Identifying Risk Factors Associated with Mortality in Critically Ill Ventilated Infants at a Tertiary Care Setting

Open Access

Abstract

Background: Critically ill infants requiring mechanical ventilation face a high risk of mortality, especially in resource-limited settings. Identifying modifiable risk factors is crucial to improving survival outcomes. Objective: To evaluate risk factors associated with mortality among ventilated infants in a tertiary care hospital. Methods & Materials: This observational study was conducted in the Department of Intensive Care Unit of Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh, from January 2020 to December 2020. This study included 50 critically ill young infants up to 2 months of age who required mechanical ventilation. Among these infants, 37 (74.0%) died during the study period, while 13 (26.0%) survived. Results: The study showed no significant differences in age, gestational age, birth weight, or sex distribution between the two groups. Higher initial ventilatory settings, including FiO₂ >80%, PIP >18 cmH₂O, and PEEP >5 cmH₂O, were significantly associated with death (p<0.01). Hypernatremia (Na⁺ >145 mmol/L) also showed a significant association with mortality (p =0.039). However, severe respiratory distress before extubation and ventilation duration >5 days were significantly associated with poor outcomes. Multivariable regression analysis confirmed initial high PIP, low bicarbonate, severe respiratory distress, and prolonged ventilation as independent predictors of mortality. Conclusion: Infants on mechanical ventilation with high initial settings, metabolic acidosis, severe respiratory distress, and prolonged ventilation have increased mortality risk. Early recognition and management of these factors may improve survival outcomes.