilator-associated pneumonia, and use of norepinephrine. Conclusions: Patients with prolonged mechanical ventilation have more complications and require more pediatric intensive care unit resources. Mortality in these patients duplicates that from those requiring shorter support.
Adverse Events Related to Mechanical Ventilation in a Pediatric Intensive Care Unit
Revista Paulista de Pediatria, 2021
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 associat...
Clinical profile of mechanically ventilated children aged 1 month to 18 years
IP international journal of medical paediatrics and oncology, 2022
Background: Mechanical Ventilation (MV) is a life supporting device indicated in acute cardio-respiratory failure in children. A limited data is available about MV in children from India and our region too. Aim: To study clinical profile of mechanically ventilated children aged 1 month to 18 years of age. Materials and Methods: This retrospective study was conducted between 1 s t May 2014 to 30 s t April 2019 at Pediatric Intensive Care Unit (PICU) of D.Y.Patil Medical college and hospital, Kolhapur among 103 children who required MV. The medical records like PICU Register and case sheets were reviewed for details like age, gender, clinical diagnosis, comorbid conditions and indications , length, mode and complications of MV. The data was analyzed statistically. Results: The incidence of MV was 13.08% (1348/103) and 54.37% patients were under-five age. The primary diagnosis was respiratory 42(40.78%), neurological 29(28.15%), and cardiac 10 (9.70%) illnesses. Pneumonia and status epilepticus were the commonest causes. The indications for MV were highest with respiratory failure 31(30.09%) and cardiorespiratory failure 23 (22.33%). The median duration of MV was 3 days. The stridor 20(19.42%) and endotracheal tube blockages 08(07.77%) were the commonest complications. The outcome of patients was improved in 60(58.25%) while death in 38(36.89%) patients. The highest deaths occurred in 9(23.68%) , 8 (21.05%) patients with sepsis and pneumonia respectively. Conclusions: The indication for MV was either respiratory or cardiorespiratory failure while respiratory (Pneumonia) and neurological (Status Epilepticus) were the commonest illnesses. Most of the patients were improved while deaths occurred mainly in sepsis and pneumonia patients. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Experience in a Pediatric Prolonged Mechanical Ventilation Unit from a public hospital in Chile
Archivos Argentinos de Pediatria, 2021
Introduction: Hospitalized patients with high respiratory technology dependency are increasingly common and result in lengthy stays in intensive care units. Strategies mitigating its impact have been scarcely described. Objective: To describe a 6-year experience in a Pediatric Prolonged Mechanical Ventilation Unit. Methods: Retrospective study. All children admitted to the unit between October 2012 and December 2018 were included. Descriptive and inferential statistical methods were used, analyzing lengths of stay and readmissions. Different outcome measures were compared according to the type of pathology and mechanical ventilation. Results: A total of 113 patients had 310 admissions to the unit. Age at admission: 2.2 years (0.6-8.8); males: 60.2 %. Pathologies: neuromuscular disease (22.1 %), chronic lung disease (20.4 %), neurological damage (34.5 %), upper airway obstruction (9.7 %), heart disease (3.5 %), Down syndrome (9.7 %). A total of 10 507 bed-days were used; with a 92.6 % occupancy rate, 54.8 % of transfers to the intensive care unit, and 66.1 % of readmissions. Mean length of stay: 16 days (6.5-49.0); differences in age at admission observed by pathology (p = 0.032). More readmissions were observed in children with neurological damage and Down syndrome (p = 0.004). Children with invasive ventilation were observed to have a longer length of stay (p < 0.001) and more readmissions (p < 0.001). Conclusion: The occupancy rate at the PMVU was over 90 %, which allowed more available intensive care beds and discharging all patients. Children with invasive ventilation had a longer length of stay and more readmissions.
