Daily practice of mechanical ventilation in Italian pediatric intensive care units: A prospective survey*

Wolfler, Andrea; Calderoni, Edoardo; Ottonello, Giancarlo; Conti, Giorgio; Baroncini, S; Santuz, Pierantonio; Vitale, Pasquale; Salvo, Ida

doi:10.1097/pcc.0b013e3181dbaeb3

Cited by 62 publications

(84 citation statements)

References 29 publications

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“…Hypoxemia itself is the cause of death in only 9-27% in different series of patients with ARDS, and multiorgan failure is the major cause of the remaining deaths [24,27,28]. Mortality was 9% in the ARDS group, similar to other pediatric studies [29,30] and with mortality predicted by PIM2 and PELOD scores. Currently, we do not have enough clinical information to relate specific ACE polymorphisms to a given prognosis for pediatric ARDS.…”

Section: Discussionsupporting

confidence: 61%

Angiotensin-converting enzyme insertion/deletion polymorphism is associated with severe hypoxemia in pediatric ARDS

et al. 2011

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Section: Discussionsupporting

confidence: 61%

Angiotensin-converting enzyme insertion/deletion polymorphism is associated with severe hypoxemia in pediatric ARDS

et al. 2011

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“…The frequency of utilizing MV, according to previous studies, varies from 24–60% of all pediatric intensive care units (PICUs) (1–4). Two multicenter studies, the International Group for Mechanical Ventilation in Children (IGMVC) and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) have studied characteristics of pediatric patients on MV (6, 7).…”

Section: Introductionmentioning

confidence: 99%

Mechanical ventilation practice in Egyptian pediatric intensive care units

Kamal

2017

Electron physician

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IntroductionMechanical ventilation is one of the indispensable tools in pediatric intensive care units. Few studies addressed the epidemiology of pediatric patients on mechanical ventilation and the frequently used modes of ventilation. This is the first study to describe the practice of mechanical ventilation (MV) in Egyptian pediatric intensive care units (PICUs).MethodsThis prospective observational study was conducted from January 2014 to December 2014 in two pediatric intensive care units at Cairo University Pediatric Hospital. The study included all children who were intubated and mechanically ventilated for more than 12 hours of admission. Pre-coded data was entered into the SPSS version 21 for data analysis. Comparison between groups was performed using Mann Whitney test for quantitative variables and Chi square with Fisher’s exact test for qualitative ones. Multivariate logistic regression model was conducted to explore the significant predictors for PICU mortality.ResultsIn total, 893 children were admitted and 293 were mechanically ventilated. The incidence of utilizing MV in children was 32.8%. Neurologic causes were the most common reasons for initiation of MV, with 114 (38.9%) cases. The most commonly preferred mode for initiation of MV is SIMV with PS. Complication occurred in 117 (39.9%) of the cases. The most commonly preferred method of weaning was PS with CPAP in 115/154 (74.7%) cases. Mortality occurred in 134/293 (45.7%) of patients. Duration of mechanical ventilation was significantly longer with neuromuscular diseases, and with the occurrence of complications (p<0.001). There was a significant relationship between mortality and higher PRISM III score, cardiovascular cases, sepsis, multiple organ dysfunction syndrome (MODS), ventilator-associated pneumonia (VAP), and with barotrauma.ConclusionsIn our practice, MV is used oftentimes with almost a third of admissions requiring intubation for different reasons. Most children are ventilated due to neurologic causes. This study paves the way for improving our knowledge of MV with avoiding the fatal complications.

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“…Recent multicenter studies provide important information on characteristics and outcomes of children undergoing mechanical ventilation in the PICU and current ventilation practices. [2][3][4][5] Despite ubiquitous use of mechanical ventilation in children, no professional society has published practice guidelines to date. 6 Delineation of roles and responsibilities for ventilation and weaning may vary according to unit structure, staffing and skill mix, patient case mix, and medical and nursing leadership models.…”

Section: Design and Settingmentioning

confidence: 99%

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

Blackwood¹,

Junk²,

Lyons³

et al. 2013

American Journal of Critical Care

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Background Organizational processes affect the duration of mechanical ventilation in adult and pediatric intensive care units, but surprisingly little is known about role responsibilities for mechanical ventilation and weaning and related contextual factors that may influence timely liberation from mechanical ventilation. Objective To determine the professional group and seniority of clinicians responsible for key decisions regarding ventilation and weaning; use of ventilation protocols and automated closed loop systems; and provision of education on mechanical ventilation. Methods Mailed survey to nurse managers of pediatric intensive care units in the United Kingdom. Results Response rate was 61%. In most units, nurse managers reported that physicians and nurses usually collaborated in making decisions about initializing (63%) and adjusting (94%) ventilator settings and for determining weaning readiness (88%), weaning method (59%), extubation readiness (82%), and weaning failure (100%). Protocols for mechanical ventilation were available in 35% of units, some specific to weaning (18%) and others for noninvasive ventilation (35%). Automated closed loop systems were used in 18% of units. Competency training was required before nurses could adjust ventilator settings in 35% of responding units; in the remaining units, settings were adjusted by nurses who had no specific competency training. Conclusions Key decisions were mainly collaborative, but nurses were limited in their ability to adjust ventilator settings independently. This limitation may be due to a lack of standardized competency programs and the infrequent use of non-physician-led weaning protocols and automated systems. These findings indicate some ways of improving processes to avoid delays in ventilator weaning.

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Daily practice of mechanical ventilation in Italian pediatric intensive care units: A prospective survey*

Cited by 62 publications

References 29 publications

Angiotensin-converting enzyme insertion/deletion polymorphism is associated with severe hypoxemia in pediatric ARDS

Angiotensin-converting enzyme insertion/deletion polymorphism is associated with severe hypoxemia in pediatric ARDS

Mechanical ventilation practice in Egyptian pediatric intensive care units

Role Responsibilities in Mechanical Ventilation and Weaning in Pediatric Intensive Care Units: A National Survey

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