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G372 Prolonged invasive ventilation in paediatric intensive care: children resident in england and wales, 2004–2013
  1. SJ Fleming1,
  2. CR Lamming2,
  3. A Evans2,
  4. KP Morris3,
  5. ES Draper2,
  6. RC Parslow1
  1. 1School of Medicine, University of Leeds, Leeds, UK
  2. 2Department of Health Sciences, University of Leicester, Leicester, UK
  3. 3Birmingham Children’s Hospital, Birmingham, UK

Abstract

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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