title: Mechanical ventilation in pediatric intensive care units during the season for acute lower respiratory infection: a multicenter study.
abstract: OBJECTIVE
  To describe the characteristics and outcomes of mechanical ventilation in pediatric intensive care units during the season of acute lower respiratory infections.
  
  
  METHODS
  Prospective cohort of infants and children receiving mechanical ventilation for at least 12 hrs.
  
  
  METHODS
  Sixty medical-surgical pediatric intensive care units.
  
  
  METHODS
  All consecutive patients admitted to participating pediatric intensive care units during a 28-day period.
  
  
  RESULTS
  Of 2,156 patients admitted to pediatric intensive care units, 1185 (55%) received mechanical ventilation for a median of 5 days (interquartile range 2-8). Median age was 7 months (interquartile range 2-25). Main indications for mechanical ventilation were acute respiratory failure in 78% of the patients, altered mental status in 15%, and acute on chronic pulmonary disease in 6%. Median length of stay in the pediatric intensive care units was 10 days (interquartile range 6-18). Overall mortality rate in pediatric intensive care units was 13% (95% confidence interval: 11-15) for the entire population, and 39% (95% confidence interval: 23 - 58) in patients with acute respiratory distress syndrome. Of 1150 attempts at liberation from mechanical ventilation, 62% (95% confidence interval: 60-65) used the spontaneous breathing trial, and 37% (95% confidence interval: 35-40) used gradual reduction of ventilatory support. Noninvasive mechanical ventilation was used initially in 173 patients (15%, 95% confidence interval: 13-17).
  
  
  CONCLUSIONS
  In the season of acute lower respiratory infections, one of every two children admitted to pediatric intensive care units requires mechanical ventilation. Acute respiratory failure was the most common reason for mechanical ventilation. The spontaneous breathing trial was the most commonly used method for liberation from mechanical ventilation.
authors: Hospital de Niños R Gutiérrez, CABA, Argentina. jufarias@intramed.net.ar
authors: Julio A
authors: JA
authors: Farias
authors: Analía
authors: A
authors: Fernández
authors: Ezequiel
authors: E
authors: Monteverde
authors: Juan C
authors: JC
authors: Flores
authors: Arístides
authors: A
authors: Baltodano
authors: Amanda
authors: A
authors: Menchaca
authors: Rossana
authors: R
authors: Poterala
authors: Flavia
authors: F
authors: Pánico
authors: María
authors: M
authors: Johnson
authors: Bettina
authors: B
authors: von Dessauer
authors: Alejandro
authors: A
authors: Donoso
authors: Inés
authors: I
authors: Zavala
authors: Cesar
authors: C
authors: Zavala
authors: Eduardo
authors: E
authors: Troster
authors: Yolanda
authors: Y
authors: Peña
authors: Carlos
authors: C
authors: Flamenco
authors: Helena
authors: H
authors: Almeida
authors: Vidal
authors: V
authors: Nilda
authors: Andrés
authors: A
authors: Esteban
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007843:Latin America / Q000453:epidemiology; D008297:Male; D011174:Portugal / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000401:mortality / Q000628:therapy*; D012621:Seasons; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome