Profile and consequences of children requiring prolonged mechanical ventilation in three Brazilian pediatric intensive care units Cristiane Traiber, MD, MSc; Jefferson P. Piva, MD, PhD; Carlos C. Fritsher, MD, PhD; Pedro Celiny R. Garcia, MD, PhD; Patrícia M. Lago, MD, PhD; Eliana A. Trotta, MD, MSc; Cla ´ udia P. Ricachinevsky, MD, MSc; Fernanda U. Bueno, MD, MSc; Vero ˆ nica Baecker, MD; Bianca D. Lisboa, MD M echanical ventilation (MV) has changed the outcome and the prognosis of a great number of pediatric diseases. Nowadays, there is an increased number of children depending on MV to survive in the hospital setting as well as at home environment (1–5). The definition of prolonged MV, de- pending on the study, ranges from 48 hours to 6 months (1, 6 –10). According to the latest consensus of the National Association for Medical Direction on Re- spiratory Care, prolonged MV is defined as the need for ventilatory support during 21 consecutive days or more, for at least 6 hr/day (7). Most studies of prolonged MV in the pediatric population refer to children on MV for 3 months or more, many submit- ted to domiciliary ventilation. In 1996, a survey of 282 Japanese hospitals identi- fied 434 patients younger than 20 years submitted to MV for longer than 3 months (11). On the other hand, in the United Kingdom, 65 children required prolonged MV (10). Among adult patients, mortality with prolonged MV ranges from 24% to 65% and may reach 76% after 1 year of fol- low-up (3, 4, 6 –9, 12). Some factors were associated with mortality in adults sub- mitted to prolonged MV: old age, severity of illness, diagnosis at the admission, and presence of chronic comorbidities (3, 6 –9, 12–14). Data on child mortality as- sociated with prolonged MV are scarce, especially for pediatric intensive care units (PICUs) in Brazil. Several countries developed special- ized units to provide MV to stable patients (3, 4, 6, 8, 13, 15). These units have a lower complexity and lower costs com- pared with the intensive care unit (ICU) and allow available ICU beds to be desig- nated for unstable patients. Because few regions in Brazil have specific units for children on chronic MV, we hypothesize that prolonged MV would be performed in the PICU, using the scarce ICU beds des- ignated for unstable patients. This study aims to describe the char- acteristics of pediatric patients on pro- longed MV in three Brazilian PICUs, eval- From the Pediatric Intensive Care Unit at Hospital Sa ˜ o Lucas (CT, JPP, CCF, PCRG, FUB, BDL), School of Medicine—Pontificia Universidade Cato ´lica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Pediatric Intensive Care Unit at Hospital de Clínica de Porto Alegre (PML, EAT, VB), School of Medicine— Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; and Pediatric Intensive Care Unit at Hospital da Crianc ¸a Santo Anto ˆ nio de Porto Alegre (CPR), Irmandade Santa Casa de Miserico ´ rdia de Porto Alegre, Porto Alegre, Brazil. The authors have not disclosed any potential con- flicts of interest. For information regarding this article, E-mail: jpiva@terra.com.br, jpiva@pucrs.br Copyright © 2009 by the Society of Critical Care Medicine and the World Federation of Pediatric Inten- sive and Critical Care Societies DOI: 10.1097/PCC.0b013e3181a3225d Objective: To describe the characteristics of children submit- ted to prolonged mechanical ventilation (MV), and evaluate their mortality, and associated factors as well as the potential impact at admissions to the pediatric intensive care unit (PICU). Methods: We conducted a retrospective study enrolling all children admitted to three Brazilian PICUs between January 2003 and December 2005 submitted to MV >21 days. The three se- lected PICUs were located in university-affiliated hospitals. From the medical charts were reported anthropometric data, diagnosis, ventilator parameters on the 21st day, length of MV, length of stay in the PICU, specific interventions (e.g., tracheostomy), and out- come. Results: One hundred eighty-four children (190 admissions) were submitted to prolonged MV (2.5% of all admissions to these 3 Brazilian PICUs), with a median age of 6 months. The mortality rate was 48% and the median time on MV was 32 days. Trache- ostomy was performed on only 19% of the patients and, on average after 32 days of intubation. Mortality was associated with peak inspiratory pressure >25 cm H 2 O (odds ratio  2.3; 1.1–5.1), fraction of inspired oxygen >0.5 (odds ratio  6.3; 2.2–18.1), and vasoactive drug infusion (odds ratio  2.6; 1.1–5.9) on the 21st day of MV. Seventy-six children (1% of the all admissions) were dependent on MV without other organ failures were 830 PICU admissions and were potentially prevented. Conclusions: A small group of children admitted to the PICU requires prolonged MV. The elevated mortality rate is associated with higher ventilatory parameters and vasoactive drug support on the 21st day of MV. Stable children requiring prolonged MV in the PICU potentially prevent additional admissions of a large number of acute and unstable patients. (Pediatr Crit Care Med 2009; 10:375–380) KEY WORDS: outcome; child; pediatrics; critical care; mechanical ventilation; respiratory failure; intensive care; tracheal intubation 375 Pediatr Crit Care Med 2009 Vol. 10, No. 3