Daily practice of mechanical ventilation in Italian pediatric intensive care units: A prospective survey* Andrea Wolfler, MD; Edoardo Calderoni, MD; Giancarlo Ottonello, MD; Giorgio Conti, MD; Simonetta Baroncini, MD; Pierantonio Santuz, MD; Pasquale Vitale, MD; Ida Salvo, MD; on behalf of the SISPE Study Group* M echanical ventilation (MV) is one of the fields with ma- jor advances in pediatric critical care medicine with the introduction of many new ventilatory modes in the last years (1). Surprisingly, little data have been published on how chil- dren are ventilated in pediatric intensive care units (PICUs). Some studies have com- pared different ventilatory modes (2, 3) or different ventilatory weaning strategies in pediatric patients (4, 5), but only two papers have reported epidemiologic data from large, multicenter, prospec- tive surveys collected between 1999 and 2001: one from the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network (6) and one from the International Group of Mechanical Ven- tilation in Children (IGMVC) (7). The PALISI study was conducted in 15 North American PICUs during 6 months from November to April, whereas the IGMVC study was con- ducted in 36 units located in seven Eu- ropean, Central American, and South American countries during 2 months (from April to May). Up to now, the IGMVC study is the only prospective multicenter survey describing the ven- tilatory modes of used in PICUs. No data on daily practice of MV are avail- able from the Italian PICU network. The aim of this national, multicenter, pro- spective, observational survey was to describe children requiring MV for 24 hrs across pediatric referral centers and Objectives: To assess how children requiring endotracheal intubation are mechanically ventilated in Italian pediatric inten- sive care units (PICUs). Design: A prospective, national, observational, multicenter, 6-month study. Setting: Eighteen medical-surgical PICUs. Patients: A total of 1943 consecutive children, aged 0 –16 yrs, admitted between November 1, 2006 and April 30, 2007. Interventions: None. Measurements and Main Results: Data on cause of respiratory failure, length of mechanical ventilation (MV), mode of ventilation, use of specific interventions were recorded for all children requiring endotracheal intubation for >24 hrs. Children were stratified for age, type of patient, and cause of respiratory failure. A total of 956 (49.2%) patients required MV via an endotracheal tube; 673 (34.6%) were ventilated for >24 hrs. The median length of MV was 4.5 days for all patients. If postoperative patients were excluded, the median time was 5 days. Bronchiolitis (6.7%), pneumonia (6.7%), and upper airway obstruction (5.3%) were the most frequent causes of acute respiratory failure, and altered mental status (9.2%) was the most frequent reason for MV. The overall mortality was 6.7% with highest rates for heart disease (nonoperative), sepsis, and acute respiratory distress syndrome (26.1%, 22.2%, and 16.7% respectively). Length of stay, associated chronic disease, severity score on admission, and PICU mortality were significantly higher in children who received MV (p < .05) than in children who did not. Controlled MV and pressure support ventilation  synchronized intermittent mandatory ventila- tion were the most frequently used modes of ventilatory assistance during PICU stay. Conclusions: Mechanical ventilation is frequently used in Ital- ian PICUs with almost one child of two requiring endotracheal intubation. Children treated with MV represent a more severe category of patients than children who are breathing spontane- ously. Describing the standard care and how MV is performed in children can be useful for future clinical studies. (Pediatr Crit Care Med 2011; 12:141–146) KEY WORDS: pediatric; mechanical ventilation; respiratory fail- ure; intensive care *See also p. 219. From the Department of Anesthesia and Intensive Care (AW, IS), Children’s Hospital V Buzzi, Milan, Italy; Department of Pediatric Anesthesia and Intensive Care (EC), Fondazione Ospedale Maggiore Policlinico, Man- giagalli e Regina Elena, Milan, Italy; Department of Anes- thesia and Intensive Care (GO), Children’s Hospital G Gaslini, Genoa, Italy; Department of Pediatric Anesthesia and Intensive Care (GC), Policlinico Universitario A. Ge- melli, Universita ` ‘ Cattolica del Sacro Cuore, Rome, Italy; Department of Pediatric Anesthesia and Intensive Care (SB), S. Orsola-Malpighi University Hospital, Bologna, It- aly; Department of Pediatrics (PS), Ospedale Civile Mag- giore, Verona, Italy; and the Department of Pediatric Anesthesia and Intensive Care (PV), Children’s Hospital Regina Margherita, Torino, Italy. *SISPE study group: A. Conio (Ospedale Regina Mar- gherita, Torino, Italy); P. Tuo (Ospedale Gaslini, Genova, Italy); R. Gilodi, J. Gualino (Ospedale Sant’Antonio e Biagio e Cesare Arrigo, Alessandria, Italy); R. Osello, F. Ferrero (Ospedale Maggiore della Carita ` , Novara, Italy); E. Zoia, A. Mandelli (Ospedale dei Bambini V Buzzi, Milano, Italy); L. Napolitano, S. Leoncino (Fondazione Ospedale Maggiore Policlinico Mangiagalli Regina Elena, Milano, Italy); A. Baraldi, S. Molinaro (Spedali Civili, Brescia, Italy); P. Biban (Ospedale Civile Maggiore, Verona, Italy); P. Cogo, A. Pettenazzo (Ospedale Civile T. I. pediatrica, Padova, Italy); F. Savron, S. Furlan (Ospedale Burlo Garofalo, Trieste, Italy) E. Iannella (Ospedale Sant’Orsola Malpighi, Bologna, Italy); M Calamandrei, A Messeri (Ospedale Meyer, Firenze, Italy); M. Marano, C. Tomasello (Ospedale Bam- bin Gesu’ DEA, Roma, Italy); A. Onofri, M. Ferrari (Osped- ale Bambin Gesu ` Anestesia, Roma, Italy); M. Piastra, O. Genovese (Policlinico Universitario A. Gemelli, Roma, It- aly); P. Papoff, C. Moretti (Policlinico Universitario Um- berto I, Roma, Italy); A. Dolcini, L. D’Amato (Ospedale Santo Bono, Napoli, Italy); A. M. Guddo (Ospedale G. A. Di Cristina, Palermo, Italy); D. Salvo, D. Buono (Ospedale San Vincenzo, Taormina, Italy). The authors have not disclosed any potential con- flicts of interest. For information regarding this article, E-mail: andrea.wolfler@icp.mi.it Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Inten- sive and Critical Care Societies DOI: 10.1097/PCC.0b013e3181dbaeb3 141 Pediatr Crit Care Med 2011 Vol. 12, No. 2