Assessment of invasive mechanical ventilated patients during one year at pediatric intensive care unit of Çukurova University faculty of Medicine

Assessment of Invasive Mechanical Ventilated Patients During One Year At Pediatric Intensive Care Unit of Çukurova University Faculty of Medicine Objective: The aim of this study was to evaluate pediatric mechanical ventilation incidence, indications, methods and complication also demographics of patients, weaning and extubation process, tracheostomy rate and mortality risks of invasive mechanical ventilated patients at our pediatric intensive care unit. Matherial and methods: Indication, methods, duration and complication of invasive mechanical ventilation, weaning and extubation process, postextubation management, demographics of patients, underline diseases, accompanying diseases as acute respiratory distress syndrome, tracheostomy or ventilator associated pneumonia, using sedative and analgesic drugs, length of pediatric intensive care unit stay, PIM II, PRISM III, PELOD scores and mortality rate of invasive mechanical ventilated patients were analyzed. For this purpose, data collected from the daily charts, patient records, mechanical ventilation records and clinician opinion everyday for included patients from February/2015 to February/2016. Results: Seventy four (%42.8) female and 99(%57.2) male total 173 patients were evaluated in this study. The median age was 68.1±65.7(2-216) months. Length of PICU stay was 1-65(10±10.9 days) days. Mechanical ventilation duration was 1-61(7.69±8.76 days) days. Hypercarbic respiratory failure was the most common indications for mechanical ventilation (88 patients, %50.8). Neurological diseases were the most common underline diseases (%44.5). PIM II scores were %4.5-100(%40.8±32.7), PRISM III scores were 5-67(23.5±11.9) and PELOD scores were %0.1- 100(%25.3±33.4).Ninety two (%53.2) patients were with tracheostomy. Four of these patients tracheostomy applied for emergency situations and the other patients were needed tracheostomy because of chronic respiratory failure. Sedation analgesia was used at 126(%72.8) patients. Sedation duration was 1-61(5.4±9.1) days. Midazolam was the most preferred agent (126 patients, %72.8) and fentanyl was second (87 patients, %50.3). Remifentanil was used at 31(%17.9) patients while morphine was 11(%6.4). Neuromuscular blocking agents just used the patient has got tracheostomy or acute respiratory distress syndrome (57 patients, %32.9). Multıple inotropic agent using is the most important factor for mortality. Dopamine was the widely used as inotropic agent (57 patients, %32.9). Atelectasis was the most complication (%7.5). Ventilator associated pneumonia was detected at 12 patients (%6.4). The general mortality rate was %2.4 at our intensive care unit while 19(%11) invasive mechanical ventilated patient had died. At these patients, the most reason of exitus was multıple organ dysfunction syndrome (12 patients, %63.1). Conclusion: İnvasive mechanical ventilation is indispensable treatment for pediatric intensive care units and clinician experience is very important factor for treatment success. There is no consensus about ventilator mods at children. According to our results, invasive mechanical ventilation strategies at our intensive care unit are similar to the world standards. Our results will provide important information about actual state of mechanical ventilation and will be perspective for future research.