Mechanical ventilation practice of pediatric patients with Covid-19 in Indonesian tertiary hospital

Abstract

Background: Coronavirus Disease-2019 (COVID-19) in children tend to have milder clinical manifestation. However, some develop critical conditions and require mechanical ventilation in the Pediatric Intensive Care Unit (PICU). Various modalities are recommended for mechanical ventilation, such as High Flow Nasal Cannula (HFNC), Continuous Positive Airway Pressure (CPAP), or invasive ventilation with intubation. This study aims to describe the clinical feature, ventilation modalities usage, and the outcome of children with critical COVID-19.
 Methods: This is a retrospective study in COVID-19 children with respiratory distress who were treated in the COVID-19 isolation PICU room of Saiful Anwar General Hospital for one year. The data was gained from the medical record and analyzed descriptively. Data were analyzed using Ms. Excel for Windows.
 Results: A total of 51 children with COVID-19 were admitted to Saiful Anwar general Hospital in one year period, with 12 of them in critical condition and 6 children require mechanical ventilation. The main signs developed were fever and dyspnea. Invasive mechanical ventilation applicated in 5 patients, and only 1 patient received Non-Invasive Ventilation (NIV). The mean of PEEP used in invasive ventilation is 7-9 cmH2O, lower than ESPNIC’s recommendation of 8-10 cmH2O. Length of ventilator usage is 2-21 days, with 2 patients passed away, both with a comorbid and organ system injury.
 Conclusion: The mechanical ventilation setting must be determined individually based on the patients’ condition, despite several guidelines providing the recommendation.