2001 OPEN FORUM Abstracts
FACTORS ASSOCIATEDWITH MECHANICAL VENTILATION IN A PEDIATRIC POPULATION.
Ronald E. Dechert,RRT, Roxanne Sadowski, RRT, Colleen Ducker, RRT, Jennifer Benson, RRT,Sue Smith, RRT, Sue Mack, Kenneth Bandy, RRT, Frank Moler, MD, Joseph Custer,MD. University of Michigan Medical Center, Ann Arbor, Michigan
Introduction: Mechanicalventilation (MV) is commonly employed in support of pediatric ICU (PICU) patientswho exhibit respiratory dysfunction. Many RC departments employ protocols toreduce the incidence or duration of MV in this population. Scant empirical informationexist which identify various baseline factors that are associated with MV inthis population. As a result, few protocols account for contributory factorsin the development of treatment protocols. The purpose of this study is to examinefactors associated with pediatric MV.
Methods: 1979 PICUadmissions were included in this retrospective, case-control study. Co-morbiditiessuch as age, prior ICU admission, operative status, and diagnosis, as well as,worst perturbed physiologic parameter during first 24 hours following admissionwere captured for each of the 1979 patients. Cases were identified as thosepatients who required MV at anytime during their PICU admission. Once patientswere appropriately identified (case/control), the comordities and physiologicderangements were examined using bivariate analysis to identify those factorsthat were associated with the need for MV.
Results: The result are shownin table 1 below:
|Cases (n=754)||Controls (n=1225)||p-value|
|Age||5.4 + 5.8||6.9 + 6.1||<0.001|
|BP systolic (highest)||118 + 23||122 + 19||<0.001|
|Heart Rate (highest)||153 + 29||142 + 29||<0.001|
|pH (highest)||7.42 +0.09||7.37 +0.16||<0.001|
|Previous ICU||162/754 (27%)||115/1225 (9%)||<0.001|
|Cardiac arrest||16/754 (2%)||11/1225 (1%)||0.023|
|Cardiac arrythmias||109/754 (14%)||91/1225 (7%)||<0.001|
|Meningitis||29/754 (4%)||22/1225 (2%)||0.005|
|Pneumonia||163/754 (22%)||104/1225 (8%)||<0.001|
|331/754 (44%)||377/1225 (31%)||<0.001|
Conclusions: Our study demonstratesthat a variety of factors, present or immediately following PICU admission,are associated with the need for MV in our pediatric population. The importanceof these and other factors in predicting the need for or duration of MV in aPICU population must be further delineated. Identification of contributory factorsassociated with MV, as identified in this study, may further aid practitionersin the development of treatment protocols that target MV support and duration.