Time Toxicity: Quantifying Healthcare Utilization Attributable to Pediatric Home Ventilation.

Area of Science:

• Pediatric critical care medicine
• Health services research
• Patient-reported outcomes

Background:

• Pediatric invasive home ventilation is a complex intervention for infants with severe respiratory conditions.
• Quantifying the non-medical burden, termed "time toxicity," is crucial for understanding the holistic impact on families.
• Previous research has not comprehensively measured the healthcare utilization time associated with pediatric home ventilation.

Purpose of the Study:

• To determine the
• time toxicity,
• or time burden, experienced by pediatric patients requiring invasive home ventilation.
• To compare healthcare utilization between pediatric patients with tracheostomy with/without home ventilation and matched controls.
• To provide objective data to aid families in preparing for the demands of home ventilation.

Main Methods:

• Retrospective chart review of patients from a single neonatal intensive care unit (2016-2024).
• Inclusion of patients who received a tracheostomy with/without home ventilation (T+/-HV).
• Matched controls were selected based on gestational week distribution; healthcare encounters were compared.

Main Results:

• The T+/-HV cohort (62 patients) had significantly higher mortality (35.5%) than controls (9%).
• Median healthcare encounters (64.0 vs. 15.5) and days of utilization (296 vs. 46) were substantially greater in the T+/-HV cohort.
• Healthcare utilization differences were most pronounced in the first year of life, with survivors showing higher utilization if not decannulated.

Conclusions:

• This study quantifies "time toxicity" for pediatric invasive home ventilation, highlighting a significant healthcare burden.
• Neonates receiving a tracheostomy spent over half of their first two years interacting with the healthcare system.
• Objective data on "time toxicity" can better prepare families for the realities of home ventilation care.