Prevalence, management, health-care burden, and 90-day outcomes of prolonged mechanical ventilation in the paediatric intensive care unit (LongVentKids) : An international, prospective, cross-sectional cohort study

Journal article


Kawaguchi, Atsushi, Fernandez, Analia, Baudin, Florent, Chiusolo, Fabrizio, Lee, Jan Hau, Brierley, Joe, Colleti, José, Reiter, Karl, Won Kim, Kyung, Lopez Fernandez, Yolanda, Kneyber, Martin, Pons-Òdena, Marti, Napolitano, Natalie, Graham, Robert J., Kawasaki, Tatsuya, Garros, Daniel, Garcia Guerra, Gonzalo, Jouvet, Philippe, Maxvold, Norma, ... Liedel, Jennifer. (2025). Prevalence, management, health-care burden, and 90-day outcomes of prolonged mechanical ventilation in the paediatric intensive care unit (LongVentKids) : An international, prospective, cross-sectional cohort study. The Lancet Child & Adolescent Health. 9(1), pp. 37-46. https://doi.org/10.1016/S2352-4642(24)00296-7
AuthorsKawaguchi, Atsushi, Fernandez, Analia, Baudin, Florent, Chiusolo, Fabrizio, Lee, Jan Hau, Brierley, Joe, Colleti, José, Reiter, Karl, Won Kim, Kyung, Lopez Fernandez, Yolanda, Kneyber, Martin, Pons-Òdena, Marti, Napolitano, Natalie, Graham, Robert J., Kawasaki, Tatsuya, Garros, Daniel, Garcia Guerra, Gonzalo, Jouvet, Philippe, Maxvold, Norma, Falcão, Ricardo, Ekinci, Faruk, Shabana, Medhat, Ujiro, Atsushi, Tai, Chian Wern, Hough, Judith, Aoki, Satoshi, Kim, Soo Yeon, Kim, Younga, Takehiro Niitsu, Takehiro Niitsu, Sho Kimura, Sho Kimura, Tsuboi, Norihiko, Hagen, Scott A., Choi, Yu Hyeon, Park, June Dong, Bansal, Arun, Thong, Wen Yi, Fan, Li Jia, Jindal, Atul, Varghese, Anjali Rachel, Kusumastuti, Neurinda, Miyashita, Norihisa, Sugimura, Hiroko, Colak, Mustafa, Karaarslan, Utku, Özkaya, Pınar Yazici, Yavaş, Damla Pınar, Ulgen Tekerek, Nazan, Udurgucu, Muhammed, Kangin, Murat, Koizumi, Taku, Duval, Els Lim, Erickson, Simon, Balmaks, Reinis, Franchini, Diego, Brossier, David, Kim, Kyunghoon, Talip Petmezci, Mey, Sarıtaş, Ümit Aslan, Dominguez, Dominguez, José Manuel González, Gómez, Martínez, Antonio, Volakli, Eleni A., Sdougka, Maria, Duyu, Muhterem, Phan, Phuc Huu, Thanh, Lam Thi, Davis, Peter J., Akçay, Nihal, Okada, Hiroshi, Gregorio, Gil Rossetti, Diez, Mikel Mendizabal, McCrory, Michael C., Woodruff, Alan G., Fontela, Patricia, Weiss, Matthew, Bonanomi, Ezio, Gehlbach, Jonathan A., Garcia-Teresa, Maria Angeles, Mosciaro, Marta, Guerrero, Maria Sol Garcia, Shappley, Rebekah, Adu-Darko, Michelle A., Spaeder, Michael C., Gaboli, Mirella, Parrilla, Julio, Stavroula, Ilia, Constanza, Laporte María, Monteverde, Ezequiel, Sandal, Özlem Sarac, Yazici, Mutlu Uysal, Heidemann, Sabrina, Munoz, Alvaro Coronado, Vavřina, Martin, González, Rafael, V-Ter, Mervin Loi, Flores-González, Jose Carlos, Harney, Kathy, Nettuno, Claudio, Enomoto, Yuki, Sherring, Claire, McMahon, Kimberly, Kulluoglu, Emine Pinar, Anil, Ayse Berna, Kalliopi, Straka, Ganu, Subodh, Wolfe, Katie, Agulnik, Asya, Duffett, Mark, Newth, Christopher J. L., Karsies, Todd, Gaspers, Mary G., Abu-Sultaneh, Samer, González, María García, Maroni, Arielle, Serrate, Alejandro Siaba, Giugni, Cristina, Reyes, Kara, López-Alarcón, Yúrika Paola, Cesar, Regina Grigolli, de Oliveira, Felipe Rezende Caino, Amoretti, Carolina Friedrich, Ortiz, Hudman Cunha, Ramos, Paulo, Almeida, Carlos Gustavo, Foronda, Flávia Andrea Krepel, de Castilho, Taisa Roberta Ramos Nantes, Mendes, Camila Fernandes, Zeitel, Raquel, Flintz, Rosana, Guedes, Camila, Moulin, Rodrigo, Kanazawa, Tomoyuki, Willems, Ariane, Baleine, Julien, de Souza, Vanessa Vieira, Scarlato, Ana Carolina Cabral Pinheiro, Gedeit, Rainer, Riveiro, Paula Marins, Robaina, Jaqueline Rodrigues, Lloyd, Simon D., de Oliveira, Mariana Barros Genuíno, Prata-Barbosa, Arnaldo, Chegondi, Madhuradhar, Vijayakumar, Niranjan, Gajraj, Malcolm, Lima-Setta, Fernanda, Montes, Miguel Ruz, Xavier, Glaciele N., Malisie, Ririe Fachrina, Cito, Fabiana, Jabur, Fernanda, Maia, Mary Lucy Ferraz, Mondardini, Maria Cristina, Nett, Sholeen, Smith, Arden Z., Dean Jarvis, Dean, McNally, Mary, Porter, Melissa, Ejzenberg, Fernanda, Ferreira, João Miguel Rodrigues, Leung, Karen Ka Yan, Nagaraj, Ravishankar, Sorbo, Marcello, Trastoy-Quintela, Javier, Slain, Katherine N., Miller, Andrew G., Rotta, Alexandre T., Hongxing, Dang, Chow, Chin Ying, Santschi, Miriam, De Barelli, Marta, Ödek, Çağlar, McNally, James Dayre, Lodha, Rakesh, Sankar, Jhuma, Davidson, Mark, Aneja, Himanshu, Darvas, Jennifer, Seby, Sebastian, Kelly, Nicola and Liedel, Jennifer
Abstract

