Average Duration Of Mechanical Ventilation Research Articles

Shift-Level Team Familiarity Is Associated with Improved Outcomes in Mechanically Ventilated Adults.

Organizing intensive care unit (ICU) interprofessional teams- nurses, physicians, and respiratory therapists -is high priority due to workforce crises but how often clinicians work together (i.e., interprofessional familiarity) remains unexplored. Determine if mechanically ventilated patients cared for by teams with greater familiarity have lower mortality, shorter duration of mechanical ventilation (MV) and greater spontaneous breathing trial (SBT) implementation. Using electronic health records from 5 ICUs (2018-2019), we identified the interprofessional team that cared for each mechanically ventilated patient each shift, calculated familiarity and modeled familiarity exposures separately on ICU mortality, duration of MV and SBT implementation using encounter-level generalized linear regression models with a log link, unit-level fixed effects adjusting for cofounders, including severity of illness. Familiarity was defined as how often clinicians worked together for all patients in an ICU (i.e., coreness) and for each patient (i.e., mean team value). Among 4,292 patients (4,485 encounters, 72,210 shifts), unadjusted mortality was 12.9%, average duration of MV was 2.32 days and SBT implementation was 89%. An increase in coreness and mean team value, by each's standard deviation, was associated with lower probability of dying (coreness, adjusted marginal effect (AME) = -0.038, 95% CI (-0.07, -0.004); mean team value, AME=-0.0034 (-0.054, -0.014), greater probability of receiving SBT when eligible (coreness, 0.45, (0.007, 0.083); mean team value, 0.012 (-0.017, 0.042)) and shorter duration of MV (coreness, -0.23 (-0.321, -0.139)). Interprofessional familiarity was associated with improved outcomes; assignment models that prioritize familiarity might be a novel solution.

Admission time and outcomes of patients admitted to intensive care unit in a tertiary hospital in Nepal: an observational study

Background and aims: Time of admission to the intensive care unit may have a significant impact on the outcome. However, there is scarcity of published literature regarding admission hours and outcomes from low-income and middle-income countries like Nepal. The aim of this study was to compare the outcome of patients admitted to intensive care units at office hours and off hours. Methods: This observational study was conducted in the intensive care units of Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Data from 1 January 2020 to 31 December 2022, over a period of three years, were curated from the ICU registry. Patients were divided into two groups based on the time of admission to intensive care unit: 1) office hours (from 9:00 am till 4:59 pm that day) and 2) off hours (5:00 pm to 8:59 am next day, including Saturdays and public holidays). Results: Among 3733 patients admitted to ICU, 3242 patients were enrolled for analysis. There were no significant differences in mortality rate as well as average duration of mechanical ventilation between two groups. The average length of stay was however longer by 1 day among patients admitted during off hours compared to office hours. Conclusion: The time of admission in ICU has no significant effect on the outcome of patients. Off hour ICU admission is not associated with poor patient outcomes compared to office hours.

Comparison of the Methods of Surgical Treatment of Complex Congenital Heart Defects Combined with Right Ventricular Hypoplasia

