P2.120: Characteristics and clinical course of invasive mechanical ventilation in a pediatric intensive care unit in Lima, Peru (2022-2024).

Background: Invasive mechanical ventilation (IMV) is a common intervention in the Pediatric Intensive Care Units (PICU). It is estimated that between 30% to 54% of patients admitted to the PICU require IMV. Previous studies have described the characteristics of these patients in high-income settings. However, data remains scarce in LMICs, where mortality and morbidity rates tend to be higher. Therefore, this study aims to describe the characteristics and clinical course of patients receiving IMV in the PICU of Hospital Nacional Edgardo Rebagliati Martins (HNERM) in Lima, Peru, 2022-2024.

Methods: This was a cross-sectional and retrospective study conducted in children aged 1 month to 14 years. Clinical data were collected from medical records and entered into an Excel database, where quality control procedures were performed.The data were then exported to Stata version 18.0. Descriptive statistics will be performed. The study was approved by the Ethics Committee of HNERM.

Results: We included 1,019 participants, most were males (55.44%), with a median age of 4 years (interquartile range [IQR]: 0.83–9.08). About 25% of the patients were in each of the following age groups: under 1 year, 1 to < 5 years, and 5 to < 10 years. The majority had comorbidities (62.32%), the main reason for initiating IMV was of surgical origin (53.88%), and the median PRISM score at admission was 1.2 (IQR: 0.5–4.5).
Regarding clinical outcomes in the PICU, the median ICU stay was 5 days (IQR: 2 to 11), and the median duration of IMV was 2 days (IQR: 1 to 5.5), with a maximum duration of 63 days (approximately 42.8% of patients required IMV for less than 2 days, while 38.0% required it for 2 to 7 days). Furthermore, prone positioning was required in 4.71%, tracheostomy in 2.55%, and high-frequency oscillatory ventilation (HFOV) in 1.28%. Extubation failure occurred in 8.34% of patients (at least once), and overall mortality was 11.48%. The main diagnoses were septic shock (19.82%), and unspecified pneumonia (19.04%). Mortality increased to around 40% in patients with post-cardiac arrest, congestive heart failure, or acute kidney injury; approximately 30% in those with liver failure; and up to around 20% in patients with septic or multifactorial shock. Additionally, we observed a trend suggesting that longer duration of IVM may be related to worse clinical outcomes, including higher PRISM scores at admission, longer ICU stay, increased use of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV), as well as higher mortality.

Conclusion: In this Peruvian cohort, severe outcomes were related to a longer duration of IMV, and mortality was significantly higher among patients with organ failure and shock. These findings underscore the importance of early risk stratification and the development of context-specific strategies to reduce IMV duration, especially in resource-limited settings.