Abstract
Introduction: In a multi-center study from 1991 of pediatric patients (pts) with acute respiratory failure (ARF), defined as FiO2>50% and PEEP >6 cm H2O for >12 hours, mortality was 43%.1 We prospectivery collected data on non-consecutive pts with ARF to determine if survival is improving in this population and to establish survival characteristics of these patients. Methods: Data were collected from 4 pediatric ICU's in the Mid-Atlantic region. Demographic, diagnostic and outcome data was collected on standardized data sheets. Data were entered into Excel spreadsheet for evaluation. From 1996-98, data on 42 pts. was collected. Pts were analyzed based on presence or absence of exclusionary diagnoses and outcome. Exchtsiomary diagnoses included: BPD, head injury, genetic defect, congenital heart disease. Pts were managed via an algothrimic approach that limited peak inspiralory pressure to 35-40 cm H2O, used pressure control ventilation, permissive hypercapnia (PH) when needed and allowed use of other techniques sach as surfactant (surf), high frequency ventilation (HFV), inhaled nitric oxide (iNO) and ECMO. Results: In addition to conventional ventilation, 1 pt. received ECMO, 6 pts. received surf. 7 received iNO. 7 received HFV and 5 pts. were treated with PH. Survivors (n=29) Non Survivors (n=13) Exclusions 12 10 No exclusions 17 3 Total Patients (n=42) 29/42 (69%) 13/42 (31%) Survival in pts. without exclusionary diagnoses was 85% versus 55% in those with exclusionary diagnoses. (Chi square analysis, p=.008, degrees of freedom 1). Conclusions: Compared to 1991, survival in ARF is improving. However, in pts. with exlusionary diagnoses, mortality remains high, despite the use of alternative techniques. Validation of these foldings is required to establish prognostic information, guide appropriate use of alternative therapies and develop outcome scores in survivors.