Surgical treatment of complex congenital heart defects (CHD) in patients who cannot undergo radical correction due to pronounced hypoplasia or dysfunction of the right ventricle (RV) remains one of the most urgent problems in pediatric cardiac surgery. In 1989, Billingsley et al. first reported the addition of bidirectional cavopulmonary anastomosis to definitive biventricular repair in patients with RV hypoplasia, pulmonary artery atresia, and intact interventricular septum in four patients, and introduced the term one and half ventricle repair (1.5VR). The method of 1.5VR consists of bidirectional cavopulmonary anastomosis, which reduces the volume load on the RV, in addition to the complete repair of other CHDs.
 The aim. To assess perioperative characteristics of patients, immediate and long-term results after surgical correction of complex CHD through the method of 1.5VR.
 Materials and methods. In the period from 1996 to 2022, surgical correction was performed in 33 patients with complex CHD combined with hypoplasia and/or dysfunction of the RV at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 21 male patients (64%) and 12 female patients (36%). The mean age of the patients at the time of surgery was 57.9 months. Me = 34 [3.5; 312] months. The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities, which made it possible to assess the morphology, kinetics of the heart structures, and hemodynamic state. Depending on the selected tactics of surgical treatment, all the patients were divided into two groups: group І (n=21) with patients operated through the method of 1.5VR, and group ІІ (n = 12) including those operated through the single ventricle pathway.
 Results. In the early postoperative period, there were 3 (9%) deaths in both groups: one (4.7%) death in group I, and 2 (16%) deaths among patients of group II. In all the deceased patients, the cause of death was acute heart failure, which subsequently led to multiple organ failure. In one patient of the group II, in addition to heart failure, acute cerebrovascular accident occurred. In the group I, the average indicator of systemic saturation (92±6.2%) at discharge from the hospital was higher, than that in group II (87±4.7%). Average duration of mechanical ventilation (10±7.3 vs. 15±7.8 hours), total exudation (65±34 vs. 88.8±39.9 hours), total duration of sympathomimetic support (71±27.5 vs. 108±75.5 hours) and its doses (4.8±2 vs. 6.5±3.8 μkg/kg/hour) were significantly lower in the group I, therefore, the patients of the group II stayed almost twice as long in the intensive care department (146±56 vs. 96±49.8 hours), although the total length of hospital stay did not differ significantly (25±3.8 vs. 26±12.3 days). An uncomplicated course of the early postoperative period was observed in 15 (46%) patients. Other 18 (54%) patients had complications: 8 patients (24%) of group I had 9 complications, and 10 patients (30%) of group II had 14 complications. The mean observation period was 48±29.8 months, (6 to 190 months). No deaths were observed during the observation period in 26 patients (79%) of both groups, 4 (12%) patients were lost to follow-up. Total cavоpulmonary anastomosis (Fontan procedure) was performed in 7 patients (58%) of the group II. Hemodynamic indicators in the examined 17 patients (81%) of the group I showed good long-term results that did not require other interventions. In 15% (3 of 20) of the patients of the group I, a high mean pressure in the right atrium of 14±1.8 mmHg attracts attention with dilatation of the inferior vena cava and hepatic veins, and 5 (20%) patients had high mean pressure of 16±2.7 mmHg in the superior vena cava. Transplantation-free survival during the observation period in patients of both groups was 100%.
 Conclusions. 1.5VR is a reasonable alternative to the palliative Fontan strategy in children in whom the anatomic or functional status of the RV is between biventricular reconstruction and the single ventricle pathway and shows good immediate and long-term results.

Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19

ObjectiveWe sought to determine the influence of venovenous extracorporeal membrane oxygenation (ECMO) on outcomes of mechanically ventilated patients with COVID-19 during the first 120 days after hospital discharge. MethodsFive academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 admitted during March through May 2020. Survivors had access to a multidisciplinary postintensive care recovery clinic. Physical, psychological, and cognitive deficits were measured using validated instruments and compared based on ECMO status. ResultsTwo hundred sixty two mechanically ventilated patients were compared with 46 patients cannulated for venovenous ECMO. Patients receiving ECMO were younger and traveled farther but there was no significant difference in gender, race, or body mass index. ECMO patients were mechanically ventilated for longer durations (median, 26 days [interquartile range, 19.5-41 days] vs 13 days [interquartile range, 7-20 days]) and were more likely to receive inhaled pulmonary vasodilators, neuromuscular blockade, investigational COVID-19 therapies, blood transfusions, and inotropes. Patients receiving ECMO experienced greater bleeding and clotting events (P < .01). However, survival at discharge was similar (69.6% vs 70.6%). Of the 217 survivors, 65.0% had documented follow-up within 120 days. Overall, 95.5% were residing at home, 25.7% had returned to work or usual activity, and 23.1% were still using supplemental oxygen; these rates did not differ significantly based on ECMO status. Rates of physical, psychological, and cognitive deficits were similar. ConclusionsOur data suggest that COVID-19 survivors experience significant physical, psychological, and cognitive deficits following intensive care unit admission. Despite a more complex critical illness course, longer average duration of mechanical ventilation, and longer average length of stay, patients treated with venovenous ECMO had similar survival at discharge and outcomes within 120 days of discharge.

