Incidence, outcome, and prognostic factors of prolonged mechanical ventilation among children in Chinese mainland: a multi-center survey

作者全名：Zhang, Zhengzheng; Cai, Xiaodi; Ming, Meixiu; Huang, Li; Liu, Chengjun; Ren, Hong; Qu, Dong; Gao, Hengmiao; Cheng, Yibing; Zhang, Furong; Yang, Zihao; Xu, Wei; Miao, Hongjun; Liu, Pan; Liu, Yuxin; Lu, Guoping; Chen, Weiming

作者地址：[Zhang, Zhengzheng; Cai, Xiaodi; Ming, Meixiu; Liu, Pan; Liu, Yuxin; Lu, Guoping; Chen, Weiming] Fudan Univ, Childrens Hosp, Natl Childrens Med Ctr, Pediat Intens Care Unit, Shanghai, Peoples R China; [Huang, Li] Guangzhou Women & Childrens Med Ctr, Natl Childrens Med Ctr South Cent Reg, Dept Pediat Intens Care Unit, Guangzhou, Peoples R China; [Liu, Chengjun] Chongqing Med Univ, Childrens Hosp, Dept Pediat Intens Care Unit, Western Pediat Dev Union, Chongqing, Peoples R China; [Ren, Hong] Shanghai Jiao Tong Univ, Natl Childrens Med Ctr, Shanghai Childrens Med Ctr, Sch Med,Dept Pediat Intens Care Unit, Shanghai, Peoples R China; [Qu, Dong] Capital Inst Pediat, Childrens Hosp, Dept Pediat Intens Care Unit, Beijing, Peoples R China; [Gao, Hengmiao] Capital Med Univ, Beijing Childrens Hosp, Natl Ctr Childrens Hlth, Dept Pediat Intens Care Unit, Beijing, Peoples R China; [Cheng, Yibing] Zhengzhou Univ, Childrens Hosp, Dept Pediat Intens Care Unit, Zhengzhou, Peoples R China; [Zhang, Furong] Huazhong Univ Sci & Technol, Wuhan Childrens Hosp, Tongji Med Coll, Dept Pediat Intens Care Unit, Wuhan, Hubei, Peoples R China; [Yang, Zihao] Zhejiang Univ, Childrens Hosp, Natl Clin Res Ctr Child Hlth, Sch Med,Dept Pediat Intens Care Unit, Hangzhou, Zhejiang, Peoples R China; [Xu, Wei] China Med Univ, Shengjing Hosp, Natl Childrens Northeast Reg Med Ctr, Dept Pediat Intens Care Unit, Shenyang, Peoples R China; [Miao, Hongjun] Nanjing Med Univ, Childrens Hosp, Dept Emergency Crit Med, Nanjing, Jiangsu, Peoples R China

通信作者：Lu, GP; Chen, WM (通讯作者)，Fudan Univ, Childrens Hosp, Natl Childrens Med Ctr, Pediat Intens Care Unit, Shanghai, Peoples R China.

来源：FRONTIERS IN PEDIATRICS

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001249471300001

JCR分区：Q2

影响因子：2.1

年份：2024

卷号：12

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：prolonged mechanical ventilation; prognostic factors; pediatric intensive care unit; critical care; chronic respiratory failure

摘要：Objective: To evaluate the incidence, outcome, and prognostic factors of prolonged mechanical ventilation (PMV) in children in Mainland China. Methods: A prospective study was conducted in 11 pediatric intensive care units (PICUs) from May 1, 2021, to April 30, 2022. All pediatric patients on mechanical ventilation meeting the criteria for PMV were included in the study. Results: Out of 5,292 patients receiving mechanical ventilation, 278 children met the criteria for PMV (5.3%). After excluding case with incomplete data or lost to follow-up, the study included 250 patients. Among them, 115 were successfully weaned from mechanical ventilation, 90 died, and 45 were still on mechanical ventilation. The 6-month survival rate was 64%. The primary associated conditions of PMV were lower airway diseases (36%), central nervous system diseases (32%), and neuromuscular diseases (14%). The stepwise multiple logistic regression analysis indicated that the utilization of vasoactive agents and an elevated pediatric logistic organ dysfunction-2 (PELOD-2) score on the day of PMV diagnosis were significantly associated with an increased of PMV death. Specifically, the odds ratio (OR) for vasoactive agent use was 2.86; (95% CI: 0.15-0.84; P = 0.018), and for the PELOD-2 score, it was 1.37; 95% CI: 1.17-1.61; P < .001). Conversely, early rehabilitation intervention was negatively associated with the risk of PMV death (OR = 0.45; 95% CI: 0.22-0.93; P = .032). Furthermore, the tracheotomy timing emerged as an independent predictor of failure to wean from PMV, with an OR of 1.08, (95% CI: 1.01-1.16; P = .030). Conclusions: The study revealed a 5.3% incidence of PMV in children requiring mechanical ventilation in China. The use of vasoactive agents and a higher PELOD-2 score at PMV diagnosis were significantly associated with an increased risk of PMV death, whereas early rehabilitation intervention was identified as crucial for improving patient outcomes. The timing of tracheostomy was identified as a high-risk factor for failure to wean from mechanical ventilation.

基金机构：National Key Research and Development Program of China10.13039/501100012166

基金资助正文：Thank all colleagues from National PMV Network for their contributions to the study.