Related Experiment Video
Updated: Jun 12, 2025
Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
Adolescents and Young Adults With Respiratory Failure in U.S. PICUs: A Pediatric Health Information System Database
Kevin S Gochenour1, Melissa H Ross1, Heidi R Flori2
1Division of General Pediatrics, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
Insights
Adolescents and young adults (AYAs) with respiratory failure admitted to pediatric intensive care units (PICUs) have higher mortality and resource use. Unique comorbidities in AYAs highlight the need for specialized care transition strategies.
Area of Science:
- Critical Care Medicine
- Pediatric Pulmonology
- Health Services Research
Background:
- Adolescents and young adults (AYAs) represent a significant patient population in pediatric intensive care units (PICUs).
- Respiratory failure is a common reason for PICU admission across various age groups.
- Understanding the specific needs of AYAs with respiratory failure is crucial for optimizing care.
Purpose of the Study:
- To investigate the clinical characteristics of AYAs admitted to PICUs with respiratory failure.
- To analyze the outcomes and resource utilization for AYAs with respiratory failure.
- To compare AYAs with younger pediatric patients regarding comorbidities and critical care management.
Main Methods:
- Retrospective cohort study utilizing de-identified data from the Pediatric Health Information System (PHIS) database.
- Analysis of 430,238 PICU admissions for respiratory failure from January 2011 to December 2022 across 48 U.S. children's hospitals.
- Patients were stratified into five age cohorts: < 15, 15-18, 19-21, 22-25, and > 25 years old.
Main Results:
- AYAs (≥ 15 years) constituted 15% of all PICU admissions for respiratory failure.
- Older AYAs (> 25 years) exhibited higher rates of medical technology dependence (49%) and cardiovascular comorbidities (61%) compared to younger children (< 15 years).
- AYAs experienced higher crude mortality rates (7.7%) and median hospital charges ($163K) than younger patients, despite similar ventilator days and length of stay for survivors.
Conclusions:
- AYAs with respiratory failure represent a substantial PICU population with distinct comorbidity profiles and increased mortality risk.
- The medical complexity and sequelae of pediatric conditions in AYAs may impede their transition to adult care.
- Enhanced collaboration between pediatric and adult critical care specialists is essential for developing evidence-based guidelines and improving care across the age spectrum.
Objectives:
To examine the clinical characteristics, outcomes, and resource use of adolescents and young adults (AYAs) admitted to PICUs in the United States with respiratory failure.
Design:
Retrospective cohort study.
Setting:
De-identified data from 48 U.S. children's hospitals contributing to the Pediatric Health Information System (PHIS) database.
Patients:
All patients older than 30 days old with respiratory failure, defined as encounters with clinical transaction codes for noninvasive or invasive mechanical ventilation, admitted to PHIS database PICUs from January 2011 to December 2022. Patients were categorized into five cohorts (< 15, 15-18, 19-21, 22-25, and > 25 yr old).
Interventions:
None.
Measurements And Main Results:
A total of 430,238 patients were identified. AYA (≥ 15 yr old) accounted for 15% (65,740) of all PICU admissions with respiratory failure. Forty-nine percent (32,232/65,740) of AYA older than 25 years had medical technology dependence compared with 39% in those younger than 15 years ( p < 0.001). Sixty-one percent of AYA older than 25 years had a cardiovascular comorbidity compared with 35% of those younger than 15 years ( p < 0.001). Forty percent of AYA older than 25 years had a neurologic comorbidity, and 27% a gastrointestinal comorbidity, compared with 27% and 31%, respectively, in those younger than 15 years (all p < 0.001). Compared with those younger than 15 years, AYA median hospital crude mortality rate was higher at 7.7% compared with 5.2%, as were median hospital charges per encounter at $163K (interquartile range [IQR], $77K-$350K) vs. $121K (IQR, $53K-$278K; all p < 0.001). Median ventilator days and hospital length of stay in survivors were similar for all age cohorts.
Conclusions:
AYA represent a substantial proportion of patients admitted to the PICU with respiratory failure. These individuals have unique comorbidities and are at risk for increased mortality and resource utilization compared with younger patients during hospitalization. Medical complexity and sequelae of pediatric illness may delay the transition of AYA to adult care, necessitating collaboration between adult and pediatric critical care physicians to increase research across the age spectrum and develop and implement appropriate evidence-based guidelines.
Related Concept Videos
01:30Acute Respiratory Failure-III
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:23Acute Respiratory Failure-IV
01:27Physical Assessment of the Respiratory Tract II: Inspection
Chest Configuration
The chest configuration...