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Predictors of longitudinal outcomes for children using long‐term noninvasive ventilation
Author(s) -
Bedi Prabhjot K.,
DeHaan Kristie,
MacLean Joanna E.,
CastroCodesal Maria L.
Publication year - 2021
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25188
Subject(s) - medicine , discontinuation , continuous positive airway pressure , bronchopulmonary dysplasia , pediatrics , ventilation (architecture) , retrospective cohort study , mechanical ventilation , intensive care medicine , obstructive sleep apnea , gestational age , pregnancy , mechanical engineering , engineering , biology , genetics
Background Noninvasive ventilation (NIV) is a first‐line therapy for sleep‐related breathing disorders and chronic respiratory insufficiency. Evidence about predictors that may impact long‐term NIV outcomes, however, is scarce. The aim of this study is to determine demographic, clinical, and technology‐related predictors of long‐term NIV outcomes. Methods A 10‐year multicentred retrospective review of children started on long‐term continuous or bilevel positive airway pressure (CPAP or BPAP) in Alberta. Demographic, technology‐related, and longitudinal clinical data were collected. Long‐term outcomes examined included ongoing NIV use, discontinuation due to improvement in underlying conditions, switch to invasive mechanical ventilation (IMV) or death, patient/family therapy declination, transfer of services, and hospital admissions. Results A total of 622 children were included. Both younger age and CPAP use predicted higher likelihood for NIV discontinuation due to improvement in underlying conditions ( p < .05 and p < .01). Children with upper airway disorders or bronchopulmonary dysplasia were less likely to continue NIV ( p < .05), while presence of central nervous system disorders had a higher likelihood of hospitalizations ( p < .01). The presence of obesity/metabolic syndrome and early NIV‐associated complications predicted higher risk for NIV declination ( p < .05). Children with more comorbidities or use of additional therapies required more hospitalizations ( p < .05 and p < .01) and the latter also predicted higher risk for being switched to IMV or death ( p < .001). Conclusions Demographic, clinical data, and NIV type impact long‐term NIV outcomes and need to be considered during initial discussions about therapy expectations with families. Knowledge of factors that may impact long‐term NIV outcomes might help to better monitor at‐risk patients and minimize adverse outcomes.