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Hypochloremia, blood transfusion, and neuromuscular drug use can be associated with prolonged mechanical ventilation in pediatric intensive care

Fatih Aygun

Background: Mechanical ventilation (MV) is one of the most important components of modern intensive care practice. Longer MV time is associated with increased morbidity and mortality. Therefore, it is important to identify the risk factors associated with longer duration of MV. The objective of this study was to determine the clinical and the laboratory risk factors for prolonged invasive MV in the pediatric intensive care unit (PICU).

Methods: We performed a retrospective analysis of the records of all patients admitted to our PICU between October 2016 and March 2018. Patients with invasive MV were included in the study.

Results: A total of 121 children with a mean age of 3.58 ± 4.84 years were enrolled in this study. The most frequent diagnosis at the time of admission to the PICU was primary respiratory disease (31.4%), followed by neurological diseases (22.3%), and sepsis (17.4%). Pressure control was the most commonly used MV method in 97 (80.2%) patients. Pressure regulated volume control was used in the other (19.8%) patients. The mean duration of mechanical ventilation was 9.17 ± 8.12 days. Risk factors for prolonged MV in the PICU included red blood cell (RBC) transfusion, hypochloremia, high gamma-glutamyl transferase (GGT), and low body mass index (BMI). The logistic regression analysis showed that hypochloremia prolonged MV by 3.234 fold, neuromuscular blocker drug uses prolonged MV by 3.689 fold, and RBC transfusion prolonged MV by 8.031 fold.

Conclusion: Hypochloremia, need for RBC transfusion, and neuromuscular blocker drug use may be early predictors of prolonged MV in critically ill children.