TY - JOUR
T1 - Predictors for invasive home mechanical ventilation duration in bronchopulmonary dysplasia
AU - Foster, Carolyn
AU - Noreen, Paige
AU - Grage, Jennifer
AU - Kwon, Soyang
AU - Hird-McCorry, Lindsey P.
AU - Janus, Angela
AU - Davis, Matthew M.
AU - Goodman, Denise
AU - Laguna, Theresa Annette
N1 - Funding Information:
Dr. Foster is supported under 1K23HL149829‐01A1 for research on care of children with home mechanical ventilation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. REDCap is supported at FSM by the Northwestern University Clinical and Translational Science (NUCATS) Institute, Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
Dr. Foster is supported under 1K23HL149829-01A1 for research on care of children with home mechanical ventilation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. REDCap is supported at FSM by the Northwestern University Clinical and Translational Science (NUCATS) Institute, Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.
PY - 2023/7
Y1 - 2023/7
N2 - Background: Children with bronchopulmonary dysplasia (BPD) who require invasive home mechanical ventilation (IHMV) are medically vulnerable and experience high caregiving and healthcare costs. Predictors for duration of IHMV in children with BPD remain unclear, which can make prognostication and decision-making challenging. Methods: A retrospective cohort study of children with BPD requiring IHMV was conducted from independent children's hospital records (2005–2021). The primary outcome was IHMV duration, defined as time from initial discharge home on IHMV until cessation of positive pressure ventilation (day and night). Two new variables were included: discharge age corrected for tracheostomy (DACT) (chronological age at discharge minus age at tracheostomy) and level of ventilator support at discharge (minute ventilation per kg per day). Univariable Cox regression was performed with variables of interest compared to IHMV duration. Significant nonlinear factors (p < 0.05) were included in the multivariable analysis. Results: One-hundred-and-nineteen patients used IHMV primarily for BPD. Patient median index hospitalization lasted 12 months (interquartile range [IQR] 8.0,14.4). Once home, half of the patients were weaned off IHMV by 36.0 months and 90% by 52.2 months. Being Hispanic/Latinx ethnicity (hazard ratio [HR] 0.14 (95% confidence interval [CI] 0.04, 0.53), p < 0.01) and having a higher DACT were associated with increased IHMV duration (HR 0.66 (CI 0.43, 0.98), p < 0.05). Conclusions: Disparity in IHMV duration exists among patients using IHMV after prematurity. Prospective multisite studies that further investigate new analytic variables, such as DACT and level of ventilator support, and address standardization of IHMV care are needed to create more equitable IHMV management strategies.
AB - Background: Children with bronchopulmonary dysplasia (BPD) who require invasive home mechanical ventilation (IHMV) are medically vulnerable and experience high caregiving and healthcare costs. Predictors for duration of IHMV in children with BPD remain unclear, which can make prognostication and decision-making challenging. Methods: A retrospective cohort study of children with BPD requiring IHMV was conducted from independent children's hospital records (2005–2021). The primary outcome was IHMV duration, defined as time from initial discharge home on IHMV until cessation of positive pressure ventilation (day and night). Two new variables were included: discharge age corrected for tracheostomy (DACT) (chronological age at discharge minus age at tracheostomy) and level of ventilator support at discharge (minute ventilation per kg per day). Univariable Cox regression was performed with variables of interest compared to IHMV duration. Significant nonlinear factors (p < 0.05) were included in the multivariable analysis. Results: One-hundred-and-nineteen patients used IHMV primarily for BPD. Patient median index hospitalization lasted 12 months (interquartile range [IQR] 8.0,14.4). Once home, half of the patients were weaned off IHMV by 36.0 months and 90% by 52.2 months. Being Hispanic/Latinx ethnicity (hazard ratio [HR] 0.14 (95% confidence interval [CI] 0.04, 0.53), p < 0.01) and having a higher DACT were associated with increased IHMV duration (HR 0.66 (CI 0.43, 0.98), p < 0.05). Conclusions: Disparity in IHMV duration exists among patients using IHMV after prematurity. Prospective multisite studies that further investigate new analytic variables, such as DACT and level of ventilator support, and address standardization of IHMV care are needed to create more equitable IHMV management strategies.
KW - bronchopulmonary dysplasia
KW - children with medical complexity
KW - chronic lung disease
KW - long-term mechanical ventilation
UR - https://www.scopus.com/pages/publications/85156208522
UR - https://www.scopus.com/inward/citedby.url?scp=85156208522&partnerID=8YFLogxK
U2 - 10.1002/ppul.26437
DO - 10.1002/ppul.26437
M3 - Article
C2 - 37114844
AN - SCOPUS:85156208522
SN - 8755-6863
VL - 58
SP - 2085
EP - 2093
JO - Pediatric Pulmonology
JF - Pediatric Pulmonology
IS - 7
ER -