A narrative review of advanced ventilator modes in the pediatric intensive care unit
Translational Pediatrics, 2021
Respiratory failure is a common reason for pediatric intensive care unit admission. The vast majority of children requiring mechanical ventilation can be supported with conventional mechanical ventilation (CMV) but certain cases with refractory hypoxemia or hypercapnia may require more advanced modes of ventilation. This paper discusses what we have learned about the use of advanced ventilator modes [e.g., high-frequency oscillatory ventilation (HFOV), high-frequency percussive ventilation (HFPV), high-frequency jet ventilation (HFJV) airway pressure release ventilation (APRV), and neurally adjusted ventilatory assist (NAVA)] from clinical, animal, and bench studies. The evidence supporting advanced ventilator modes is weak and consists of largely of single center case series, although a few RCTs have been performed. Animal and bench models illustrate the complexities of different modes and the challenges of applying these clinically. Some modes are proprietary to certain ventilators, are expensive, or may only be available at well-resourced centers. Future efforts should include large, multicenter observational, interventional, or adaptive design trials of different rescue modes (e.g., PROSpect trial), evaluate their use during ECMO, and should incorporate assessments through volumetric capnography, electric impedance tomography, and transpulmonary pressure measurements, along with precise reporting of ventilator parameters and physiologic variables.
Epidemiology of Mechanical Ventilation: Analysis of the SAPS 3 Database
Intensive Care Medicine, 2009
Objective: To evaluate current practice of mechanical ventilation in the ICU and the characteristics and outcomes of patients receiving it. Design: Pre-planned sub-study of a multicenter, multinational cohort study (SAPS 3). Patients: 13,322 patients admitted to 299 intensive care units (ICUs) from 35 countries. Interventions: None. Main measurements and results: Patients were divided into three groups: no mechanical ventilation (MV), noninvasive MV (NIV), and invasive MV. More than half of the patients (53% [CI: 52.2-53.9%]) were mechanically ventilated at ICU admission. FIO 2 , VT and PEEP used during invasive MV were on average 50% (40-80%), 8 mL/kg actual body weight (6.9-9.4 mL/kg) and 5 cmH 2 O (3-6 cmH 2 O), respectively. Several invMV patients (17.3% (CI:16.4-18.3%)) were ventilated with zero PEEP (ZEEP). These patients exhibited a significantly increased riskadjusted hospital mortality, compared with patients ventilated with higher PEEP (O/E ratio 1.12 [1.05-1.18]). NIV was used in 4.2% (CI: 3.8-4.5%) of all patients and was associated with an improved risk-adjusted outcome (OR 0.79, [0.69-0.90]). Conclusion: Ventilation mode and parameter settings for MV varied significantly across ICUs. Our results provide evidence that some ventilatory modes and settings could still be used against current evidence and recommendations. This includes ventilation with tidal volumes [8mL/ kg body weight in patients with a low PaO2/FiO2 ratio and ZEEP in invMV patients. Invasive mechanical ventilation with ZEEP was associated with a worse outcome, even after controlling for severity of disease. Since our study did not document indications for MV, the association between MV settings and outcome must be viewed with caution.
Early outcome of mechanical ventilation in pediatric surgery patients
The professional medical journal, 2022
Material & Methods: The patients requiring mechanical ventilation were included, while patients requiring non-invasive ventilation (CPAP), or with cardiac anomalies and pneumonia were excluded. Demographic variables, diagnosis, source of ICU admission, mechanical ventilation setting and cause of mechanical initiation was recorded. Outcome noted were mortality and morbidity, sepsis, ventilator associated pneumonia (VAP), and ventilator associated lung injury (VILI). For pneumonia and sepsis, vancomycin and meropenem was started, while for VILI chest intubation was done. Results: Total numbers of children enrolled in study were 60. Mean age of the patient was 14.6±3.8 months. Mean weight was 6.3±0.99 kg. Mean number of days on mechanical ventilation were 1.8±0.3 days. Mean length of hospital stay was 7.9±1.2 days. There were 35 patients (58.3%) on Synchronus mode (SIMV) group, and 25 patients (41.7%) on control mode (A/C, pressure) group. Mortality was noted in 39 (65%) children, while 21 (35%) children survived. Thirteen (21.7%) children developed VAP, while 40(66.7%) developed sepsis. VILI was noted in 12 (20%) children. No association was seen between mortality and sepsis, VAP, VILI. Conclusion: If initiated at the right time, mechanical ventilation is not only useful but also life-saving. However, to prevent complications like VAP, VILI early weaning off is mandatory. Mortality was noted in 65% children, while 21.7% developed VAP, 66.7% developed sepsis, and 20% suffered from VILI.