Lakshmi, S (2015) Epidemiology and clinical profile of children managed with CPAP and mechanical ventilation in a tertiary care hospital. Masters thesis, Chengalpattu Medical College, Chengalpattu.
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Abstract
Majority of critically ill children require either invasive or non-invasive ventilation. The clinical profile and management of children with such respiratory support in developing countries with limited resources is entirely different. In our study we have observed that flow inflating device- Jackson- Rees/Bain circuit can effectively provide CPAP –continuous positive airway pressure in an indigenous way, in settings without NIV machines. We have also studied the profile and outcome of children managed with invasive ventilation. Methods: An observational study was undertaken in the Paediatric intensive care unit of Chengalpattu medical college hospital, during a one year period from November 2013-September 2013. All children who required CPAP/ invasive ventilation in the age group 1 month -12 years of both sexes were included. The demographic profile, symptomatology, clinical assessment of the children were recorded. They were started on CPAP through flow inflating device / mechanical ventilation based on clinical assessment, and the duration and outcome were recorded. Results: We studied 325 children, of which 69.2% were managed with direct invasive ventilation. CPAP alone was successful in 89.7% of cases and the most successful clinical condition with CPAP was bronchiolitis accounting to 93.7%.CPAP failure was noted in 10.3% of cases, and the major risk factor observed was pneumonia with septic shock. The major complications with invasive ventilation were upper lobe atelectasis and ventilator associated pneumonia (VAP). Comorbidity predisposed to direct invasive ventilation and increased mortality. The mortality in our study population was 14.8%. Conclusion: This study highlights that flow inflating device can effectively provide CPAP in an indigenous way in public sector settings without access to conventional NIV machines. The profile and outcome of children on invasive ventilation were analysed. Children in such settings, can be successfully managed with a background of good clinical skills and vigilant monitoring of clinical parameters.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Jackson-Rees circuit; Bain Circuit; CPAP; Bronchiolitis; Atelectasis |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Punitha K |
| Date Deposited: | 23 Feb 2018 09:30 |
| Last Modified: | 23 Feb 2018 09:30 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5868 |
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