SURVIVAL AND FUNCTIONAL OUTCOME OF CHILDREN REQUIRING MECHANICAL VENTILATION DURING THERAPY FOR ACUTE BACTERIAL-MENINGITIS

Objective: To determine predictors of survival and functional outcome of pediatric patients requiring mechanical ventilation during therapy for acute bacterial meningitis, Design: Retrospective case series. Set ting: Pediatric intensive care unit (ICU) at a midwestern tertiary car e children's hospital, Patients: Consecutive sample of 32 patients (me dian age 9.8 months; range 9 days to 12 yrs) from 1985 to 1990 with ac ute bacterial meningitis severe enough to require mechanical ventilati on during therapy, Of these patients, 59% were female and 59% were whi te, Interventions: None. Measurements and Main Results: Data were anal yzed to identify predictors of survival and functional status after ho spital discharge, Variables included were vital signs, Pediatric Risk of Mortality (PRISM) score within the first 24 hrs of hospitalization, Glasgow Coma Score, and course of illness, Functional status was asse ssed at hospital discharge and at followup (median follow-up: 41.5 mon ths, range 7 to 77) in the areas of locomotion, self-care, and communi cation, There were ten inhospital deaths, The 22 survivors formed thre e groups, At hospital discharge, seven children showed no functional d isability, Seven patients were dependent in all three areas of functio n at discharge, with six still dependent at followup evaluation, Eight patients showed mild to moderate impairment in at least one area of f unction at hospital discharge, At follow-up, four of these eight patie nts demonstrated no functional disability, one had improved status, tw o were unchanged, and one was lost to follow-up, The best predictor of death and functional status at follow-up was the admission PRISM scor e, Hypotension and tachycardia within the first 24 hrs after pediatric ICU admission were strongly associated with poor outcome, Conclusions : After bacterial meningitis in children whose care included mechanica l ventilation, half of the patients died or survived with severe funct ional deficits, Patients with mild or moderate functional deficits at hospital discharge improved with time.