Mechanical ventilation practices in pediatric intensive care unit patients in Turkey : A point prevalence

Introduction: Respiratory failure is one of the most common reasons for intensive care unit (ICU) admissions worldwide. Treatment options include low-flow or high-flow oxygen therapies, non-invasive ventilation (NIV), and invasive mechanical ventilation (IMV) depending on the patient's clinical condition and the physician's experience. This study aims to investigate the respiratory support methods applied in ICUs in Turkey and compare them with literature data. Method: This is a cross-sectional survey study. Responsible physicians of pediatric intensive care units (PICUs) in Turkey who agreed to participate in the study were sent two electronic surveys. Data on unit characteristics, demographic structure, patients' demographic characteristics, admission indications, respiratory support methods, device settings, application durations, and characteristics of patients with acute respiratory distress syndrome (ARDS) were recorded. Descriptive statistics of the data were performed. Results: The study included 23 centers with an average bed count of 13.09 ± 5.74 and an average specialist count of 2.35 ± 1.03. On the day of the study, there were 186 patients, with 49.5% being female and a median age of 27 (9-98) months. The median PRISM-3 score was 9 (5-16), and the median length of stay was 11 (4-33) days. The most common admission diagnosis was bronchopneumonia (41.9%), and 76.3% of patients had chronic illnesses. On the study day, 26 (14%) patients did not receive respiratory support, while IMV was applied in 104 (55.9%) patients. The most preferred mode was SIMV-P (73.1%). ARDS was detected in 32 (17.2%) patients, with 10 (31%) of them being severe cases. Modified DP (PIP-PEEP) was >15 in 20 (76.9%) patients, and FiO2/PEEP titration was not compliant with pediatric ARDS guidelines in 27 (84.3%) patients. The KOVA method was used for weaning in 60.9% of units, while daily sedation breaks and spontaneous breathing trials were applied in 39.1%. The most common complication encountered was ventilator-associated pneumonia (63%), and 22.6% of patients were followed with tracheostomy. Conclusion: This study highlights the necessity of using current evidence-based guidelines during mechanical ventilation applications. Various adjustments and strategies in mechanical ventilation practices will have effects on mortality and morbidity. Increasing the availability of palliative care centers is necessary for implementing lung-protective ventilation strategies and managing the burden of chronic illness. Keywords: Pediatric Intensive Care Unit, Respiratory Support, Mechanical Ventilation, ARDS