Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
Impact Factor (IF) – 1.227
Index Copernicus (ICV 2018) – 157.72
MNiSW – 40
Average rejection rate – 84.38%
ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download PDF

Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 1, January-February, p. 57–61

Publication type: original article

Language: English

Complications of Mechanical Ventilation in Pediatric Patients in Serbia

Snezana Rsovac1,A,B,C,D, Katarina Milosevic2,A,B,C,D, Branimir Nestorovic2,A,C,E,F, Aleksandra Nikolic3,C,D,E,F

1 Pediatric Intensive Care Unit, University Children’s Hospital, Belgrade, Serbia

2 Department of Pulmonology and Allergology, University Children’s Hospital, Belgrade, Serbia

3 Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia


Background. Mechanical ventilation is a frequently applied therapy in critically ill children and can be lifesaving in many cases. Clinical use of this technique has well documented benefits, but can be associated with different complications and adverse physiologic effects.
Objectives. The aim of this study was to investigate the complications and clinical outcome of mechanical ventilation in Serbian pediatric patients.
Material and Methods. The study encompassed 42 children with respiratory insufficiency that underwent mechanical ventilation during hospitalization over a period of 12 consecutive months. The influence of clinical and mechanical parameters on the occurrence of complications and clinical outcome were analyzed.
Results. The patients were ventilated for a total of 432 days and a total of 61 complications were observed in 42 patients (97 complications per 1000 ventilation days). The most common complications associated with mechanical ventilation in Serbian pediatric patients with respiratory insufficiency were cardiovascular insufficiency (52.4%) and multiple organ failure (35.7%). High values of applied PIP (> 26 cm H2O), PEEP (> 6 cm H2O) and Tv (> 6 mL/kg) were associated with the occurrence of complications and negative clinical outcome.
Conclusion. Complications of mechanical ventilation in the pediatric population occur frequently, but lower volumes/pressures of ventilation contribute to a decrease in incidence. Further studies are needed to examine associated risk factors and strategies to reduce the occurrence of complications and improve clinical outcome.

Key words

mechanical ventilation, respiratory insufficiency, complications, clinical outcome.

References (27)

  1. Principi T, Fraser DD, Morrison GC, et al.: Complications of mechanical ventilation in the pediatric population. Pediatr Pulmonol 2010, 46, 452–457.
  2. Benjamin PK, Thompson JE, O’Rourke PP: Complications of mechanical ventilation in a children’s hospital multidisciplinary intensive care unit. Respir Care 1990, 35, 873–878.
  3. Cox RG, Barker GA, Bohn DJ: Efficacy, results, and complications of mechanical ventilation in children with status asthmaticus. Pediatr Pulmonol 1991, 11, 120–126.
  4. Rivera R, Tibballs J: Complications of endotracheal intubation and mechanical ventilation in infants and children. Crit Care Med 1992, 20, 193–199.
  5. Kolatat T, Aunganon K, Yosthiem P: Airway complications in neonates who received mechanical ventilation. J Med Assoc Thai 2002, 85, Suppl 2, S455–S462.
  6. Elward AM, Warren DK, Fraser VJ: Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics 2002, 109, 758–764.
  7. Edmunds S, Weiss I, Harrison R: Extubation failure in a large pediatric ICU population. Chest 2001, 119, 897–900.
  8. Fontela PS, Piva JP, Garcia PC: Risk factors for extubation failure in mechanically ventilated pediatric patients. Pediatr Crit Care Med 2005, 6, 166–170.
  9. Kurachek SC, Newth CJ, Quasney MW: Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes. Crit Care Med 2003, 31, 2657–2664.
  10. Marraro GA: Innovative practices of ventilatory support with pediatric patients. Pediatr Crit Care Med 2003, 4, 8–20.
  11. Nitu ME, Eigen H: Respiratory failure. Pediatr Rev 2009, 30, 470–478.
  12. Wilkinson JD, Pollack MM, Glass NL: Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit. J Pediatr 1987, 111, 324–328.
  13. Dellinger RP, Levy MM, Carlet JM: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36, 296–327.
  14. Nava S, Carlucci A: Non-invasive pressure support ventilation in acute hypoxemic respiratory failure: common strategy for different pathologies? Intensive Care Med 2002, 28, 1205–1207.
  15. Keenan SP, Sinuff T, Cook DJ: Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit Care Med 2004, 32, 2516–2523.
  16. Carvalho WB, Fonseca MC: Noninvasive ventilation in pediatrics: we still do not have a consistent base. Pediatr Crit Care Med 2004, 5, 408–409.
  17. Teague WG: Non-invasive positive pressure ventilation: current status in paediatric patients. Paediatr Respir Rev 2005, 6, 52–60.
  18. Pinsky MR: Cardiovascular issues in respiratory care. Chest 2005, 128, S592–S597.
  19. Del Sorbo L, Slutsky AS: Acute respiratory distress syndrome and multiple organ failure. Curr Opin Crit Care 2011, 17, 1–6.
  20. Mutlu GM, Mutlu EA, Factor P: GI complications in patients receiving mechanical ventilation. Chest 2011, 119, 1222–1241.
  21. Bigham MT, Amato R, Bondurrant P: Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr 2009, 154, 582–587.
  22. Elward AM: Pediatric ventilator-associated pneumonia. Pediatr Infect Dis J 2003, 22, 445–446.
  23. Zambon M, Vincent JL: Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest 2008, 133, 1120–1127.
  24. Albuali WH, Singh RN, Fraser DD: Have changes in ventilation practice improved outcome in children with acute lung injury? Pediatr Crit Care Med 2007, 8, 324–330.
  25. Amato MB, Barbas CS, Medeiros DM: Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998, 338, 347–354.
  26. Villar J, Kacmarek RM, Perez-Mendez L: A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med 2006, 34, 1311–1318.
  27. Brower R, Thompson BT: ARDS Network Investigators. Tidal volumes in acute respiratory distress syndrome – one size does not fit all. Crit Care Med 2006, 34, 263–264.