IN-HOSPITAL MORTALITY IN MECHANICALLY VENTILATED PATIENTS WITH COVID-19 WITH DIFFERENT ARDS PHENOTYPES

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The purpose of the study is to investigate the in-hospital mortality of mechanically ventilated, COVID-19 (i.e., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) patients with high lung compliance (i.e., atypical acute respiratory distress syndrome (ARDS)) compared to those with low lung compliance (i.e., classic ARDS). METHODS: It is a retrospective cohort study of patients older than 18 years diagnosed with COVID-19 infection that required mechanical ventilation (MV) for at least 24 hours between January 20, 2020, and April 30, 2020. Atypical ARDS was defined as driving pressure is less than 15 cm H2O throughout the period of MV, suggesting compliant lung based on the currently available evidence (Amato, Marcelo BP, et al., 2015). If it was impossible to maintain driving pressure less than 15 cm H2O for more than two days, the case was defined as classic ARDS with low compliance. Patients who required mechanical ventilation not more than 24 hours or expired within 24 hours since intubated and those transferred to another hospital were excluded. Patients who received remdesivir were also excluded because 95% of the patients did not receive it during their index hospitalization. The outcome was adjusted by age, sex, days of onset to ICU, the severity of illness estimated by APACHE score, and severity of ARDS based on PaO2/FiO2 ratio. RESULTS: A total of 60 patients that required mechanical ventilation for COVID-19 induced ARDS during the study period were reviewed per inclusion and exclusion criteria. In-hospital mortality of 30 patients of the atypical ARDS group was 50% during the index hospitalization whereas it was 53 % for 30 patients of the classic ARDS group (p=0.80) when both were treated with the same ARDS protocol, including low tidal volume and higher PEEP. The average duration of mechanical ventilation, length of ICU and hospital stay was 10.23, 12.33, and 12.93 days for the atypical ARDS group, respectively, compared to 16.57, 18.33, and 19.33 for the classic ARDS group (p=0.003, 0.011, and 0.004, respectively). The classic ARDS group required prone positioning (67% vs. 37%;p=0.02) and use of paralytics (73% vs. 43%;p=0.018) more frequently compared to the atypical ARDS group. CONCLUSIONS: In this retrospective cohort study of 60 patients that required mechanical ventilation for COVID-19 induced ARDS between January 20, 2020, and April 30, 2020, in-hospital mortality was not significantly different between the atypical ARDS group and the classic ARDS group. However, the duration of mechanical ventilation, length of ICU and hospital stay was significantly shorter in the atypical ARDS group compared to the classic ARDS group. CLINICAL IMPLICATIONS: The difference in the duration of mechanical ventilation between the two groups may suggest a different pathophysiologic process and a need for a different approach to COVID-induced ARDS depending on lung compliance. DISCLOSURES: No relevant relationships by Mariam Charkviani, source=Web Response No relevant relationships by Chul Won Chung, source=Web Response No relevant relationships by Harvey Friedman, source=Web Response No relevant relationships by Jooseob Lee, source=Web Response No relevant relationships by Guillermo Rodriguez-Nava, source=Web Response No relevant relationships by Daniela Trelles Garcia, source=Web Response No relevant relationships by Maria Yanez-Bello, source=Web Response

P0096 / #565: THE TRAVAILS OF SETTING UP A LIVING DONOR LIVER TRANSPLANT PROGRAM: THE PICU PERSPECTIVES EXPERIENCE FROM TUNISIA

Aims & Objectives: To report our first experience of PICU care of living donor liver transplant (LDLT) in Tunisia, and the challenges encountered. Methods: This was a retrospective, descriptive study, collecting the first 10 pediatric LDLT at the Fattouma Bourguiba Hospital between November 2017 and March 2019. Results: The patients average age was 5 years and 11 months. The most common indication of LDLT was cirrhosis complicating PFIC. The average duration of mechanical ventilation was 1.8 days. One child developed hepatic artery thrombosis, another patient developed supra hepatic vein thrombosis. 2 patients developed acute rejection treated with immunosuppressant. The PICU length of stay ranged from 4 to 10 days and there was no ICU mortality. Challenges: - The Creation of liver transplant unit, - The Shortage of nursing staff was addressed by the participation of nurses from pediatric and adult ICU while awaiting the recruitment of more nurses, - The lack of experience of nurses in post- LT care necessitated to send few of them to Necker enfant malades to gain exposure to various aspects of LDLT, - The lack of Pediatric intensivist with expertise in LT was alleviated by the collaboration of pediatric intensivist from France. A daily staff by tele medicine guarantees the continuity of follow-up by the 2 teams. Conclusions: This study marks the successful development of a pediatric LT program in Tunisia. In the developing countries PICU care faces unique challenges in developing LDLT programs. Acknowledgements: We thank Christophe Chardot for his efforts and support in the inception of our transplant program

Advance Care Planning for Intensive Care Patients During the Perioperative Period: A Qualitative Study.

