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Change in Frequency of Invasive and Noninvasive Respiratory Support in Critically Ill Pediatric Subjects
Dhimitri A Nikolla1, Ashar Ata2, Nancy Brundage3
1Department of Emergency Medicine, Allegheny Health Network, Erie, Pennsylvania. dhimitri.nikolla@med.lecom.edu.
Insights
Noninvasive respiratory support increased in critically ill children from 2009 to 2017, surpassing invasive methods by 2017. This trend suggests a shift towards less invasive ventilation strategies in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Respiratory support strategies
- Health services research
Background:
- Noninvasive respiratory support is increasingly utilized in pediatric populations.
- It may offer an alternative to invasive procedures like endotracheal intubation.
- Understanding trends and associated factors is crucial for optimizing care.
Purpose of the Study:
- To analyze the frequency of invasive and noninvasive respiratory support in critically ill pediatric patients.
- To examine trends in respiratory support from 2009 to 2017.
- To identify patient-related factors associated with invasive support.
Main Methods:
- Analysis of prospectively collected data from 17 pediatric ICUs (2009-2017).
- Utilized the Virtual Pediatric Systems database.
- Employed univariate and multivariate regression analyses to identify associated factors.
Main Results:
- A total of 69,262 cases of respiratory support were analyzed.
- Invasive support decreased from 66.9% to 48.5% (P < .001).
- Noninvasive support increased from 28.7% to 57.7% (P < .001), exceeding invasive support by 2017.
- Younger infants (<1 month) and trauma cases were more likely to receive invasive support.
- Later years and Black or Hispanic race were associated with less invasive support.
Conclusions:
- The frequency of invasive respiratory support declined significantly between 2009 and 2017.
- Noninvasive respiratory support use increased substantially, becoming more common than invasive support by 2017.
- These findings highlight a significant shift in respiratory support modalities for critically ill children.
Background:
Noninvasive respiratory support has become more popular in the pediatric population and may prevent or replace invasive procedures, such as endotracheal intubation, in certain circumstances. The objective was to examine the frequency of invasive and noninvasive respiratory support from 2009 to 2017 in critically ill pediatric patients and to determine patient-related factors associated with invasive support using the Virtual Pediatric Systems, LLC database.
Methods:
This was an analysis of prospectively collected data on admissions with respiratory support from 17 pediatric ICUs from 2009 to 2017 reported within the Virtual Pediatric Systems database. We determined the frequency of invasive and noninvasive respiratory support over the study period by measuring the number of admissions with either invasive or noninvasive support within a given year divided by the total number of pediatric ICU admissions with respiratory support during the same year. Factors associated with invasive support were examined in univariate and multivariate regressions.
Results:
A total of 69,262 cases of respiratory support were included. There was a decrease in the rate of invasive support over the study period from 66.9% to 48.5% (P value for test of trend < .001) and an increase in the rate of noninvasive support from 28.7% to 57.7% (P value for test of trend < .001). Trauma cases and subjects < 1 month old were more likely to receive invasive support. Cases occurring in later years and subjects with Black or Hispanic race were less likely to receive invasive support.
Conclusions:
From 2009 to 2017, the frequency of admissions with invasive respiratory support decreased, and those with noninvasive respiratory support increased. By 2017, the frequency of noninvasive respiratory support was greater than that of invasive respiratory support.
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