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Characteristics and Outcomes of Critical Illness in Children With Feeding and Respiratory Technology Dependence

Heneghan, Julia A., MD1; Reeder, Ron W., PhD2; Dean, J. Michael, MD2; Meert, Kathleen L., MD3; Berg, Robert A., MD4; Carcillo, Joseph, MD5; Newth, Christopher J. L., MD, FRCPC6; Dalton, Heidi, MD7; Tamburro, Robert, MD, MSc8; Pollack, Murray M., MD1

Pediatric Critical Care Medicine: May 2019 - Volume 20 - Issue 5 - p 417–425
doi: 10.1097/PCC.0000000000001868
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Objectives: Children with dependence on respiratory or feeding technologies are frequently admitted to the PICU, but little is known about their characteristics or outcomes. We hypothesized that they are at increased risk of critical illness–related morbidity and mortality compared with children without technology dependence.

Design: Secondary analysis of prospective, probability-sampled cohort study of children from birth to 18 years old. Demographic and clinical characteristics were assessed. Outcomes included death, survival with new morbidity, intact survival, and survival with functional status improvement.

Setting: General and cardiovascular PICUs at seven participating children’s hospitals as part of the Trichotomous Outcome Prediction in Critical Care study.

Subjects: Children from birth to 18 years of age as part of the Trichotomous Outcome Prediction in Critical Care study.

Interventions: None.

Measurements and Main Results: Children with technology dependence composed 19.7% (1,989/10,078) of PICU admissions. Compared with those without these forms of technology dependence, these children were younger, received more ICU-specific therapeutics, and were more frequently readmitted to the ICU. Death occurred in 3.7% of technology-dependent patients (n = 74), and new morbidities developed in 4.5% (n = 89). Technology-dependent children who developed new morbidities had higher Pediatric Risk of Mortality scores and received more ICU therapies than those who did not. A total of 3.0% of technology-dependent survivors (n = 57) showed improved functional status at hospital discharge.

Conclusions: Children with feeding and respiratory technology dependence composed approximately 20% of PICU admissions. Their new morbidity rates are similar to those without technology dependence, which contradicts our hypothesis that children with technology dependence would demonstrate worse outcomes. These comparable outcomes, however, were achieved with additional resources, including the use of more ICU therapies and longer lengths of stay. Improvement in functional status was seen in some technology-dependent survivors of critical illness.

1Department of Pediatrics, