title: Characterization of pediatric patients receiving prolonged mechanical ventilation.
abstract: OBJECTIVE
  To describe the characteristics and risk factors of pediatric patients who receive prolonged mechanical ventilation, defined as ventilatory support for >21 days.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Four medical-surgical pediatric intensive care units in four university-affiliated hospitals in Argentina.
  
  
  METHODS
  All consecutive patients from 1 month to 15 yrs old admitted to participating pediatric intensive care units from June 1, 2007, to August 31, 2007, who received mechanical ventilation (invasive or noninvasive) for >12 hrs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Demographic and physiologic data on admission to the pediatric intensive care units, drugs and events during the study period, and outcomes were prospectively recorded. A total of 256 patients were included. Of these, 23 (9%) required mechanical ventilation for >21 days and were assigned to the prolonged mechanical ventilation group. Patients requiring prolonged mechanical ventilation had higher mortality (43% vs. 21%, p < .05) and longer pediatric intensive care unit stay: 35 days [28-64 days] vs. 10 days [6-14]). There was no difference between the groups in age and gender distribution, reasons for admission, incidence of immunodeficiencies, or Paediatric Index of Mortality 2 score. The only difference at admission was a higher rate of genetic diseases in prolonged mechanical ventilation patients (26% vs. 9%, p < .05). There was a higher incidence of septic shock (87% vs. 34%, p < .01), acute respiratory distress syndrome (43% vs. 20%, p < .01), and ventilator-associated pneumonia (35% vs. 8%, p < .01) and higher utilization of dopamine (78% vs. 42%, p < .01), norepinephrine (61% vs. 15%, p < .01), multiple antibiotics (83% vs. 20%, p < .01), and blood transfusions (52% vs. 14%, p < .01). The proportion of extubation failure was higher in the prolonged mechanical ventilation group with similar rates of unplanned extubations in both groups. Variables remaining significantly associated with prolonged mechanical ventilation after multivariate analysis were treatment with multiple antibiotics, septic shock, ventilator-associated pneumonia, and use of norepinephrine.
  
  
  CONCLUSIONS
  Patients with prolonged mechanical ventilation have more complications and require more pediatric intensive care unit resources. Mortality in these patients duplicates that from those requiring shorter support.
authors.affiliation: Unidad de Cuidados Intensivos, Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Monteverde
authors.forename: Analía
authors.initials: A
authors.lastname: Fernández
authors.forename: Rossana
authors.initials: R
authors.lastname: Poterala
authors.forename: Nilda
authors.initials: N
authors.lastname: Vidal
authors.forename: Alejandro
authors.initials: A
authors.lastname: Siaba Serrate
authors.forename: Pablo
authors.initials: P
authors.lastname: Castelani
authors.forename: Lidia
authors.initials: L
authors.lastname: Albano
authors.forename: Fernanda
authors.initials: F
authors.lastname: Podestá
authors.forename: Julio A
authors.initials: JA
authors.lastname: Farias
mesh_terms: D000293:Adolescent; D001118:Argentina; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D010361:Patients; D053717:Pneumonia, Ventilator-Associated; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012772:Shock, Septic; D013503:Surgery Department, Hospital; D013997:Time Factors