Aims To describe the characteristics of children resident in England and Wales admitted to a paediatric intensive care unit (PICU) who required prolonged invasive ventilation over the last decade and to compare their demographic and clinical characteristics to those who required a shorter period of invasive ventilation.
Methods Clinical and demographic information on all children resident in England and Wales admitted to a PICU were analysed. Prolonged invasive ventilation (PIV) was defined as receiving invasive ventilation for more than 21 days during a single admission via endeotracheal tube or tracheostomy including jet or oscillatory ventilation. The cut-off of 21 days was chosen as it has been previously used in adult studies of prolonged ventilation during intensive care stay.
Results 99,818 of 147,709 admissions (67.6%) received invasive ventilation; of these 2,980 (3.0%) required PIV. As a percentage of all invasive ventilation, PIV has increased slightly over the previous decade from 3.1% in 2004 to 3.4% in 2013. PIV was most common in the under 1s (3.6%) and was similar in males (2.9%) and females (3.0%) (chi-squared p = 0.35). Children receiving PIV account for over a quarter (26.5%) of all invasive ventilation bed days, median length of ventilation was 32 days (IQR: 26–48 days) and median length of stay was 37 days (IQR: 28–57) in those receiving PIV. Overall, those receiving PIV had a higher Paediatric Index of Mortality (PIM) score on admission (4.1% vs. 2.5% with a score >30%, chi-squared p < 0.01) and an increased in-unit crude mortality (23.6% vs. 5.6%, chi-squared p < 0.01). Multivariate logistic regression will be applied to examine whether the effect of demographic characteristics has changed over time.
Conclusion Children receiving PIV are only a small percentage of all admissions requiring invasive ventilation but account for over a quarter of all invasive ventilation bed days. A higher percentage of under 1s who receive invasive ventilation require PIV and it is associated with a higher in-unit mortality overall.
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