Recovery Trajectories in Children Requiring 3 or More Days of Invasive Ventilation.

Autor:	Maddux AB; Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO.; Pediatric Critical Care, Children's Hospital Colorado, Aurora, CO., Miller KR; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO., Sierra YL; Research Institute, Pediatric Critical Care, Children's Hospital Colorado, Aurora, CO., Bennett TD; Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO.; Pediatric Critical Care, Children's Hospital Colorado, Aurora, CO.; Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO., Watson RS; Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Washington School of Medicine and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA., Spear M; Department of Pediatrics, Dell Children's Medical Center, The University of Texas at Austin Dell Medical School, Austin, TX., Pyle LL; Pediatric Critical Care, Children's Hospital Colorado, Aurora, CO.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO., Mourani PM; Department of Pediatrics, Section of Critical Care, University of Arkansas for Medical Sciences and Arkansas Children's, Little Rock, AR.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2024 May 01; Vol. 52 (5), pp. 798-810. Date of Electronic Publication: 2024 Jan 09.
DOI:	10.1097/CCM.0000000000006187
Abstrakt:	Objectives: To characterize health-related quality of life (HRQL) and functional recovery trajectories and risk factors for prolonged impairments among critically ill children receiving greater than or equal to 3 days of invasive ventilation. Design: Prospective cohort study. Setting: Quaternary children's hospital PICU. Patients: Children without a preexisting tracheostomy who received greater than or equal to 3 days of invasive ventilation, survived hospitalization, and completed greater than or equal to 1 postdischarge data collection. Interventions: None. Measurements and Main Results: We evaluated 144 children measuring HRQL using proxy-report Pediatric Quality of Life Inventory and functional status using the Functional Status Scale (FSS) reflecting preillness baseline, PICU and hospital discharge, and 1, 3, 6, and 12 months after hospital discharge. They had a median age of 5.3 years (interquartile range, 1.1-13.0 yr), 58 (40%) were female, 45 (31%) had a complex chronic condition, and 110 (76%) had normal preillness FSS scores. Respiratory failure etiologies included lung disease ( n = 49; 34%), neurologic failure ( n = 23; 16%), and septic shock ( n = 22; 15%). At 1-month postdischarge, 68 of 122 (56%) reported worsened HRQL and 35 (29%) had a new functional impairment compared with preillness baseline. This improved at 3 months to 54 (46%) and 24 (20%), respectively, and remained stable through the remaining 9 months of follow-up. We used interaction forests to evaluate relative variable importance including pairwise interactions and found that therapy consultation within 3 days of intubation was associated with better HRQL recovery in older patients and those with better preillness physical HRQL. During the postdischarge year, 76 patients (53%) had an emergency department visit or hospitalization, and 62 (43%) newly received physical, occupational, or speech therapy. Conclusions: Impairments in HRQL and functional status as well as health resource use were common among children with acute respiratory failure. Early therapy consultation was a modifiable characteristic associated with shorter duration of worsened HRQL in older patients. Competing Interests: Dr. Maddux’s institution received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (K23HD096018) and the Francis Family Foundation, Parker B. Francis Award. Drs. Maddux and Mourani received support for article research from the National Institutes of Health (NIH). Dr. Bennett’s institution received funding from the NICHD, the National Heart, Lung, and Blood Institute, and the National Center for Advancing Translational Sciences. Dr. Spear disclosed that a trust with him as beneficiary owns mutual funds that may own stock in pharmaceuticals. Dr. Mourani’s institution received funding from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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