(1190) Outcome of Mechanically Ventilated Children in a Tertiary Care Center in Nepal

Introduction: The requirement for mechanical ventilation is a major indication for admission in the pediatric critical care unit. Increased burden of disease, limited availability of pediatric critical care services, and lack of specialized manpower make its use challenging in resource limited settings including Nepal. Our aim was to study clinical characteristics and outcome of children requiring mechanical ventilation in our setting.

Methods: A retrospective chart review was done for children from newborn period to 15 years requiring noninvasive and invasive mechanical ventilation at a tertiary care center in Lalitpur, Nepal, from April 2021 to April 2024. Data analysis was done in OpenEpi and presented as mean (SD), median (IQR) and percentages. Statistical analysis was done using Chi-square test for categorical data.

Results: Of 965 children admitted to the pediatric intensive care unit, 397 (41.1%) required mechanical ventilation, 174 (43.8%) were females. The most common age group was < 2months (30.3 %), followed by 2-12months (27.4%), 1-5years (20%), and 5-15 years (22.3%). Of 397, total of 212 (53.4%) children were invasively ventilated; 305 (76.8%) needed non-invasive mechanical ventilation, of whom 115 (37.7%) subsequently required endotracheal intubation. Primary indication for mechanical ventilation was respiratory failure in 255 (64.2%) followed by shock in 60 (15.1%), and low GCS in 29 (7.3%). Mean durations of noninvasive and invasive mechanical ventilation were 44.6 hours (± 59.8) and 31.1 hours (± 61.5), respectively. Of 397, 311 (78.3%) children survived, 60 (15.1%) died, 22 (5.5%) left against medical advice. The most common cause of death was septic shock in 22 (36.7%) children, followed by oncological emergencies in 15 (25%). Among invasive ventilation, mortality was statistically different in children over 5 years compared to under 5 years old (22.9% vs 13%; p=0.02), and children requiring inotropes (63.3% vs 3.2%; p < 0.001). Mortality was similar in children requiring invasive ventilation for < 72 hours and >72 hours (p=0.30).

Conclusions: Younger children required mechanical ventilatory support in our setting. Septic shock was the leading cause of death. Among children requiring invasive ventilation, mortality was higher over 5 years of age and those on inotropes.