title: Risk factors associated with increased length of mechanical ventilation in children.
abstract: BACKGROUND
  Invasive mechanical ventilation, if prolonged, may lead to high morbidity and mortality.
  
  
  OBJECTIVE
  To determine the incidence rate and early risk factors for prolonged acute invasive mechanical ventilation in children.
  
  
  METHODS
  Retrospective longitudinal cohort study over a 1-yr period.
  
  
  METHODS
  All consecutive episodes of invasive mechanical ventilation in the pediatric intensive care units of Sainte-Justine Hospital (Montreal, Canada) were included. Risk factors for long (≥96 hrs) vs. short (<96 hrs) duration of ventilation were determined by logistic regression.
  
  
  METHODS
  None.
  
  
  RESULTS
  Among the 360 episodes of invasive ventilation, 36% had a length of ≥96 hrs. Following multivariate analysis, significant risk factors for prolonged acute invasive mechanical ventilation were age of <12 months (odds ratio 3.27, 95% confidence interval 1.90-5.63), Pediatric Risk of Mortality score of ≥15 at admission (odds ratio 3.41, 95% confidence interval 1.31-8.89), mean airway pressure of ≥13 cm H(2)O on day 1 (odds ratio 5.92, 95% confidence interval 3.08-11.36), use of continuous intravenous sedation on day 1 (odds ratio 1.75, 95% confidence interval 1.00-3.05), and use of noninvasive ventilation before intubation (odds ratio 6.56, 95% confidence interval 1.99-21.63).
  
  
  CONCLUSIONS
  Among the risk factors identified, the use of noninvasive ventilation and continuous intravenous sedation on the first day of ventilation are the only two interventions that were associated with prolonged acute invasive mechanical ventilation. Further research is needed to study the impact of sedation protocols on the duration of mechanical ventilation in children.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada.
authors.forename: Valérie
authors.initials: V
authors.lastname: Payen
authors.forename: Philippe
authors.initials: P
authors.lastname: Jouvet
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
authors.forename: Thierry
authors.initials: T
authors.lastname: Ducruet
authors.forename: France
authors.initials: F
authors.lastname: Gauvin
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008137:Longitudinal Studies; D008297:Male; D012121:Respiration, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors