Center for Advanced Practice

Title

Risk Factors for Functional Decline and Impaired Quality of Life after Pediatric Respiratory Failure.

Publication Title

American journal of respiratory and critical care medicine

Document Type

Article

PubMed ID

31034245

Abstract

Rationale: Poor outcomes of adults surviving critical illness are well documented, but data in children are limited.

Objectives: To identify factors associated with worse postdischarge function and health-related quality of life (HRQL) after pediatric acute respiratory failure.

Methods: We assessed functional status at baseline, discharge, and 6 months after pediatric ICU discharge and HRQL 6 months after discharge in 2-week- to 17-year-olds mechanically ventilated for acute respiratory failure in the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) trial. We assessed HRQL via Infant and Toddler Quality of Life Questionnaire-97 (old) or Pediatric Quality of Life Inventory (≥2 yr old). We categorized patients with normal baseline function as having impaired HRQL if scores were greater than 1 SD below mean norms for Infant and Toddler Quality of Life Questionnaire-97 growth and development or Pediatric Quality of Life Inventory total score.

Measurements and Main Results: One-fifth (n = 192) of 949 patients declined in function from baseline to postdischarge; 20% (55/271) had impaired growth and development; 19% (64/343) had impaired HRQL. In multivariable analyses, decline in function was associated with baseline impaired function, prematurity, cancer, respiratory failure etiology, ventilation duration, and clonidine (odds ratio [OR] = 2.14; 95% confidence interval [CI] = 1.22–3.76). Independent predictors of impaired growth and development included methadone (OR = 2.27; 95% CI = 1.18–4.36) and inadequate pain management (OR = 2.94; 95% CI = 1.39–6.19). Impaired HRQL was associated with older age, non-white or Hispanic race, cancer, and inadequate sedation management (OR = 3.15; 95% CI = 1.74–5.72).

Conclusions: Postdischarge morbidity after respiratory failure is common and associated with admission factors, exposure to critical care therapies, and pain and sedation management.

Keywords

Acute Disease, Adolescent, Age Factors, Asthma, Bronchiolitis, Child, Child Development, Child, Preschool, Critical Illness, Ethnicity, Female, Growth Disorders, Humans, Infant, Infant, Newborn, Infant, Premature, Intensive Care Units, Pediatric, Male, Multivariate Analysis, Neoplasms, Pneumonia, Quality of Life, Respiration, Artificial, Respiratory Insufficiency, Risk Factors, Sepsis

DOI

10.1164/rccm.201810-1881OC

Publication Date

10-1-2019

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