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A multi-institutional analysis of children on long-term non-invasive respiratory support and their outcomes

Monica L Koncicki1, Philip Zachariah2, Adam R Lucas3

  • 1Section of Pediatric Critical Care, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.

Pediatric Pulmonology
|January 18, 2018
PubMed

Insights

Most children on long-term non-invasive respiratory support transition to transtracheal ventilation within years. Anoxia/encephalopathy and quadriplegia increase this risk, while older age and later discharge decrease it.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Critical Care

Background:

  • Chronic respiratory failure in children necessitates long-term respiratory support.
  • Non-invasive respiratory support is a common initial management strategy.
  • Understanding progression to invasive support is crucial for patient care.

Purpose of the Study:

  • To describe a cohort of pediatric patients with chronic respiratory failure on non-invasive support.
  • To analyze the time to transition to transtracheal ventilation.
  • To identify factors influencing earlier transition to transtracheal ventilation.

Main Methods:

  • Retrospective cohort study using the Pediatric Health Information System (2007-2015).
  • Included patients <21 years with chronic respiratory failure on non-invasive support.
  • Competing risk regression analysis to identify associated factors.

Main Results:

  • 3802 patients were analyzed; 8.9% transitioned to transtracheal ventilation.
  • Median transition time was 11.5 months post-discharge.
  • Anoxia/encephalopathy and quadriplegia were associated with higher hazard of transition; older age and later discharge with lower hazard.

Conclusions:

  • Progression to transtracheal ventilation typically occurs within years of initiating non-invasive support.
  • Specific clinical factors predict earlier transition, aiding in anticipatory guidance.
  • This study provides insights into the natural history of respiratory support in pediatric chronic respiratory failure.
Abstract

Keywords:
continuous positive airway pressureintermittent positive-pressure ventilationpediatricsrespiratory insufficiency

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