Factors associated with prolonged mechanical ventilation in children with pulmonary failure: Cohort study from the LARed Network registry

Abstract

ObjectivesTo identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). DesignSecondary analysis of a prospective cohort. SettingPICUs in centers that are part of the LARed Network between April 2017 and January 2022. ParticipantsPediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. InterventionsNone. Main variables of interestDemographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. Results1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17–2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87−7.36), and fungal infections (OR 6.66, 95% CI 1.87−23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12−0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79−10.20), need for tracheostomy (OR 2.91, 95% CI 1.89−4.48), transfusions (OR 2.94, 95% CI 2.18−3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48−2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89−4.48), and longer PICU stay (OR 1.13, 95% CI 1.10−1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12−2.21). ConclusionsFactors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay.