Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU
BackgroundA consensus on the definition of prolonged mechanical ventilation (PMV) for children does not exist. There is still lack of published work presenting the epidemiology, risk factors and outcomes at different cut-points for PMV patients. These are important for planning the goals of treatmen...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1167595/full |
| _version_ | 1797794248689451008 |
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| author | Tatchanapong Chongcharoenyanon Rujipat Samransamruajkit Jiratchaya Sophonphan |
| author_facet | Tatchanapong Chongcharoenyanon Rujipat Samransamruajkit Jiratchaya Sophonphan |
| author_sort | Tatchanapong Chongcharoenyanon |
| collection | DOAJ |
| description | BackgroundA consensus on the definition of prolonged mechanical ventilation (PMV) for children does not exist. There is still lack of published work presenting the epidemiology, risk factors and outcomes at different cut-points for PMV patients. These are important for planning the goals of treatment and counseling of the prognosis for patient families. We aimed to determine the incidence, baseline characteristics, risk factors and outcomes of PMV in pediatric patients at various cut-points (>14, >21 or >30days).MethodsA retrospective cohort study among children <18-years-old who were PMV > 14 days in the PICU of King Chulalongkorn Memorial Hospital was conducted. The primary outcomes were incidence of PMV with various cut-points. We stratified patients into three groups (Group 1; PMV > 14–21, Group 2; >21–30, Group 3; >30 days) for evaluating the baseline characteristics, risk factors, and outcomes of PMV (extubation success, tracheostomy status and death). Factors associated with PMV and deaths were analyzed using univariate and multivariate logistic regression.ResultsFrom January 2018 to August 2022, 1,050 patients were screened. Of these, 114 patients were enrolled. The incidence of PMV > 14, >21 and >30 days were 10.9%, 7.3% and 5.0% respectively. Extubation success was significantly lower in Group 3 than in Groups 1 & 2 (15.4% vs. 62.2% & 56.0%, P < 0.001). Consequently, the tracheostomy rate (63.5% vs. 16.2% & 12.0%, P < 0.001), VAP rate (98.1% vs. 59.5% & 80.0%, P < 0.001), mortality rate by disease (34.6% vs. 5.4% & 20.0%, P = 0.003), median PICU LOS (50.5 vs. 22.0 & 28.0 days, P < 0.001) and median hospital LOS (124.5 vs. 55.0 & 62.0 days, P < 0.001) were also significantly higher for Group 3 compared with Groups 1 & 2. The factor associated with PMV > 30 days was VAP (aOR: 19.53, 95% CI: 2.38–160.34, P = 0.01). Factors associated with non-surviving patients were 3rd degree PEM (aOR: 5.14, 95% CI: 1.57–16.88, P = 0.01), PIM3 score ≥14 (aOR: 6.75, 95% CI: 2.26–20.15, P < 0.001) and muscle relaxant usage (aOR: 5.58, 95% CI: 1.65–18.86, P = 0.01).ConclusionExtubation failure, tracheostomy rate, VAP rate, mortality rate by disease, PICU LOS and hospital LOS were significantly higher for PMV >30 days. Consequently, we suggest that a 30-day duration as a cut-point for PMV in PICUs might be more appropriate. |
| first_indexed | 2024-03-13T03:00:02Z |
| format | Article |
| id | doaj.art-cbc9380363c448d1af0a0d1d3374bf61 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-13T03:00:02Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-cbc9380363c448d1af0a0d1d3374bf612023-06-27T15:56:08ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-04-011110.3389/fped.2023.11675951167595Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICUTatchanapong Chongcharoenyanon0Rujipat Samransamruajkit1Jiratchaya Sophonphan2Division of Pulmonology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandDivision of Pediatric Critical Care, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandThe HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, ThailandBackgroundA consensus on the definition of prolonged mechanical ventilation (PMV) for children does not exist. There is still lack of published work presenting the epidemiology, risk factors and outcomes at different cut-points for PMV patients. These are important for planning the goals of treatment and counseling of the prognosis for patient families. We aimed to determine the incidence, baseline characteristics, risk factors and outcomes of PMV in pediatric patients at various cut-points (>14, >21 or >30days).MethodsA retrospective cohort study among children <18-years-old who were PMV > 14 days in the PICU of King Chulalongkorn Memorial Hospital was conducted. The primary outcomes were incidence of PMV with various cut-points. We stratified patients into three groups (Group 1; PMV > 14–21, Group 2; >21–30, Group 3; >30 days) for evaluating the baseline characteristics, risk factors, and outcomes of PMV (extubation success, tracheostomy status and death). Factors associated with PMV and deaths were analyzed using univariate and multivariate logistic regression.ResultsFrom January 2018 to August 2022, 1,050 patients were screened. Of these, 114 patients were enrolled. The incidence of PMV > 14, >21 and >30 days were 10.9%, 7.3% and 5.0% respectively. Extubation success was significantly lower in Group 3 than in Groups 1 & 2 (15.4% vs. 62.2% & 56.0%, P < 0.001). Consequently, the tracheostomy rate (63.5% vs. 16.2% & 12.0%, P < 0.001), VAP rate (98.1% vs. 59.5% & 80.0%, P < 0.001), mortality rate by disease (34.6% vs. 5.4% & 20.0%, P = 0.003), median PICU LOS (50.5 vs. 22.0 & 28.0 days, P < 0.001) and median hospital LOS (124.5 vs. 55.0 & 62.0 days, P < 0.001) were also significantly higher for Group 3 compared with Groups 1 & 2. The factor associated with PMV > 30 days was VAP (aOR: 19.53, 95% CI: 2.38–160.34, P = 0.01). Factors associated with non-surviving patients were 3rd degree PEM (aOR: 5.14, 95% CI: 1.57–16.88, P = 0.01), PIM3 score ≥14 (aOR: 6.75, 95% CI: 2.26–20.15, P < 0.001) and muscle relaxant usage (aOR: 5.58, 95% CI: 1.65–18.86, P = 0.01).ConclusionExtubation failure, tracheostomy rate, VAP rate, mortality rate by disease, PICU LOS and hospital LOS were significantly higher for PMV >30 days. Consequently, we suggest that a 30-day duration as a cut-point for PMV in PICUs might be more appropriate.https://www.frontiersin.org/articles/10.3389/fped.2023.1167595/fullprolong mechanical ventilationchildrenpediatricsdefinitioncut-pointlong-term ventilation |
| spellingShingle | Tatchanapong Chongcharoenyanon Rujipat Samransamruajkit Jiratchaya Sophonphan Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU Frontiers in Pediatrics prolong mechanical ventilation children pediatrics definition cut-point long-term ventilation |
| title | Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU |
| title_full | Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU |
| title_fullStr | Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU |
| title_full_unstemmed | Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU |
| title_short | Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU |
| title_sort | epidemiology risk factors and outcomes of prolonged mechanical ventilation with different cut points in a picu |
| topic | prolong mechanical ventilation children pediatrics definition cut-point long-term ventilation |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1167595/full |
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