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Risk factors associated with increased length of mechanical ventilation in children

Background: Invasive mechanical ventilation, if prolonged, may lead to high morbidity and mortality. Objective: To determine the incidence rate and early risk factors for prolonged acute invasive mechanical ventilation in children. Design: Retrospective longitudinal cohort study over a 1-yr period. Patients: All consecutive episodes of invasive mechanical ventilation in the pediatric intensive care units of Sainte-Justine Hospital (Montreal, Canada) were included. Risk factors for long (≥96 hrs) vs. short (<96 hrs) duration of ventilation were determined by logistic regression. Intervention: None. Measurements and Main Results: Among the 360 episodes of invasive ventilation, 36% had a length of ≥96 hrs. Following multivariate analysis, significant risk factors for prolonged acute invasive mechanical ventilation were age of <12 months (odds ratio 3.27, 95% confidence interval 1.90–5.63), Pediatric Risk of Mortality score of ≥15 at admission (odds ratio 3.41, 95% confidence interval 1.31–8.89), mean airway pressure of ≥13 cm H2O on day 1 (odds ratio 5.92, 95% confidence interval 3.08–11.36), use of continuous intravenous sedation on day 1 (odds ratio 1.75, 95% confidence interval 1.00–3.05), and use of noninvasive ventilation before intubation (odds ratio 6.56, 95% confidence interval 1.99–21.63). Conclusions: Among the risk factors identified, the use of noninvasive ventilation and continuous intravenous sedation on the first day of ventilation are the only two interventions that were associated with prolonged acute invasive mechanical ventilation. Further research is needed to study the impact of sedation protocols on the duration of mechanical ventilation in children.