IntroductionPatients in intensive care units (ICUs) may transition into an end-of-life phase during treatment. Advance care planning (ACP) for this population has not been studied comprehensively, and support for its implementation is insufficient.ObjectiveThis study aims to clarify the ACP support needs among critical perioperative patients.MethodsIn this qualitative descriptive study, semistructured interviews were conducted with patients previously admitted to the ICU. The survey was conducted from September to November 2019. Participants comprised 13 individuals, who were admitted to the ICU for a period of 3 months to 2 years after surgery.ResultsThe average age of the participants was 63.8 years. The average mechanical ventilation duration following surgery was 24.5 h. The interviews focused on the ACP needs from the preoperative period to discharge. About 90% of the patients thought about the possibility of death before surgery and considered giving advance orders (e.g., “I don't want life-sustaining treatment”). The participants discussed inheritance, work-related matters, and household issues with their families but rarely spoke about treatment and care. Although they examined the content of the advance directives, the medical staff was not informed about them. Patients revealed that they wanted to understand the distinction between life-prolonging and life-saving treatments and discuss it with the medical staff, apart from being educated on ACP. Many patients previously admitted to the ICU are unclear about the difference between life-prolonging and life-saving treatments; this is also true for medical staff.ConclusionPatients who had been admitted to the ICU after high-risk surgery thought they needed help with ACP before surgery. Therefore, patients have the right to know about treatment risks; however, medical staff believes that this is difficult to communicate. Thus, medical staff should consider ways to communicate clearly with patients, including discussing the risks associated with surgery.

Prognostic risk factors for respiratory failure after esophagectomy.

BackgroundEsophagectomy is a high-risk surgical procedure with significant postoperative morbidity and mortality. Respiratory failure is one of the most common complications after esophageal cancer surgery. The purpose of this study was to explore risk factors that affect the recovery of respiratory failure in this kind of patients.MethodsTotally 2,360 patients underwent esophagectomies with cervical anastomosis or intrathoracic anastomosis in our center from January 2012 to December 2017. Among them, 130 patients with respiratory failure requiring mechanical ventilation were included in the study. The Spearman’s rank correlation test and Mann-Whitney U test were performed to identify the influential factors for the duration of mechanical ventilation.ResultsMost patients (81.5%) in this study recovered in the first two weeks of mechanical ventilation, the average duration of mechanical ventilation was 10.1 days. Statistical analysis indicated that lung function test parameters such as FEV1/FVC ratio and RV/TLC ratio could have significant influence on the duration of mechanical ventilation. The abnormally increased FEV1/FVC ratio and RV/TLC ratio could obviously prolong the ventilation duration. Old age, thrombocytopenia, the elevated creatinine, C-reactive protein (CRP) and lactate could also significantly lengthen the duration of mechanical ventilation.ConclusionsAbnormally increased FEV1/FVC ratio and RV/TLC ratio as well as old age, thrombocytopenia, elevated creatinine, CRP and blood lactate were found to be risk factors for the recovery of patients with respiratory failure after esophagectomies.

Obesity as a Predictor of Prolonged Mechanical Ventilation.

To examine the effect of including obesity with parameters of the I-TRACH scale in predicting the need for prolonged mechanical ventilation. A retrospective cohort study. Tertiary care academic medical center. Consecutive patients were identified retrospectively over a 45-month period based on need for mechanical ventilation in the medical intensive care unit. Chart review was performed to collect demographic information as well as clinical data, including duration of mechanical ventilation, body mass index (BMI), and I-TRACH parameters (heart rate >110, serum urea nitrogen >25, serum pH <7.25, serum creatinine >2, serum bicarbonate <20). Statistical analysis was performed to identify any predictors of prolonged mechanical ventilation, defined as ≥14 days and as ≥10 days. In total, 455 patients were identified, with an average duration of mechanical ventilation of 10.4 days (range, 0-248 days). On univariate and multivariate regression analysis, only BMI >30 reached statistical significance with respect to prolonged mechanical ventilation (P < .05). The I-TRACH parameters-either alone or in combination-were not significantly predictive. This study challenges previous findings regarding the I-TRACH scale and the relation of its parameters to prolonged mechanical ventilation. Furthermore, BMI >30 alone was predictive of prolonged intubation. Inclusion of BMI in predictive models could assist current decision making in determining the likelihood of prolonged mechanical ventilation in medical intensive care unit patients going forward, and obesity should be considered a predictor of prolonged mechanical ventilation.

