Mechanical ventilation practices in a pediatric intensive care unit located at rural tertiary care teaching hospital of Gujarat - A retrospective descriptive study

Abstract

Objective: It is common to see many NICU across India but well equipped separate PICU is rarity especially in smaller cities and rural hospitals. Our aim is to share our experience of PICU from a rural background catering services to 1 month to 18 years patients. Material and Methods: In this retrospective study, we present data (retrieved from medical records) of 216 mechanically ventilated children from total of 1084 PICU admissions in 3 years period. Results: Mechanical Ventilation (MV) rate was 31%. Male: Female ratio was 1.8:1 with 37.04% infants. Majority (77%) were referred cases, of which 67% required immediate endotracheal intubation on arrival at our ED. Patients who were transported in ambulance with staff and facility (22.2%) showed improved outcome in terms of mortality (6.25% Vs 14.88%: Proper Vs Improper transport). Indications for MV were Respiratory-32.4%, Neurologi- cal-29.16%, Circulatory failure-14.81% and others-23.6%. Pressure SIMV and Pressure A/C were the most preferred initial modes (80%) whereas CPAP/PSV was preferred weaning mode (75.7%). Prolonged (>7days) MV required in 14%. Endotracheal intubation and MV related events were observed in 35%, including Pneumothorax in 0%, VAP in 1.85%, Atelectasis in 2.78%, Postextubation stridor in 15.74% cases. Vasopressors, Central line insertion and RRT were offered in 73%, 12.96% and 2.3% cases respectively. Among nosocomial infections (Culture proven) BSI, VAP and CAUTI were 7%, 2% and 0.9% respectively. Overall Mean ventilator days were 3.98 (4.3 in discharged patients). Successful extubation was achieved in 107/216 (49.53%). Death rate was 12.5%. Conclusion: Our study offers comprehensive information which may assist paediatrician in the decision-making process to allow better resource allocation in rural settings.