Document Detail


How is mechanical ventilation employed in a pediatric intensive care unit in Brazil?
MedLine Citation:
PMID:  20037703     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the relationship between mechanical ventilation and mortality and the practice of mechanical ventilation applied in children admitted to a high-complexity pediatric intensive care unit in the city of São Paulo, Brazil.
DESIGN: Prospective cohort study of all consecutive patients admitted to a Brazilian high-complexity PICU who were placed on mechanical ventilation for 24 hours or more, between October 1(st), 2005 and March 31(st), 2006.
RESULTS: Of the 241 patients admitted, 86 (35.7%) received mechanical ventilation for 24 hours or more. Of these, 49 met inclusion criteria and were thus eligible to participate in the study. Of the 49 patients studied, 45 had chronic functional status. The median age of participants was 32 months and the median length of mechanical ventilation use was 6.5 days. The major indication for mechanical ventilation was acute respiratory failure, usually associated with severe sepsis / septic shock. Pressure ventilation modes were the standard ones. An overall 10.37% incidence of Acute Respiratory Distress Syndrome was found, in addition to tidal volumes > 8 ml/kg, as well as normo- or hypocapnia. A total of 17 children died. Risk factors for mortality within 28 days of admission were initial inspiratory pressure, pH, PaO2/FiO2 ratio, oxygenation index and also oxygenation index at 48 hours of mechanical ventilation. Initial inspiratory pressure was also a predictor of mechanical ventilation for periods longer than 7 days.
CONCLUSION: Of the admitted children, 35.7% received mechanical ventilation for 24 h or more. Pressure ventilation modes were standard. Of the children studied, 91% had chronic functional status. There was a high incidence of Acute Respiratory Distress Syndrome, but a lung-protective strategy was not fully implemented. Inspiratory pressure at the beginning of mechanical ventilation was a predictor of mortality within 28 days and of a longer course of mechanical ventilation.
Authors:
Dafne Cardoso Bourguignon da Silva; Audrey Rie Ogawa Shibata; Julio A Farias; Eduardo Juan Troster
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinics (São Paulo, Brazil)     Volume:  64     ISSN:  1980-5322     ISO Abbreviation:  Clinics (Sao Paulo)     Publication Date:  2009  
Date Detail:
Created Date:  2009-12-28     Completed Date:  2010-07-23     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  101244734     Medline TA:  Clinics (Sao Paulo)     Country:  Brazil    
Other Details:
Languages:  eng     Pagination:  1161-6     Citation Subset:  IM    
Affiliation:
Instituto da Criança, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. dafnecbs@usp.br
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MeSH Terms
Descriptor/Qualifier:
Brazil / epidemiology
Child, Preschool
Epidemiologic Methods
Female
Humans
Intensive Care Units, Pediatric
Length of Stay / statistics & numerical data
Male
Respiration, Artificial / mortality*
Respiratory Insufficiency / mortality,  therapy*
Risk Factors
Tidal Volume / physiology
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