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Updated: Sep 14, 2025
Mechanical Ventilation Boot Camp Curriculum
Published on: March 12, 2018
Parent and Provider Perspectives on Short-Term Outcomes of Critically Ill Ventilated Children
Megan M Shannon1, Garrett Keim1, Michael O Harhay2
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
Insights
Families and PICU providers both prioritize ventilator duration as a key outcome for children. Ventilator-free days (VFDs) align with patient-centered priorities in pediatric critical care research.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Research Methodology
- Patient-Centered Outcomes
Background:
- Mortality is rare in pediatric critical care, necessitating alternative composite outcomes.
- Ventilator-free days (VFDs) and other free-day metrics are common but their patient-centeredness is debated.
- Understanding family and provider priorities is crucial for selecting relevant outcomes.
Purpose of the Study:
- To compare priorities of families and PICU providers for nonmortality outcomes in ventilated pediatric patients.
- To determine if commonly used composite outcomes reflect true patient-centered preferences.
- To hypothesize differing priorities between families and providers.
Main Methods:
- Prospective, cross-sectional survey at a single academic PICU.
- Surveyed 50 adult caregivers and 30 PICU faculty caring for ventilated children.
- Ranked five nonmortality outcomes: duration of invasive ventilation, total ventilation duration, oxygen support duration, PICU length of stay (LOS), and hospital LOS.
Main Results:
- Poor agreement within families (kappa=0.11) and providers (kappa=0.15) on outcome rankings.
- Both groups ranked duration of invasive ventilation highest and total ventilation duration second highest.
- Families prioritized oxygen support duration, then PICU LOS, then hospital LOS; providers prioritized PICU LOS, then hospital LOS, then oxygen support duration.
Conclusions:
- Duration of invasive ventilation is a patient- and family-centered outcome measure.
- Length of stay (LOS) is less prioritized by families and providers compared to ventilation duration.
- Composite outcomes based on ventilator duration, such as VFDs, are supported as patient-centered.
Objectives:
As mortality is rare in pediatrics, alternative composite outcomes such as ventilator-free days (VFDs), PICU-free days, or hospital-free days, are often used in pediatric critical care research. However, it is unclear which of these nonmortality components of composite outcomes are prioritized by families, and thus reflect true patient-centered outcomes. We therefore aimed to determine and compare families' and PICU providers' priorities regarding outcomes for ventilated patients in the PICU. We hypothesized that families and providers would prioritize different nonmortality outcomes.
Design:
This is a single-center, prospective cross-sectional survey of immediate caregivers of children experiencing both invasive and noninvasive ventilation and asynchronously of PICU attending providers. Subjects were asked to rank, in order of priority, five nonmortality outcomes: duration of invasive ventilation, duration of invasive and noninvasive ventilation, duration of any oxygen support, PICU length of stay (LOS), and hospital LOS.
Setting:
Quaternary, academic PICU in urban setting.
Subjects:
We surveyed 50 adult caregivers and 30 PICU faculty.
Interventions:
Survey administration at a single timepoint.
Measurements And Main Results:
While both families (kappa = 0.11) and providers (kappa = 0.15) demonstrated poor overall intra-group agreement of rankings, most families and providers ranked duration of invasive ventilation highest, and duration of invasive and noninvasive ventilation second highest. However, families ranked their subsequent priorities (in order) as the duration of all oxygen support, PICU LOS, and then hospital LOS. In contrast, providers ranked PICU LOS, then hospital LOS, and lastly, duration of all oxygen support.
Conclusions:
In a study that directly assessed family and provider preferences of nonmortality outcomes, we found that duration of invasive ventilation is indeed a patient- and family-centered outcome measure, while LOS is less prioritized in intubated PICU patients. This suggests that composites based on ventilator duration, such as VFDs, are indeed patient-centered.
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