Recovery Trajectories in Children Requiring 3 or More Days of Invasive Ventilation
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Published on: April 7, 2021
Aline B Maddux1,2, Kristen R Miller3, Yamila L Sierra4
1Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO.
Insights
Critically ill children often experience impaired quality of life and function after invasive ventilation. Early therapy consultation may improve recovery, especially for older children with better baseline health.
Area of Science:
- Pediatric Critical Care Medicine
- Health-Related Quality of Life (HRQL) Research
- Functional Recovery in Children
Background:
- Critically ill children receiving invasive ventilation face prolonged recovery challenges.
- Understanding health-related quality of life (HRQL) and functional recovery is crucial for this population.
- Identifying risk factors for persistent impairments is essential for targeted interventions.
Purpose of the Study:
- To characterize HRQL and functional recovery trajectories in critically ill children.
- To identify risk factors associated with prolonged impairments after invasive ventilation.
- To evaluate the impact of early interventions on recovery outcomes.
Main Methods:
- Prospective cohort study involving 144 children requiring invasive ventilation for ≥3 days.
- Assessment of HRQL using the Pediatric Quality of Life Inventory and functional status via the Functional Status Scale (FSS).
- Data collection at baseline, hospital discharge, and at 1, 3, 6, and 12 months post-discharge; analysis using interaction forests.
Main Results:
- At 1 month post-discharge, 56% reported worsened HRQL and 29% had new functional impairments.
- These impairments improved by 3 months but remained significant throughout the 12-month follow-up.
- Early therapy consultation (within 3 days of intubation) was linked to better HRQL recovery in older children.
Conclusions:
- Impairments in HRQL and functional status are common in children with acute respiratory failure.
- Significant health resource utilization, including emergency visits and new therapy referrals, was observed.
- Early therapy consultation represents a modifiable factor associated with improved HRQL recovery in specific pediatric patient groups.
Objectives:
To characterize health-related quality of life (HRQL) and functional recovery trajectories and risk factors for prolonged impairments among critically ill children receiving greater than or equal to 3 days of invasive ventilation.
Design:
Prospective cohort study.
Setting:
Quaternary children's hospital PICU.
Patients:
Children without a preexisting tracheostomy who received greater than or equal to 3 days of invasive ventilation, survived hospitalization, and completed greater than or equal to 1 postdischarge data collection.
Interventions:
None.
Measurements And Main Results:
We evaluated 144 children measuring HRQL using proxy-report Pediatric Quality of Life Inventory and functional status using the Functional Status Scale (FSS) reflecting preillness baseline, PICU and hospital discharge, and 1, 3, 6, and 12 months after hospital discharge. They had a median age of 5.3 years (interquartile range, 1.1-13.0 yr), 58 (40%) were female, 45 (31%) had a complex chronic condition, and 110 (76%) had normal preillness FSS scores. Respiratory failure etiologies included lung disease ( n = 49; 34%), neurologic failure ( n = 23; 16%), and septic shock ( n = 22; 15%). At 1-month postdischarge, 68 of 122 (56%) reported worsened HRQL and 35 (29%) had a new functional impairment compared with preillness baseline. This improved at 3 months to 54 (46%) and 24 (20%), respectively, and remained stable through the remaining 9 months of follow-up. We used interaction forests to evaluate relative variable importance including pairwise interactions and found that therapy consultation within 3 days of intubation was associated with better HRQL recovery in older patients and those with better preillness physical HRQL. During the postdischarge year, 76 patients (53%) had an emergency department visit or hospitalization, and 62 (43%) newly received physical, occupational, or speech therapy.
Conclusions:
Impairments in HRQL and functional status as well as health resource use were common among children with acute respiratory failure. Early therapy consultation was a modifiable characteristic associated with shorter duration of worsened HRQL in older patients.
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