Mechanical ventilation on paediatric intensive care units in Czech Republic

Objective: The aims of this study were to evaluate the incidence of mechanically ventilated children in participating units, to find out the demographic data of the patients, to evaluate ventilator settings and to assess the mortality of ventilated children. Design: Prospective observational multicenter study between 1.2.2002 and 30.4.2002. Setting: Seven paediatric intensive care units in tertiary hospitals in the Czech Republic. Patients: All children between 1 month and 18 years admitted to the participating paediatric intensive care units who required intubation and mechanical ventilation were enrolled. Method: Following parameters were recorded in all patients: demographic data (age, weight, gender), the origin of the admitting diagnosis, severity of illness (Pediatric Risk of Mortality Score - PRISM, Multiorgan System Failure - MCSF, Lung Injury Score - LIS), the origin of respiratory failure, presence of chronic disease and immunosuppression, length of ventilation, length of stay, ventilator setting, the use of unconventional ventilation, outcome (mortality), blood gas analyses and indices (alveoloarterial oxygen difference - AaDO(2), oxygenation index - OI, hypoxemia score PaO2/FiO(2) and ventilation index - VI), deadspace to tidal volume ratio-Vd/Vt and dynamic respiratory system compliance (Cdyn). Results: One hundred and forty four children (42% girls) were enrolled in total which represent 23% of all admitted children. The mean age of the patients was 70 months and mean weight was 23 kg. PRISM score and the length of stay were twofold against mean values (11.7 vs. 5.7 and 10.4 vs. 4.8 days respectively). The mean length of ventilation was 117 hours, 66% of the patients had an extrapulmonary origin of respiratory failure, 19% of the patients were chronically ill, and 0,7% had the evidence of immunosuppression. Pressure regulated volume controlled and Biphasic positive airway pressure were the most frequently used ventilator settings. Unconventional ventilation in all was used in 13% of the patients. Mortality was 3.5%. Conclusion: Children on mechanical ventilation create 23% of all patients admitted to paediatric intensive care units. The severity of illness and length of stay were twofold against mean values. Mortality rate was 3.5% and hypoxia was not a cause of death in any patient.