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Risk factors for prolonged mechanical ventilation for children on ventricular assist device support

Parthak Prodhan1, Giridhar Kalikivenkata2, Xinyu Tang3

  • 1Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas.

The Annals of Thoracic Surgery
|March 11, 2015
PubMed

Insights

Children needing mechanical ventilation (MV) after ventricular assist device (VAD) implantation face prolonged support if they previously required extracorporeal membrane oxygenation (ECMO) or have significant valve regurgitation.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • End-stage heart failure in children often necessitates mechanical ventilation (MV).
  • Limited data exist on MV support duration and factors influencing it in pediatric ventricular assist device (VAD) recipients.
  • This study investigates MV duration and associated patient factors post-VAD implantation in children.

Purpose of the Study:

  • To determine the duration of mechanical ventilation (MV) in pediatric patients following ventricular assist device (VAD) implantation.
  • To identify indications for respiratory support in the post-VAD implantation period.
  • To explore patient-specific factors associated with prolonged MV in this population.

Main Methods:

  • A single-center retrospective study included 43 pediatric patients (<18 years) receiving VADs as a bridge to transplantation.
  • Data were collected from January 2005 to December 2011.
  • Multivariable analysis using a multiple Poisson regression model assessed the duration of MV.

Main Results:

  • 33% of pediatric VAD recipients remained on MV until heart transplant or death.
  • Pre-VAD extracorporeal membrane oxygenation (ECMO) significantly increased the likelihood of prolonged MV (63% vs. 8%, p < 0.001).
  • Moderate/severe mitral or tricuspid regurgitation and left VAD-only implants were associated with increased MV duration.

Conclusions:

  • Pediatric VAD recipients with prior ECMO support, moderate/severe mitral or tricuspid regurgitation, or left VAD-only implants face a higher risk of prolonged mechanical ventilation.
  • These findings highlight specific risk factors for extended respiratory support in pediatric VAD patients.
  • Larger cohort studies are needed to validate these single-institution findings.
Abstract

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