Frequency of Ventilator Associated Pneumonias in Patients in the Intensive Care Unit.

Introduction:Ventilator associated pneumonia (VAP) is defined as nosocomial pneumonia in patients who have mechanical ventilation (MV) for more than 48 hours. The diagnosis of VAP is based on radiological-microbiological examinations. In the United States, the Centers for Disease Control and Prevention (CDC) and the National Health Care Network (NHSN) have an incidence of VAP of 5.8% per 1,000 days on mechanical ventilator.Aim:In this study, we had an aim to determine the occurrence of ventilator-associated pneumonia (VAP) in patients with MV who were hospitalized in the intensive care unit.Method:The study was retrospective, clinical, conducted in the period from January 1, 2016 until December 31, 2016. In a one-year period, 719 patients of both sex, aged 14 to 91, were hospitalized in the intensive care unit of the Clinic for Anesthesia and Resuscitation of the University Clinical Center in Sarajevo. The study included 250 patients of both sex who had respiratory support with mechanical ventilator. No patient was excluded from the study. As a confirmation of VAP, we used microbiological reports from the patient history documentation. The results were presented statistically through tables and graphs, numerically, by a percentage, and by a mean value with standard deviation.Results:Out of the 719 hospitalized patients, 250 or 34.8% underwent controlled ventilation. In 103 or 41.2% of patients some form of pneumonia was confirmed microbiologically. An average patient age on controlled ventilation was 60.4 ± 16.8 years. The mean age of a female patients who were on controlled ventilation was 63.2 ± 16.7, higher than that of male patients, which was 57.8 ± 16.6 years. The most frequent patients were over 60 years of age (52.8%). The shortest hospitalization of patients on controlled mechanical ventilation was 1 day and the longest was 120 days. Average duration of mechanical ventilation was 6.9 ± 10.5 days.Conclusion:VAP is a relatively common complication in patients with MV that can increase morbidity and mortality, as well as treatment costs. It is more frequent in females and in the elderly. Medical staff should provide normal maintenance of respiratory functions to a patient who is on MV, which will reduce the risk of VAP.

A preventive effect of early and comprehensive pulmonary rehabilitation on pneumonia associated with invasive mechanical ventilation

Objective To observe any effect of pulmonary rehabilitation in preventing ventilator-associated pneumonia (VAP) among patients receiving invasive mechanical ventilation (MV). Methods A total of 117 adults who had be receiving mechanical ventilation for at least 48 hours were randomly divided into an observation group and a control group. Both groups were given routine drug treatment and nursing, but the observation group also received comprehensive and individualized pulmonary rehabilitation interventions including airway clearance, respiration training, electrical stimulation of the sacral nerve, lung expansion and early mobilization. The main indicators were the incidence of VAP, mortality, MV duration, ICU stay time, and total hospital stay. Results At the end of the treatment the average clinical pulmonary infection score, the acute physiology and chronic health evaluation II score, SpO2 level and oxygenation index of the observation group were all significantly better than those of the control group. The incidence of VAP within one month after leaving the ICU was 47.5% in the observation group and the mortality rate was 44.1%, both significantly lower than in the control group. The average MV duration, total hospitalization time and the ICU stay of the observation group were also significantly shorter than those of the control group. Conclusion Early and comprehensive pulmonary rehabilitation can prevent VAP and shorten the length of hospital stays, ICU stays and time on a mechanical ventilator, improving patients′ survival chances and prognoses. Key words: Chest physiotherapy; Mechanical ventilation; Ventilator-associated pneumonia; Pneumonia

Perioperative monitoring characteristics of infants with severe Pierre Robin syndrome

Objective To study perioperative monitoring characteristics of severe Pierre Robin syndrome in children. Methods The clinical data of 48 infants with Pierre Robin syndrome admitted to the department of surgical intensive care unit from March 2013 to January 2015 were retrospectively reviewed. Results All 48 cases were cured and discharged without death.The average duration of mechanical ventilation after the operation was(2.76±3.58)days.There were significant differences in blood gas analysis before and after treatment in surgical intensive care unit(pH: 7.33±0.07 vs. 7.44±0.08, PaCO2: (49.12±15.63)mmHg vs.(36.19±8.13) mmHg, PaO2: (74.28±17.09) vs.(114.00±53.55) mmHg)(P<0.05, respectively). The levels of prealbumin and retinol binding protein increased significantly after treatment[prealbumin: (0.10±0.04)g/L vs.(0.14±0.05) g/L, retinol binding protein: (19.85±9.76)mg/L vs.(25.15±8.72)m g/L](P<0.05, respectively). Conclusion Reasonable mechanical ventilation combined with available nourishments support could help to improve the prognosis of severe Pierre Robin syndrome. Key words: Pierre-Robin syndrome; Perioprative; Respirary; Nutrition

