Indications and Short-Term Outcomes of Conventional Mechanical Ventilation in a Neonatal Intensive Care Unit of a Tertiary Care Hospital in a Developing Country

Abstract

Background: Mechanical ventilation is an advanced intervention employed in neonatal intensive care units (NICUs) to assist neonates who require external ventilation for adequate gas exchange, while minimizing associated complications. Understanding the indications and short-term outcomes of mechanical ventilation is crucial for improving neonatal care, especially in developing countries with limited resources.

Objective: To examine the indications and short-term outcomes of conventional mechanical ventilation in a neonatal intensive care unit of a tertiary care hospital in a developing country.

Methods: This descriptive cross-sectional study was conducted from July 2022 to February 2023 in the Department of Paediatrics at Combined Military Hospital, Kharian. The study included 227 pediatric patients admitted to the NICU for mechanical ventilation, selected via consecutive non-probability sampling. Written informed consent was obtained from parents or guardians. Data collected included neonatal and pregnancy parameters, primary indication for mechanical ventilation, duration of mechanical ventilation, and length of hospital stay. Patients were monitored for complications such as pneumothorax, sepsis, and ventilator-associated pneumonia. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0. Quantitative variables were expressed as mean ± standard deviation or median and interquartile range, while qualitative variables were presented as frequencies and percentages. Comparisons were made using the Chi-square test, Fisher's exact test, independent samples t-test, or Mann-Whitney U test as appropriate, with a p-value of ≤0.05 considered significant.

Results: The study included 128 males (56.4%) and 99 females (43.6%). The mean gestational age at birth was 36.4 ± 1.5 weeks, and the mean birth weight was 2994.1 ± 450.1 grams. Common indications for mechanical ventilation included pneumonia (26.4%), respiratory distress syndrome (24.7%), and sepsis (18.5%). The mean duration of mechanical ventilation was 7.1 ± 2.5 days, and the mean length of hospital stay was 13.4 ± 6.0 days. Complications were observed in 29.5% of patients, with ventilator-associated pneumonia (18.1%) being the most common, followed by sepsis (9.7%) and pneumothorax (5.3%). The overall mortality rate was 18.5%. Significant associations were found between mortality and duration of mechanical ventilation (p<0.001), occurrence of complications (p<0.001), and requirement for re-intubation (p<0.001).

Conclusion: The study highlights the significant association between prolonged mechanical ventilation, the development of complications, and increased mortality in neonates. Effective strategies to prevent and manage complications, as well as to limit the duration of mechanical ventilation, are essential to improve neonatal outcomes in resource-limited settings.