Evaluation of mechanical ventilation practices in turkish pediatric intensive care units

Objectives: The aim of this study was to evaluate the mechanical ventilation practices in Turkey, to determine the clinical features of patients undergoing mechanical ventilation, to investigate the mechanical ventilation and weaning modes used, assess morbidity and mortality rates and associated factors.Methods: All consecutive patients between 1 month and 18 years of age admitted during a 2 month period between December 2008 and February 2009 to 8 Pediatric Intensive Care Units in Turkey requiring intubation and ventilation for >12 hrs were enrolled in the study. Maximum follow up time for the patients was 28 days. Demographic data of the patients, criteria for admission to intensive care unit and initiation of mechanical ventilation, mechanical ventilation practices, associated morbidity and mortality was recorded.Results: Of the total 124 patients, 74 were male and 50 female. The mean age of the patients was 3,89±4,71 (1mo-17y) years of age. In 61,3% of the patients an underlying chronic disease was present with central nervous system diseases (%22) the most common type. In 85 patients (68,5%) mechanical ventilation was initiated owing to acute respiratory failure and pneumonia (50%) was the most common diagnosis. Pressure controlled SIMV±PS mode was determined to be the most commonly (76,6%) used mechanical ventilation mode. Estimated mortality rate according to PIM 2 (Pediatric Mortality Index) of patients admitted to intensive care was 35,17% whereas 28,2% of patients in the study died. Gradual weaning, spontaneous breathing tests (SBT) or their combination was used in 34,7%, 8%, and 25,8% of patients, respectively. Use of SBT are associated with a significantly shorter duration of ventilation and ICU stay. The rate of unsuccessful extubation was 13,5%. Duration of intubation and hospitalization was associated with unsuccessful extubation. Sedation and analgesia use was associated with prolonged ventilation and duration of hospitalization.Conclusion: Mechanical ventilation practices in Turkish PICUs are similar to other countries? practices. SBT lead to shorter children ventilation and hospital stay; whereas sedative and analgesic usage is associated with prolonged hospitalization.Key words: Pediatric intensive care unit, mechanical ventilation,