Mechanical ventilation (MV) is indispensable in paediatric intensive care units (PICUs), providing life-saving support in acute respiratory and circulatory failure. Despite advancements, MV is linked to complications such as ventilator-associated pneumonia (VAP), barotrauma, and prolonged ICU stay, increasing morbidity and mortality. The study aims to evaluate the clinical profile, complications, and outcomes of mechanically ventilated children in a tertiary care setting.

Study Design: Prospective hospital-based Study Setting: Paediatric Intensive Care Unit, SVRR Government General Hospital, Tirupati Sample Size: 157 children (1 month–12 years) over one year Inclusion Criteria: All mechanically ventilated children admitted to PICU Data Collected: Demographics, diagnosis, intubation details, complications, and outcomes Analysis: SPSS v21, Chi-square test; p <0.05 considered significant

Infants comprised the majority (56.7%). The commonest indication for intubation was respiratory failure (26.1%), followed by circulatory dysfunction (12.7%). Complications occurred in 12% of cases, with ventilator-associated pneumonia being most common (10.8%). Mortality was 69.4%, significantly higher among infants (p=0.042) and males (p=0.015).

This study provides insight into the clinical profile and outcomes of children requiring mechanical ventilation in a tertiary care PICU. The majority of cases were infants, who also demonstrated the highest mortality. This aligns with previous studies reporting increased vulnerability in infants due to immature immune responses and underdeveloped respiratory systems. Respiratory illnesses such as pneumonia were the leading cause for admission and intubation, consistent with global literature. The high proportion of ventilator-associated pneumonia as a complication mirrors findings from other studies, where infection control remains a major challenge in PICU settings. The mortality rate of nearly 70% observed in this cohort is higher than reported in developed countries, highlighting disparities in healthcare infrastructure, early recognition, and resource allocation. Comparisons with international studies show that mortality in developed countries ranges between 20-40%, while studies from developing nations like India and Brazil report higher figures. Factors contributing to poor outcomes include late referrals, limited availability of advanced ventilatory support, and higher prevalence of sepsis and respiratory infections. Uncuffed tubes, though commonly used in this cohort, were associated with higher risks of displacement and obstruction. Current evidence suggests that appropriately monitored cuffed tubes may reduce complications. Strengthening training, early intervention, and improving nurse-to-patient ratios could improve survival rates.

This study concludes that mechanical ventilation in PICU carries a high risk of mortality, particularly in infants and children with respiratory etiologies such as pneumonia and sepsis. Ventilator-associated pneumonia was the most frequent complication. Measures including early detection of respiratory failure, judicious intubation practices, better infection control, and systematic weaning protocols are critical to reducing mortality. Investments in healthcare infrastructure and training are essential to improve outcomes in resource-limited settings.

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