Oropharyngeal Decontamination with Antiseptics to Prevent Ventilator-Associated Pneumonia: Rethinking the Benefits of Chlorhexidine.

Daily oral care with chlorhexidine for mechanically ventilated patients is ubiquitous in contemporary intensive care practice. The practice is predicated upon meta-analyses suggesting that adding chlorhexidine to daily oral care regimens can reduce ventilator-associated pneumonia (VAP) rates by up to 40%. Close analysis, however, raises three concerns: (1) the meta-analyses are dominated by studies in cardiac surgery patients in whom average duration of mechanical ventilation is < 1 day and thus their risk of VAP is very different from other populations, (2) diagnosing VAP is subjective and nonspecific yet the meta-analyses gave equal weight to blinded and nonblinded studies, potentially biasing them in favor of chlorhexidine, and (3) there is circularity between diagnostic criteria for VAP and chlorhexidine; as an antiseptic, chlorhexidine may decrease the frequency of positive respiratory cultures but fewer cultures does not necessarily mean fewer pneumonias. It is therefore important to look at other outcomes for corollary evidence on whether or not oral chlorhexidine benefits patients. An updated meta-analysis restricted to double-blinded studies in noncardiac surgery patients showed no impact on VAP rates, duration of mechanical ventilation, or intensive care unit length of stay. Instead, there was a possible signal that oral chlorhexidine may increase mortality rates. Observational data have raised similar concerns. This article will review the theoretical basis for adding chlorhexidine to oral care regimens, delineate potential biases in randomized controlled trials comparing oral care regimens with and without chlorhexidine, explore the unexpected mortality signal associated with oral chlorhexidine, and provide practical recommendations.

Mechanical Ventilation in the Intensive Care Unit: A Prospective Study of Indications and Factors that Affect Outcome in a Tertiary Hospital in Nigeria

The need for ventilatory support is one of the commonest indications for admission into the intensive care unit (ICU). Despite the usefulness of mechanical ventilation, its damaging effect on the lungs has also been widely recognized. The study was a prospective, case-controlled survey of all mechanically ventilated patients admitted in our ICU from November 2013 to April 2014. For every ventilated patient, a non-ventilated similar patient served as a control. A total of 128 patients were admitted into the ICU over the six month period and 44 patients constituting 34.4% were mechanically ventilated. The average duration of mechanical ventilation was 12.30 ± 10.10 days. Duration of mechanical ventilation, use of arterial blood gas measurement and ionotropic support had significant effect on weaning from ventilation with p values of 0.005, 0.05 and 4 times chance of death than non-ventilated patients. Mechanical ventilation though a useful therapeutic intervention in the ICU is associated with increased mortality. Duration of ventilation, use of arterial blood gas (ABG) and need for ionotropic support influenced successful weaning off ventilator. It may be expedient therefore to weigh the risk: benefit assessment of mechanical ventilation before commencement in the ICU.

Abstract PR118

Background & Objectives: The need for ventilatory support is one of the commonest indications for admission into the intensive care unit (ICU). Despite the usefulness of mechanical ventilation, its damaging effect on the lungs has also been widely recognized in the literature. Materials & Methods: The study was a prospective, case-control survey of all mechanically ventilated patients admitted in our ICU from November 2013 to April 2014. For every ventilated patient, a non-ventilated similar patient served as a control. Results: A total of 128 patients were admitted into the ICU over the six month period and 44 patients constituting 34.4% were mechanically ventilated. The average duration of mechanical ventilation was 12.30±10.10 days. Duration of mechanical ventilation, use arterial of arterial blood gas measurement and ionotropic support had significant effect on weaning from ventilation with p values of 0.005, 0.05 and <0.001 respectively. Mechanically ventilated patients had >4 times chance of death than non-ventilated patients. Conclusion: A total of 128 patients were admitted into the ICU over the six month period and 44 patients constituting 34.4% were mechanically ventilated. The average duration of mechanical ventilation was 12.30±10.10 days. Duration of mechanical ventilation, use arterial of arterial blood gas measurement and ionotropic support had significant effect on weaning from ventilation with p values of 0.005, 0.05 and <0.001 respectively. Mechanically ventilated patients had >4 times chance of death than non-ventilated patients.

