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Chronic respiratory failure of infancy and childhood: clinical outcomes based on underlying etiology
W B Wheeler1, E L Maguire, S C Kurachek
1Division of Pulmonary and Critical Care Medicine, Minneapolis Children's Medical Center, Minnesota.
Insights
Outcomes for pediatric chronic respiratory failure patients vary by diagnosis. Chronic lung disease patients showed better outcomes than those with neurologic or congenital conditions, despite higher rates of specific morbidities.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Neonatology
Background:
- Chronic respiratory failure of infancy and childhood (CRFIC) presents diverse clinical challenges.
- Understanding how underlying diagnoses impact patient outcomes is crucial for effective management.
Purpose of the Study:
- To evaluate the influence of underlying diagnosis on morbidity and mortality in pediatric patients with chronic respiratory failure.
- To compare outcomes among patients with chronic lung disease (CLD), neurologic/neuromuscular diseases (NM), and congenital abnormalities (CA).
Main Methods:
- A cohort of 55 pediatric patients with CRFIC was studied.
- Patients were categorized into CLD, NM, or CA groups.
- Outcomes including mortality, ventilatory support duration, tracheostomy, weaning success, neurodevelopment, and specific morbidities were assessed over a mean follow-up of 21.3 months.
Main Results:
- Overall mortality was low (7%) with no significant differences between diagnostic groups.
- Patients with CLD demonstrated superior outcomes in ventilatory support duration, tracheostomy duration, and weaning success compared to NM and CA groups.
- CLD patients experienced higher frequencies of tracheomalacia, feeding disorders, and hypogammaglobulinemia G.
Conclusions:
- Survival rates for pediatric chronic respiratory failure are high across different underlying diagnoses.
- Morbidity profiles and treatment requirements significantly differ based on the etiology of chronic respiratory failure in children.
- Chronic lung disease in pediatric patients with respiratory failure is associated with better long-term functional outcomes despite specific associated morbidities.
Abstract:
To assess whether underlying diagnosis affects morbidity and mortality outcomes in patients with chronic respiratory failure, we studied 55 patients with chronic respiratory failure of infancy and childhood (CRFIC). Entry criteria included patients with chronic respiratory failure due to static neurologic or neuromuscular conditions or secondary to other disease processes considered likely to improve or resolve over time. Subjects were grouped into those having chronic lung disease (CLD, n = 22), neurologic or neuromuscular diseases (NM, n = 21), or congenital abnormalities affecting the respiratory system (CA, n = 12). The average duration of follow-up was 21.3 months. There were no differences between groups in mortality with only four deaths (7%). Patients with CLD fared better than those with NM or CA in duration of ventilatory support, duration of tracheostomy, percentage of successful weaning from mechanical ventilation, and neurodevelopmental outcomes. Subjects with CLD had a significantly greater frequency of tracheomalacia (86%), feeding disorders (86%), and hypogammaglobulinemia G (77%). There were no differences between groups for respiratory readmissions or family dysfunction. We conclude that almost all patients with CRFIC will survive, but morbidity outcomes will vary based on the underlying diagnosis.