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. 2019 Oct 1;200(7):900-909.
doi: 10.1164/rccm.201810-1881OC.

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

R Scott Watson  1   2 , Lisa A Asaro  3 , Larissa Hutchins  4 , G Kris Bysani  5   6 , Elizabeth Y Killien  1   7 , Derek C Angus  8 , David Wypij  3   9   10 , Martha A Q Curley  11   12
Affiliations

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

R Scott Watson et al. Am J Respir Crit Care Med. .

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 (<2 yr 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: functional status; health-related quality of life; healthcare outcomes; pediatric; respiratory failure.

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Figures

Figure 1.
Figure 1.
Change in Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) from baseline to hospital discharge to follow-up (n = 935). Values are number of patients (%).
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