Pediatric Burns: A Single Institution Retrospective Review of Incidence, Etiology, and Outcomes in 2273 Burn Patients (1995-2013).

Unintentional burn injury is the third most common cause of death in the U.S. for children age 5 to 9, and accounts for major morbidity in the pediatric population. Pediatric burn admission data from U.S. institutions has not been reported recently. This study assesses all pediatric burn admissions to a State wide Certified Burn Treatment Center to evaluate trends in demographics, burn incidence, and cause across different age groups. Demographic and clinical data were collected on 2273 pediatric burn patients during an 18-year period (1995-2013). Pediatric patients were stratified by age into "age 0 to 6," "age 7 to 12," and "age 13 to 18." Data were obtained from National Trauma Registry of the American College of Surgeons and analyzed using standard statistical methodology. A total of 2273 burn patients under age 18 were treated between 1995 and 2013. A total of 1663 (73.2%) patients were ages 0 to 6, 294 (12.9%) were 7 to 12, and 316 (13.9%) were age 13 to 18. A total of 1400 (61.6%) were male and 873 (38.4%) were female (male:female ratio of 1.6:1). Caucasians had the highest burn incidence across all age groups (40.9%), followed by African-Americans (33.6%), P < .001. Caucasian teenagers formed 62.1% of patients age 13-18, P < .001. A total of 66.3% of all pediatric burns occurred at home, P < .001. Mean TBSA burned was 8.9%, with lower extremity being the most common site (38.5%). Scald burns constituted the majority of cases (71.1%, n = 1617), with 53% attributable to hot liquids related to cooking, including coffee or tea, P < .001. In the teenage group, flame burns were the dominant cause (53.8%). Overall mean length of stay was 10.5 ± 10.8 days for all patients, and15.5 ± 12 for those admitted to the intensive care unit, P < .005. One hundred (4.4%) patients required ventilator support (P = .02), and average duration of mechanical ventilation was 11.9 ± 14.5 days. Skin grafting was performed for 520 (22.9%) patients, P < .001. Overall mortality was 0.9% (n = 20), with mean TBSA involved of 61.5%. The majority of pediatric burn injuries are scald burns that occur at home and primarily affect the lower extremities in Caucasian and African-American males. Among Caucasian teenagers flame burns predominate. Mean length of stay was 10 days, 23% of patients required skin grafting surgery, and mortality was 0.9%. The results of this study highlight the need for primary prevention programs focusing on avoiding home scald injuries in the very young, as well as fire safety training for teenagers.

Characteristics and progression of children with acute viral bronchiolitis subjected to mechanical ventilation.

ObjectiveTo analyze the characteristics of children with acute viral bronchiolitis subjected to mechanical ventilation for three consecutive years and to correlate their progression with mechanical ventilation parameters and fluid balance.MethodsLongitudinal study of a series of infants (< one year old) subjected to mechanical ventilation for acute viral bronchitis from January 2012 to September 2014 in the pediatric intensive care unit. The children's clinical records were reviewed, and their anthropometric data, mechanical ventilation parameters, fluid balance, clinical progression, and major complications were recorded.ResultsSixty-six infants (3.0 ± 2.0 months old and with an average weight of 4.7 ± 1.4kg) were included, of whom 62% were boys; a virus was identified in 86%. The average duration of mechanical ventilation was 6.5 ± 2.9 days, and the average length of stay in the pediatric intensive care unit was 9.1 ± 3.5 days; the mortality rate was 1.5% (1/66). The peak inspiratory pressure remained at 30cmH2O during the first four days of mechanical ventilation and then decreased before extubation (25 cmH2O; p < 0.05). Pneumothorax occurred in 10% of the sample and extubation failure in 9%, which was due to upper airway obstruction in half of the cases. The cumulative fluid balance on mechanical ventilation day four was 402 ± 254mL, which corresponds to an increase of 9.0 ± 5.9% in body weight. Thirty-seven patients (56%) exhibited a weight gain of 10% or more, which was not significantly associated with the ventilation parameters on mechanical ventilation day four, extubation failure, duration of mechanical ventilation or length of stay in the pediatric intensive care unit.ConclusionThe rate of mechanical ventilation for acute viral bronchiolitis remains constant, being associated with low mortality, few adverse effects, and positive cumulative fluid balance during the first days. Better fluid control might reduce the duration of mechanical ventilation.

