Respiratory Complications of Intensive Care

A significant proportion of children admitted to pediatric intensive care units receive invasive mechanical ventilation. While respiratory disease in children is a major indication for endotracheal intubation and ventilation, these patients comprise only one-fifth of pediatric intensive care unit (ICU) admissions, and there are numerous non-respiratory indications for mechanical ventilation, including postoperative care and pain management, neurologic and neuromuscular pathology, congenital heart disease, cardiomyopathy, and shock. However, mechanical ventilation can contribute to significant complications including mucus plugging, suction-induced airway injury, atelectasis, ventilator-induced lung injury, ventilator-associated pneumonia, air leak syndromes, and ICU neuropathy and myopathy. This chapter discusses the risk factors, presentation, and evidence-based management of these ICU-related respiratory complications. Additionally, this chapter discusses special pulmonary considerations in management of critically ill children with congenital heart diseases, neuromuscular diseases, malignancy, and hematopoietic stem cell transplantation..