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

Am J Respir Crit Care Med. 2019 Oct 1;200(7):900-909. doi: 10.1164/rccm.201810-1881OC.

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Disease
  • Adolescent
  • Age Factors
  • Asthma / complications
  • Bronchiolitis / complications
  • Child
  • Child Development
  • Child, Preschool
  • Critical Illness
  • Ethnicity / statistics & numerical data
  • Female
  • Growth Disorders / epidemiology
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care Units, Pediatric
  • Male
  • Multivariate Analysis
  • Neoplasms / epidemiology
  • Pneumonia / complications
  • Quality of Life*
  • Respiration, Artificial / statistics & numerical data*
  • Respiratory Insufficiency / epidemiology
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy*
  • Risk Factors
  • Sepsis / complications