Characteristics and Outcomes of Critical Illness in Children With Feeding and Respiratory Technology Dependence
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Published on: August 19, 2020
Julia A Heneghan1, Ron W Reeder2, J Michael Dean2
1Department of Pediatrics, Children's National Health System and the George Washington School of Medicine and Health Sciences, Washington, DC.
Insights
Children requiring respiratory or feeding technology had similar critical illness outcomes but used more resources. Technology-dependent children in the pediatric intensive care unit (PICU) did not show worse morbidity or mortality rates.
Area of Science:
- Pediatric critical care medicine
- Technology dependence in children
- Healthcare resource utilization
Background:
- Children dependent on respiratory or feeding technologies are common in pediatric intensive care units (PICUs).
- Limited data exists on the characteristics and outcomes of technology-dependent children in the PICU.
- Hypothesis: Technology dependence increases risk for critical illness morbidity and mortality.
Purpose of the Study:
- To characterize technology-dependent children admitted to the PICU.
- To compare outcomes of technology-dependent children versus those without technology dependence.
- To evaluate the impact of technology dependence on critical illness outcomes.
Main Methods:
- Secondary analysis of a prospective, probability-sampled cohort study.
- Inclusion of children aged 0-18 years admitted to general and cardiovascular PICUs.
- Assessment of demographic, clinical characteristics, and various outcomes including death, new morbidity, and functional status.
Main Results:
- Technology-dependent children comprised 19.7% of PICU admissions.
- These children were younger, received more ICU therapies, and had higher readmission rates.
- New morbidity (4.5%) and mortality (3.7%) rates were similar to non-technology-dependent children, contradicting the initial hypothesis.
Conclusions:
- Technology dependence in children does not appear to worsen critical illness outcomes like morbidity and mortality.
- Comparable outcomes were achieved using additional resources, including more ICU therapies and longer hospital stays.
- Some technology-dependent survivors demonstrated improved functional status upon discharge.
Objectives:
Children with dependence on respiratory or feeding technologies are frequently admitted to the PICU, but little is known about their characteristics or outcomes. We hypothesized that they are at increased risk of critical illness-related morbidity and mortality compared with children without technology dependence.
Design:
Secondary analysis of prospective, probability-sampled cohort study of children from birth to 18 years old. Demographic and clinical characteristics were assessed. Outcomes included death, survival with new morbidity, intact survival, and survival with functional status improvement.
Setting:
General and cardiovascular PICUs at seven participating children's hospitals as part of the Trichotomous Outcome Prediction in Critical Care study.
Subjects:
Children from birth to 18 years of age as part of the Trichotomous Outcome Prediction in Critical Care study.
Interventions:
None.
Measurements And Main Results:
Children with technology dependence composed 19.7% (1,989/10,078) of PICU admissions. Compared with those without these forms of technology dependence, these children were younger, received more ICU-specific therapeutics, and were more frequently readmitted to the ICU. Death occurred in 3.7% of technology-dependent patients (n = 74), and new morbidities developed in 4.5% (n = 89). Technology-dependent children who developed new morbidities had higher Pediatric Risk of Mortality scores and received more ICU therapies than those who did not. A total of 3.0% of technology-dependent survivors (n = 57) showed improved functional status at hospital discharge.
Conclusions:
Children with feeding and respiratory technology dependence composed approximately 20% of PICU admissions. Their new morbidity rates are similar to those without technology dependence, which contradicts our hypothesis that children with technology dependence would demonstrate worse outcomes. These comparable outcomes, however, were achieved with additional resources, including the use of more ICU therapies and longer lengths of stay. Improvement in functional status was seen in some technology-dependent survivors of critical illness.
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