Care Utilization for Acute Respiratory Infections in Children Requiring Invasive Long-Term Mechanical Ventilation

Introduction: Children who use invasive long-term mechanical ventilation (LTMV) are a rare, clinically heterogenous population with relatively high hospitalization rates, most commonly for acute respiratory infection (ARI). We sought to describe patterns of ARI-related utilization and mortality in pediatric patients with LTMV, evaluating the association of a pre-existing neurologic diagnoses with outcomes. Methods: We studied a longitudinal retrospective cohort across 40 U.S. children's hospital emergency department (ED) and hospital encounters for patients (< 21 years) with LTMV and an ARI diagnosis code (10/1/2016–6/30/2023). We examined mortality and ED/hospital utilization outcomes, defining short-stay hospitalizations as ≤ 2 calendar days. We stratified analyses by high intensity neurologic impairment (HINI) using a validated coding algorithm. Results: We included 4866 patients (median age 4.5 years; 58.6% male) with LTMV and ≥ 1 ARI encounter. Most (95.1%) were hospitalized on their index encounter, and among those most received intensive care (71.7%). 4.1% died during the index hospitalization (5.3% with HINI vs. 1.3% without HINI, p < 0.001). Median hospital length of stay was 6 days (interquartile range 3–12). Short stay hospitalizations occurred in 16.9% overall but were as high as 26.6% in children without HINI. ED return visits within 1 year occurred in 60.7%; ARI was the most common reason (40.1%). Conclusions: Pediatric patients using LTMV presenting for ED care with ARI are almost always hospitalized, usually in an intensive care setting. Overall, outcomes were poorer for those with HINI than those without HINI. More precision is needed to align resources with illness severity and comorbidities to improve ARI outcomes.