Clinical report of serious complications associated with measles pneumonia in children hospitalized at Shengjing hospital, China.

Despite tremendous progress made toward elimination, measles continues to pose a great threat to the health of children in developing countries. The objective of this study was to summarize and analyze the clinical characteristics and treatment experience of serious complications of measles pneumonia in children. The study group comprised 58 infants with severe measles pneumonia who were admitted to the Second Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, from December 2013 through May 2014. The clinical characteristics of complications such as hypoxemia, acute respiratory distress syndrome (ARDS), sepsis, pneumothorax, multiple organ dysfunction syndrome (MODS), and intracranial infection were retrospectively analyzed; in addition, the death cases were summarized and analyzed. The 58 infants experienced the following: hypoxemia, 100%; ARDS, 21%; sepsis, 34%; pneumothorax, 14%; MODS, 16%; and intracranial infection, 9%. A total of 7 infants developed a secondary bacterial infection, and 12 infants received mechanical ventilation (5 with high-frequency mechanical ventilation and 3 with mechanical ventilation and NO inhalation); the average duration of mechanical ventilation was 10.08 days, and 3 infants expired. Children with measles pneumonia may experience multiple serious complications, among which ARDS and pneumothorax are particularly serious. If a patient's condition changes abruptly, it is crucial to promptly respond to the change and to administer mechanical ventilation and appropriate antibiotics. For patients with a severe pneumothorax, and especially those with severe mediastinal emphysema, timely, continuous, retrosternal, closed thoracic drainage can effectively relieve compression.

Tracheostomy in pediatric critically ill patients.

The indications for and timing of tracheostomy in children have changed significantly over recent years, and no consensus has been gathered in that regard. The purpose of this study is to present a series of critically ill patients who required a tracheostomy. All critically ill patients required a tracheostomy between 1 June 2009 and 31 March 2012. It is a retrospective, observational, descriptive study. A total of 18 patients underwent tracheostomy during the period under study. The most common indication was neuromuscular compromise. The average duration of mechanical ventilation before placement of a tracheostomy was 23.8 days (0-58 days). The complications observed were minor, and no patients died from tracheostomy-related causes. All parents were trained in airway management and cardiopulmonary resuscitation. There were no serious tracheostomy-related complications in critically ill pediatric patients. The procedure was effective in the management of patients with respiratory failure, patients with neuromuscular compromise and children with upper airway obstruction.

Right timing of mechanical ventilation in patients with bronchial asthma in emergency room

Objective To explore the right timing of mechanical ventilation in patients with bronchial asthma in emergency room. Methods A total of 67 patients with bronchial asthma undergoing mechanical ventilation were admitted into our Emergency Intensive Care Unit (EICU) from January 2010 to December 2012. According to PaCO2 before intubation, they were divided into 3 groups of low levels of PaCO2[PaCO2≤35 mmHg (1 mmHg=0.133 kPa)](n=19), normal PaCO2 (35 mmHg<PaCO2<45 mmHg)(n=21)and high PaCO2 (PaCO2 ≥45 mmHg)(n=27). Their clinical data were retrospectively analyzed. Results The in-hospital mortality of three groups were 5.3%(1/19), 9.5%(2/21) and 14.8%(4/27) and the difference was not statistically significant (χ2=1.16, P>0.05). However the average duration of mechanical ventilation of three groups were (5.6±1.7), (8.3±2.1) and (13.5±3.6) days and the difference was statistically significant (F=3.36, P=0.042). The average ICU treatment time was (7.4±2.1), (11.5±3.3) and (16.4±3.5) days and the difference was statistically significant (F=3.23, P=0.047). PaCO2 levels before intubation was positively correlated with the duration of mechanical ventilation and the ICU treatment time (r2=0.366, 0.316, P=0.031, 0.029). Conclusion The patients with bronchial asthma undergoing intubation in right time in emergency room will affect the duration of mechanical ventilation and ICU treatment time. Key words: Bronchial asthma; Mechanical ventilation; Prognosis