Survival Time and Determinants of Mortality Among Children Receiving Mechanical Ventilation in Pediatric Intensive Care Units at Selected Hospitals in Kigali, Rwanda - A Retrospective Follow-up Study.

Abstract

Background: Mechanical ventilation is one of the life-saving therapies offered to critically ill pediatric patients admitted in pediatric intensive care units (PICUs). Despite high mortality among mechanically ventilated children, evidence on duration of survival and determinants of mortality among ventilated children from low- or middle-income countries remains limited.

Objective: This study aims to assess survival time and determinants of mortality among mechanically ventilated children admitted to the Pediatric Intensive Care Units at selected hospitals in Kigali, Rwanda.

Methods: A retrospective follow-up study of 300 medical records of children aged between 29 days and 14 years that underwent mechanical ventilation admitted to the PICUs of Kigali University Teaching Hospital and Rwanda Military teaching Hospital between January 2022 and December 2025 was conducted. Data was extracted using structured checklist. SPSS version 31 was used to analyze the data. Survival probability was estimated using Kaplan-Meier curve. Variables with p < 0.25 with bivariate cox regression analysis were fitted into multivariable regression model. Results were presented as adjusted hazard ratios (AHRs) with corresponding 95% confidence intervals (CIs), and statistical significance was considered at a p-value < 0.05.

Results: Among the 300 mechanically ventilated children, 169 (56.3%) died while 131 (43.7%) were censored. The median survival time was 7 days CI [5.7, 8.3], while the mean duration of survival was 19 days CI [1.025, 28.20]. Respiratory distress (AHR = 1.42, 95% CI [1.01, 2.01], p = 0.046), post-operative period (AHR = 1.73[1.03, 2.90], p = 0.039) and vasopressor support (AHR = 1.73 [1.03, 2.62], p = 0.036) were determinants for increased mortality. Determinants associated with decreased mortality were tracheostomy (AHR = 0.25, 95% CI [0.08, 0.82], p = 0.023] and sedation (AHR = 0.40, 95% CI [0.23, 0.71], p = 0.001).

Conclusion: Mortality among mechanically ventilated children in PICU was high. Respiratory failure, postoperative condition, and vasopressor support were associated for increased mortality, while tracheostomy and sedation was associated with lower mortality.