Ludhiana, September 13
Paediatric intensive care and mechanical ventilation can substantially decrease the overall mortality in children.
‘Clinical profile and survival of children on mechanical ventilation in Punjab’, a study conducted by Dr Puneet A. Pooni, a lecturer in the Department of Paediatrics, Dayanand Medical College and Hospital, says mechanical ventilation increased the survival rate among small children from 50 per cent to 78 per cent. Respiratory failure due to multi-organ system failure (MOSF) contributed significantly to high mortality but shock, i.e. the low blood pressure, at the time of admission did not increase the mortality significantly.
Dr Pooni said the study was carried out on patients requiring mechanical ventilation over the period of two years. The paper was presented by Dr Pooni at the International Critical Congress held in New Delhi recently and was awarded the best paper.
Dr Pooni said children could have difficulty in breathing or respiratory failure due to many causes and if not provided with artificial respiration, these children would not survive.
In the study, there were 64 children (from all over the state), less than 15 years of age and 80 per cent of these were males. Patients were divided into two groups: Group 1 included children less than one month of age and Group II included children more than one month. Group II was further subdivided into three subgroups depending on the cause of respiratory failure.
In the 17 neonates, the main diagnosis were birth asphyxia (delayed crying after birth), aspiration pneumonia, meconium aspiration (where due to lack of oxygen leads to passage of stools in the unborn baby which goes to lungs causing severe pneumonia),
septicaemia (infection in the blood), congenital malformations and heart defects.
In Group II, 21 were infants ( 1-12 months) and was subdivided into A,B,C. Group A included conditions of the brain like meningitis, encephalitis, head injury, haemorrhage in the brain which caused respiratory failure in children (21 cases). Group B included neuromuscular diseases like polio, snake bites, organo phosphorous poisoning, which lead to respiratory failure (six cases). Group C included conditions which increased work of breathing like pneumonia, heart failure, drowning and asthma (20 cases).
Overall survival rate was 66.7 per cent (16 cases), newborns had the maximum mortality (41 per cent). Group II A,B,C were associated with 9.5 per cent, 16.5 per cent and 35 per cent mortality, respectively.
Mean duration of ventilation was 6.5 days ranging from 24 hours to 33 days. Mortality rate was 31 per cent in patients requiring ventilation for less than seven days and 10.5 per cent in those requiring for more than seven days. Survival increased from 50 per cent in first to 78 per cent in last six months.
“There are not many studies available on clinical profile and outcome of children on mechanical ventilation. Since clinical conditions causing respiratory failure vary in developing countries but no study has been done on this subject in this part of the region”, claimed Dr
Pooni.
