Mullai Baalaaji, A R (2011) Profile of Children Ventilated in Paediatric Intensive Care Unit of a Tertiary Care Hospital. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Ventilatory support is an essential and a common form of therapy in Pediatric Critical Care Unit. In recent years, this modality has evolved into a highly specialized discipline (1). The term mechanical ventilation refers to various artificial means used to support ventilation and oxygenation (2). Natural spontaneous ventilation occurs when the respiratory muscles (diaphragm, intercostal muscles) create negative intrathoracic pressure, in part by expanding the rib cage, leading to lung expansion, which pulls air into the alveoli and allows gas exchange to occur. In contrast, ventilation is achieved in intubated patients by delivering compressed gas to the lungs by positive pressure ventilation. During positive pressure ventilation, the flow of gas during inspiration and expiration is driven by the airway pressure gradient between the airway opening and the alveoli. During inspiration, the airway opening pressure is greater than alveolar pressure, thereby driving gas into the lungs and inflating them. Expiration is usually passive and occurs because, at the end of inspiration, alveolar pressure becomes greater than airway pressure. AIM OF THE STUDY: To study the etiological and clinical profile of children ventilated in PICU and various complications and outcome of these children. DISCUSSION: This descriptive observational study was conducted to study the demographic, clinical profile of children who were ventilated at the PICU, and their complications and outcome. The commonest indication for intubation and artificial ventilation was circulatory dysfunction including shock, unlike other studies,where neurological indications predominated in the study by Kendirli et al and respiratory causes were the commonest causes for artificial ventilation in the study by Indrajit et al. Intubation was performed orotracheally in 97.9% of children and nasotracheally in 2.1% in present study compared to no nasotracheal intubation performed in the study by Da Silva et al. Rapid Sequence intubation(RSI) was performed in 54.8% of the study population compared to routine RSI protocol used in the study by Da Silva et al. Though mechanical ventilation is the standard of care, our hospital being a Government hospital and a tertiary referral centre, many critically ill children with need for ventilation are being referred to here, which could not be met by the available resources in PICU and hence, many children needed manual ventilation. Out of the 106 children who were manually ventilated, 45 (42.5%) survived. Another 75 children required manual ventilation for varying duration in addition to mechanical ventilation, and the survival was 52.1% in that subgroup. None of the studies in available literature have data on manual ventilation. The mean duration of artificial ventilation in the study was 3.56±5.2 days. The duration of mechanical ventilation in the study was 4.6±5.9 days. A total of 181 children (96.3%) were ventilated manually during their PICU stay, and among them, 75 children were ventilated mechanically after variable duration of manual ventilation. In comparison, the ventilation days were 18.8±14.1 days in the study by Kendirli et al and the median ventilation days were 6.5 days in the study by Da Silva et al. SUMMARY AND CONCLUSIONS: 1. Infants contributed 46.3% of children who were ventilated in the Pediatric Intensive Care Unit. 2. The sex ratio was almost equal with slight male preponderance. Male:Female = 1.09:1.0 3. The commonest cause for intubation was circulatory failure and the commonest clinical diagnosis was septic shock. 4. Of the children who were ventilated in the PICU, 76.6% were intubated at the Emergency Department. 5. Rapid Sequence Intubation was performed in 54.8% of children, and orotracheal route was the commonest route of intubation. • Many children (56.4%) were manually ventilated and it was associated with an increased risk of mortality especially when done for 48 hours or more. 6. Nosocomial pneumonia was the commonest complication encountered in ventilated children and was more common in those who were reintubated. 7. Mortality and complications in ventilated children in the PICU can be reduced with increased availability of mechanical ventilators.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Profile ; Children Ventilated ; Paediatric Intensive Care Unit ; Tertiary Care Hospital |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 13 Apr 2018 10:56 |
| Last Modified: | 13 Apr 2018 10:56 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6991 |
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