Organization Characteristics in Europe

Abstract

Mechanical ventilation is the principal technology that justifies admission of critically ill patients in intensive care units (children (www.picanet.org.uk) as well as adults (Metnitz et al. 2009)). In a recent survey conducted in France in 2002 by the French Ministry of Health that included 40 intensive care units for children (30 caring for neonates and children (N-PICUs), 10 caring only for children older than 1 month (PICUs)), and 24 units completed the item “mechanical ventilation” for a total of 14,147 admissions. In total, 47 % of patients were mechanically ventilated (30 % with a duration of more than 48 h) (Table 1.1. data not published). This percentage is close to the 40–45 % reported in the Netherlands (Dahlem et al. 2003; Kneyber et al. 2008) and 49 % in Italy (Wolfler et al. 2010) and higher than that recently reported in 16 US pediatric ICUs (30 %; range 20–64 %) (Khemani et al. 2009), but lower than the 73 % reported in the UK for 2008 (www.picanet.org.uk). Also, respiratory diseases or dysfunction represent the most frequent cause of ICU admission either for neonates (Janota et al. 2008) or children (Johnston et al. 2004; Leteurtre et al. 2003). In a recent report of 51,386 children with organ dysfunction, respiratory dysfunction was the strongest predictor of death and was associated with a greater than 5-fold increase in length of stay and a 25-fold increase in total charges (Johnston et al. 2004). Finally, number of ventilation-free days is utilized as an outcome measure in clinical trials assuming that the decrease in duration of ventilation benefits the patient and reduces treatment costs (Curley and Zimmerman 2005).