Clinical Characteristics and predictors of Outcome Among Mechanically Ventilated Children Admitted to the Pediatric ICU of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, 2023

Abstract

Abstract Background: Mechanical ventilation is the highest form of respiratory support technology in intensive care units that assists or takes over the function of respiratory system during acute fatal causes of respiratory failure. Despite its indispensable advantages in preventing morbidity and mortality, the outcome and predictors of mortality in Pediatric intensive care unit (PICU) is not well studied in developing countries. Objective: To assess clinical characteristics and outcome among mechanically ventilated children admitted to Pediatric intensive care unit of Saint Paul Hospital Millennium Medical College from July 2020 to June 2023. Methodology: An institutional based cross-sectional study with retrospective chart review was used to conduct the study amongst patients admitted to PICU and mechanically ventilated from July 2020 to June 2023. Data was abstracted from the patients’ chart and SPSS version 25 software was used for analysis. The report was depicted descriptively using measures of central tendency, dispersion and displayed through tables and graphs. Bivariate logistic regressions analysis was performed to identify factors associated with mortality of mechanically ventilated patients. Multivariable logistic regression model was fitted to control the possible effect of confounders. A p-value of less than 0.05 was considered as statistically significant. Result: A total of 272 study participants were included in the analysis. Over half of them were below 1 year of age. Majority of the patients were admitted to the PICU from the pediatrics emergency room 193(71%). A quarter of the patients have comorbidity. The most common admission reason was Respiratory problems,100(38.2%). The main reasons for MV utilization in this study was respiratory failure in 51.8% of the patients followed by CNS failure in 26.8%. In over half of the patients, the initial MV mode at initiation was SIMV/PCV 146(53.9%). The median (IQR) length of stay in MV was 72 (24-144) hours and almost half of the patient stay for duration less than 72 hours in MV.183 (67.3%) of the patients had Multi organ dysfunction syndrome. The rate of mechanical ventilation complication in this study was 42/272(15.4%) while the most encountered complication was VAP 24(57.1%). Conclusion: In this study septic shock was the most common immediate cause of death. GCS at time of admission, inotropes used, PIM score and duration of MV stay were found to have statistically significant association with mortality. Key Words: SPHMMC, PICU, Mechanical ventilation, Outcome, clinical characteristics