Clinical Profile and Outcome of Mechanically Ventilated Children in a Pediatric Intensive Care Unit Surabaya

Article history: Received 21 September 2020 Received in revised form 27 October 2020 Accepted 29 October 2020 Available online 31 October 2020


Introduction
Ventilator is one of life supporting and non-therapeutic device that is used to help the process of breathing in patients who cannot breathing normally on their own. 1 Ventilator works by doing gas exchange of the respiratory system and helping the work of respiratory muscles that are paralysis to make it easier for the patients to breath. 1 One of the main reason for Intensive Care Unit (ICU) admission is based on the needs of the patient to use ventilator. 2 The frequency of children using ventilator in Pediatric Intensive Care Unit (PICU) varies from 17-64%.3-5 In Indonesia, there are 6,7-40% ventilator in children health service all around Indonesia. 6 The use of ventilator in children is based on multifactorial factor such as cardiac failure, respiratory failure, shock, neurological problems, and multi-organ dysfunction syndrome. 2 However, the use of ventilator is many needed in respiratory problem. 7 The World Health Organization Statisfical Indormation System (WHOSIS) reported that respiratory infection is the second main reasons for morbidity and mortality among children under five in Indonesia. 8 Although the use of ventilator as life-supporting device is unquestionable, there are still some other side effect for the patients from using ventilator, such as Ventilator Associated Pneumonia (VAP), atelectasis, barotrauma, etc. 7  length of use of ventilator, complication from ventilator, and outcome of children with ventilator in PICU Dr. Soetomo General Hospital, Surabaya.

Methods
A cross-sectional study conducted from June 2017 -October 2018. Study population was all pediatric patients from one-month old to 18 years old who were admitted to PICU Dr.Soetomo Hospital and treated with ventilator from January -December 2017. The inclusion criteria is patients with ventilator for at least 24 hours in PICU. Patients with incomplete medical record and patient who got discharge before the treatment is completed were excluded.
The following data were collected from secondary data of medical records: basic demographic profile (age and gender), clinical condition that become an indication for using ventilator, length of use of ventilator, complication of ventilator, and outcome of patients either discharge with better condition or expired. VAP was defined if patients on ventilation for more than 48 hours and had a fever more than 38 o C with purulent secretion and other specific supporting examination such as culture of the sputum and thorax imaging. 9 Data was entered in and statistical analysed was performed using Microsoft Excel. The categorical variables were expressed as frequency and percentage. This study was approved by Dr.Soetomo General Hospital Health Research Ethics Committee (0025/ KEPK/II/2018).

Results
During 1 st January until 31 st December 2017, there were 133 patients who admitted in PICU Dr. Soetomo General Hospital and using ventilator. From 133 patients, 59 patients met the inclusion criteria. Male:female ratio was 1:1.46. The average age was 30±46 months. The value of SD was high because of the large age range of children who admitted in PICU. The age was further divided in to five categories based on the normal range of respiratory rate of children, there are 1-12 months (45,76%), >1-3 years (33,90%), 4-5 years (5,08%), 6-12 years (8,47%) and 13-18 years (6,78%).
The mortality rate among children using ventilator who met our inclusion criteria was relatively high (67,80%). This might happen because uncompleted medical records in patients who recovered so they are excluded from this study. Distribution of outcome to demographic and clinical data of the patients were presented in Table 1. Most common indication for ventilation is status epileptics and shock, while the mortality rate was highest in patients with cardiac failure as their indication for using ventilator. Most of the patients using ventilator for >48 hours, and the mortality rate between patients with ventilator ≤48 and >48 hours was not significantly different. We recommend further study to observe profile of patients using ventilator in PICU prospectively to get more accurate data and present more accurate charateristics.