Acute mechanical ventilation: an index of the absolute need for pediatric intensive care unit beds.

Acute mechanical ventilation (MV) is an absolute indication for pediatric ICU (PICU) admission. Only 28% of PICU patients over an 8-yr period required acute MV, yet these accounted for 52.5% of total patient days. Transport admissions were more likely to require acute MV (40.4%). Subgroups of MV patients differing significantly (p less than .01) in the median duration of intensive care included the following: a) under 2 years (5 days) vs. older (4 days); b) medical (5 days) vs. all perioperative (3 days); and c) cardiac surgery (3 days) vs. other perioperative (4 days). We found that a) an average of 3.79 PICU beds per million general population (1.39 per 100,000 children under age 18 yr) were occupied daily by acute MV patients; b) the total PICU bed occupancy averaged 7.54 beds per million general population (2.76 per 100,000 children under age 18 yr) or twice that needed for acute MV patients alone; and c) regression equations based on subgroup annual admissions accurately predicted annual variability in acute MV census/day at both the study and a comparison hospital.