A multi‐institutional analysis of children on long‐term non‐invasive respiratory support and their outcomes

Koncicki, Monica L.; Zachariah, Philip; Lucas, Adam R.; Edwards, Jeffrey D.

doi:10.1002/ppul.23925

Cited by 13 publications

(23 citation statements)

References 16 publications

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“…Their main reasons for initiating LTV were lower respiratory airways diseases (55% on NIV; 10% on IMV), and spinal cord injury (50% on IMV). Our results are similar to those of many studies performed especially in western, more developed and with high-income countries [8][9][10][11][12][13][14][16][17][18][19][20]. Differences between studies may vary depending on several factors such as the availability of local facilities and skills; differences of inclusion criteria in the main diagnostic categories considered, and collaborations with referral.…”

Section: Discussionsupporting

confidence: 88%

“…Lower respiratory airways diseases more often affected children on IMV who improved. Previous studies report a discontinuation rate from ventilatory support ranging from 3.6 to 45% [15,16,18]. Children who discontinued respiratory support were those showing improvement of the underlying condition [8], such as chronic lung diseases, and upper airway abnormalities [9,10,14,16], or those ventilated < 24 h/day [10].…”

Section: Discussionmentioning

confidence: 99%

“…Reasons for tracheostomy were repetitive airway infection/aspirations and acute exacerbation of chronic respiratory failure [11]. Koncicki ML et al [18], reported that 8.9% of their patients transitioned to IMV mainly because of neurologic (58%) and neuromuscular disorders (39%). These results reinforce the concept that children suffering from neurological and NMDs overtime are more prone to deteriorate and may need tracheostomy/IMV.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies reported a deaths rate on NIV ranging from 2.6 to 17.7% [10,14], and on IMV from 0 to 40% [14,15]. Deaths have been reported in hospital [10]; because of progression of the underlying disease [10], especially in children with NMDs [8,13,16]; in children affected by cardiac, neurologic [8,11,18], and chronic lung diseases [15,16]. Furthermore, deaths have been reported as consequences of accidental disconnection from the ventilator [10,15] or decannulation [12].…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome

et al. 2020

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Background: Children with chronic respiratory failure and/or sleep disordered breathing due to a broad range of diseases may require long-term ventilation to be managed at home. Advances in the use of long-term non-invasive ventilation has progressively leaded to a reduction of the need for invasive mechanical ventilation through tracheostomy. In this study, we sought to characterize a cohort of children using long-term NIV and IMV and to perform an analysis of those children who showed significant changes in ventilatory support management.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome

et al. 2020

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“…Only 24 papers studied more than 100 patients. 2,4,5,20,29,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Of the 12 704 patients, 37% could be categorized as having ventilatory muscle weakness, 14% with chronic pulmonary disease, 10% with central hypoventilation, 9% with airway abnormalities, 6% with genetic/metabolic syndromes, 1% with cardiac/congenital heart disease, and 3% other/combined. Twenty percent of patients did not have a diagnosis reported.…”

Section: Resultsmentioning

confidence: 99%

Liberation and mortality outcomes in pediatric long‐term ventilation: A qualitative systematic review

Foy

Koncicki

Edwards

2020

Pediatric Pulmonology

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Objective: To provide a systematic review of liberation from positive pressure ventilation and mortality of children with chronic respiratory failure who used long-term invasive and noninvasive ventilation (LTV). Methods: Papers published from 1980 to 2018 were identified using Pubmed MEDLINE, Ovid MEDLINE, Embase, and Cochrane databases. Search results were limited to English-language papers with (a) patients less than 22 years at initiation, (b) patients who used invasive ventilation (IV) via tracheostomy or noninvasive ventilation (NIV), and (c) data on mortality or liberation from LTV. Data were presented using descriptive statistics; changes in outcomes over time were explored using linear regression. Follow-up variability, cohort heterogeneity, and insufficient data precluded combining data to estimate incidences or rates. Results: One hundred and thirty papers with 12 704 patients were included. The median number of patients was 37 (interquartile range [IQR] 17-74, range 6-3802). Twenty-five percent of patients were initiated on IV; 75% on NIV. The maximum follow-up ranged from 0.5 to 31.8 years (median 8.8 years). The median proportion of patients liberated in these papers was 3% (IQR 0%-21%). The median proportion of mortality was 18% (IQR 8%-27%). Proportions of liberation and mortality did not significantly change over time. Progression of underlying disease (44%), respiratory illness (19%), and LTV accident (11%) were the most common causes of death. Conclusions: These papers collectively show most patients survive for many years using LTV; in many subgroups, death is a more common outcome than liberation. However, the limitations of these papers preclude robust prognostication.

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Predictors of longitudinal outcomes for children using long‐term noninvasive ventilation

Bedi

DeHaan

MacLean

et al. 2020

Pediatric Pulmonology

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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.

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A multi‐institutional analysis of children on long‐term non‐invasive respiratory support and their outcomes

Cited by 13 publications

References 16 publications

Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome

Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome

Liberation and mortality outcomes in pediatric long‐term ventilation: A qualitative systematic review

Predictors of longitudinal outcomes for children using long‐term noninvasive ventilation

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