@article {1767, title = {Daily practice of mechanical ventilation in Italian pediatric intensive care units: a prospective survey.}, journal = {Pediatr Crit Care Med}, volume = {12}, year = {2011}, month = {2011 Mar}, pages = {141-6}, abstract = {

OBJECTIVES: To assess how children requiring endotracheal intubation are mechanically ventilated in Italian pediatric intensive care units (PICUs).

DESIGN: A prospective, national, observational, multicenter, 6-month study.

SETTING: Eighteen medical-surgical PICUs.

PATIENTS: A total of 1943 consecutive children, aged 0-16 yrs, admitted between November 1, 2006 and April 30, 2007.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Data on cause of respiratory failure, length of mechanical ventilation (MV), mode of ventilation, use of specific interventions were recorded for all children requiring endotracheal intubation for >24 hrs. Children were stratified for age, type of patient, and cause of respiratory failure. A total of 956 (49.2\%) patients required MV via an endotracheal tube; 673 (34.6\%) were ventilated for >24 hrs. The median length of MV was 4.5 days for all patients. If postoperative patients were excluded, the median time was 5 days. Bronchiolitis (6.7\%), pneumonia (6.7\%), and upper airway obstruction (5.3\%) were the most frequent causes of acute respiratory failure, and altered mental status (9.2\%) was the most frequent reason for MV. The overall mortality was 6.7\% with highest rates for heart disease (nonoperative), sepsis, and acute respiratory distress syndrome (26.1\%, 22.2\%, and 16.7\% respectively). Length of stay, associated chronic disease, severity score on admission, and PICU mortality were significantly higher in children who received MV (p < .05) than in children who did not. Controlled MV and pressure support ventilation + synchronized intermittent mandatory ventilation were the most frequently used modes of ventilatory assistance during PICU stay.

CONCLUSIONS: Mechanical ventilation is frequently used in Italian PICUs with almost one child of two requiring endotracheal intubation. Children treated with MV represent a more severe category of patients than children who are breathing spontaneously. Describing the standard care and how MV is performed in children can be useful for future clinical studies.

}, keywords = {Adolescent, Child, Child, Preschool, Clinical Protocols, Female, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Intubation, Intratracheal, Italy, Male, Prospective Studies, Respiration, Artificial, Respiratory Insufficiency}, issn = {1529-7535}, doi = {10.1097/PCC.0b013e3181dbaeb3}, author = {Wolfler, Andrea and Calderoni, Edoardo and Ottonello, Giancarlo and Conti, Giorgio and Baroncini, Simonetta and Santuz, Pierantonio and Vitale, Pasquale and Salvo, Ida} }