PROLONGED MECHANICAL VENTILATION AS A CONSEQUENCE OF ACUTE ILLNESS

Objective-To determine why acutely ill children become dependent upon mechanical ventilation and what happens to them. Methods-A retrospecti ve medical record study of all patients aged between 1 month and 16 ye ars from 1983 to 1996 who required ventilation for more than 28 days. Results-Forty children were ventilated for between 36 and 180 days bef ore discharge or death. Before their presenting illness, 13 (33%) were normal, 15 (37%) had documented predisposing conditions such as bronc hopulmonary dysplasia, and the remaining 12 (30%) had diagnoses made a fter admission. The cause of respiratory failure was central in four p atients (10%), spinal cord in eight (20%), neuromuscular in 11 (28%), and pulmonary in 17 (42%). Severe nosocomial infection requiring treat ment with intravenous antibiotics occurred in 22. To date, 16 children (40%) have died, and 10 (25%) remain ventilator dependent. Of the 24 survivors, seven (29%) have severe residual neurological deficit. Conc lusions-Increasingly, children are surviving intensive care only to re main ventilator dependent and at risk of significant comorbidity. This study should inform further debate on why such children remain ventil ator dependent, and how and where they are managed.