Ventilated patients in the Paediatric medical intensive care unit of Lady Ridgeway hospital: an audit

Abstract

INTRODUCTION AND OBJECTIVES: To analyse the outcomes related to ventilated paediatric patients admitted to paediatric ICU (PICU) in Lady Ridgeway Hospital (LRH). METHODS: This clinical audit recruited consecutive 292 patients admitted to PICU of LRH in 2Q09. The patients who admitted for <two hours, neonates, patients either intubated or extubated outside the study period were excluded. RESULTS: Nearly half of them (48%, n=73) were aged <1 year. Median duration of ventilation was six days (IRQ 4-10). Mortality among ventilated patients was 27.5% (95% CI: 21 - 35.1%, n=42). Multi organ dysfunction accounted for 80.9% (34/42, 95% CI: 67 - 90.7%) of the ultimate death irrespective of primary disease. Broncopneumonia (38.6%, 16/42) and dengue haemorrhagic fever (2.8.6%, 12/42) were the main causes of death. Significant risk factors for death were increasing age (Kolmogorov-Smirnov Z = 3.7, p < 0.001), indications other than respiratory indications (OR = 2.4, 95% CI: 1.2 -4.9), organ involvement such as renal (OR = 3.1 , 95% CI : 1.4 - 6.6), hepatic (OR = 2.8, 95% CI: 1.3 - 5.9), haematological (OR - 2.5, 95% CI : 1.2 - 5.4) and neurological (OR - 2.1, 95% CI : 1.0 - 4.5) and multi-organ failure (OR = 3.3, 95% CI: 1.4-7.8). Bronchopneumonia cases had nine times higher risk of death than other respiratory indications (OR = 9.7, 95% CI: 1.3 - 69.4) CONCLUSIONS: This audit identifies the risk factors for death and provides a baseline to monitor the improvement of the clinical outcome of the PICU in LRH.