Background
The number of children requiring prolonged mechanical ventilation (PMV) has increased with the advancement of medical care. We aimed to estimate the prevalence of PMV worldwide, document demographic and clinical characteristics of children requiring PMV in paediatric intensive care units (PICUs), and to understand variation in clinical practice and health-care burden.

Methods
This international, multicentre, cross-sectional cohort study screened participating PICUs in 28 countries for children aged >37 postgestational weeks to 17 years who had been receiving mechanical ventilation (MV; invasive or non-invasive) for at least 14 consecutive days. Screening days took place every 90 days for 3 years. Patients were eligible for inclusion in the analysis if they had been receiving MV (invasive or non-invasive) for at least 14 consecutive days by their first day of screening. Eligible patients were followed up on the subsequent screening day 90 days later or at time of hospital discharge, whichever came first. Outcome data were recorded in a validated web-based case report file. The primary outcome was the prevalence of PMV. Secondary outcomes were mortality, duration of MV, tracheostomy, and number of complications. All outcomes were assessed at 90 days post-screening. The study was registered with ClinicalTrials.gov, NCT04112459.

Findings
Between Sept 4, 2019 and Dec 7, 2022, 14 595 children were screened on four separate screening days in 158 PICUs, and 2773 patients had been receiving MV for at least 14 days and were included in the analysis. The point prevalence of PMV was 25·8% (IQR 24·1–28·5). Median age was 0·4 years (IQR 0·2–5·3) and median weight was 8·1 kg (IQR 4·7–19·1). 625 (24·0%) of 2610 patients had a history of prematurity (<37 weeks gestational age at birth). 90-day outcome data were collected for 2430 patients. 441 (18·2%) of 2430 patients had died within 90 days. 649 (29·8%) of 2176 patients who initiated ventilation support upon hospital admission had a tracheostomy placed after the first 14 days of MV. The median time to tracheostomy placement after MV initiation was 26 days (IQR 18–52). 462 (21·2%) of 2176 patients had at least one failed extubation between MV initiation and their first screening date. 556 (25·6%) of 2174 patients who started MV upon hospital admission required MV for 21 days or less, whereas 1618 (74·4%) patients required MV for 22 days or more; 90-day mortality did not differ between these groups (18·2% vs 20·30%, p=0·288). Complications were recorded for 810 (38·4%) 2109 patients who initiated MV upon hospital admission; of these 539 (67%) had ventilator-associated pneumonia, and 212 (39%) of 539 patients had multiple episodes of ventilator-associated pneumonia.

Interpretation
Timing of tracheostomy was variable, and duration of MV was longer than previously reported. The large variability in patients requiring MV and the associated health-care burden and outcomes across PICUs suggest that further investigation of the factors influencing the care of children with MV is warranted.

Funding
Réseau en Santé Respiratoire du Québec (Respiratory Research Network of Quebec), Fonds de la recherche en santé du Québec, Women and Children Health Research Institute-Clinical/Community Research Integration and Support Program, Réseau mère-enfant de la francophonie.

Translations
For the French and Spanish translations of the abstract see Supplementary Materials section.

Year2025
JournalThe Lancet Child & Adolescent Health
Journal citation9 (1), pp. 37-46
PublisherElsevier Ltd
ISSN2352-4642
Digital Object Identifier (DOI)https://doi.org/10.1016/S2352-4642(24)00296-7
PubMed ID39701660
Scopus EID2-s2.0-85211989199
Open accessPublished as ‘gold’ (paid) open access
Page range37-46
FunderRéseau en Santé Respiratoire du Québec
Fonds de la recherche en santé du Québec
Women and Children Health Research Institute
Réseau mère-enfant de la francophonie
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online17 Dec 2024
Publication process dates
Deposited08 May 2025
Additional information

© 2024 Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

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