INTRODUCTION: Ventilatory support is an essential and a common form of therapy
in Pediatric Critical Care Unit. In recent years, this modality has evolved
into a highly specialized discipline (1). The term mechanical ventilation
refers to various artificial means used to support ventilation and
oxygenation (2).
Natural spontaneous ventilation occurs when the respiratory
muscles (diaphragm, intercostal muscles) create negative intrathoracic
pressure, in part by expanding the rib cage, leading to lung expansion,
which pulls air into the alveoli and allows gas exchange to occur. In
contrast, ventilation is achieved in intubated patients by delivering
compressed gas to the lungs by positive pressure ventilation.
During positive pressure ventilation, the flow of gas during
inspiration and expiration is driven by the airway pressure gradient
between the airway opening and the alveoli. During inspiration, the
airway opening pressure is greater than alveolar pressure, thereby
driving gas into the lungs and inflating them. Expiration is usually
passive and occurs because, at the end of inspiration, alveolar pressure
becomes greater than airway pressure. AIM OF THE STUDY:
To study the etiological and clinical profile of children ventilated
in PICU and various complications and outcome of these
children. DISCUSSION: This descriptive observational study was conducted to study the
demographic, clinical profile of children who were ventilated at the
PICU, and their complications and outcome. The commonest indication for intubation and artificial ventilation
was circulatory dysfunction including shock, unlike other studies,where
neurological indications predominated in the study by Kendirli et al and respiratory causes were the commonest causes for artificial ventilation
in the study by Indrajit et al. Intubation was performed orotracheally in
97.9% of children and nasotracheally in 2.1% in present study compared
to no nasotracheal intubation performed in the study by Da Silva et al.
Rapid Sequence intubation(RSI) was performed in 54.8% of the study
population compared to routine RSI protocol used in the study by Da
Silva et al.
Though mechanical ventilation is the standard of care, our
hospital being a Government hospital and a tertiary referral centre, many
critically ill children with need for ventilation are being referred to here,
which could not be met by the available resources in PICU and hence,
many children needed manual ventilation. Out of the 106 children who
were manually ventilated, 45 (42.5%) survived. Another 75 children
required manual ventilation for varying duration in addition to
mechanical ventilation, and the survival was 52.1% in that subgroup.
None of the studies in available literature have data on manual
ventilation.
The mean duration of artificial ventilation in the study was
3.56±5.2 days. The duration of mechanical ventilation in the study was 4.6±5.9 days. A total of 181 children (96.3%) were ventilated manually
during their PICU stay, and among them, 75 children were ventilated
mechanically after variable duration of manual ventilation. In
comparison, the ventilation days were 18.8±14.1 days in the study by
Kendirli et al and the median ventilation days were 6.5 days in the study
by Da Silva et al. SUMMARY AND CONCLUSIONS: 1. Infants contributed 46.3% of children who were ventilated in the
Pediatric Intensive Care Unit.
2. The sex ratio was almost equal with slight male preponderance.
Male:Female = 1.09:1.0
3. The commonest cause for intubation was circulatory failure and
the commonest clinical diagnosis was septic shock.
4. Of the children who were ventilated in the PICU, 76.6% were
intubated at the Emergency Department.
5. Rapid Sequence Intubation was performed in 54.8% of children,
and orotracheal route was the commonest route of intubation.
• Many children (56.4%) were manually ventilated and it was
associated with an increased risk of mortality especially when
done for 48 hours or more.
6. Nosocomial pneumonia was the commonest complication
encountered in ventilated children and was more common in those
who were reintubated.
7. Mortality and complications in ventilated children in the PICU
can be reduced with increased availability of mechanical
ventilators
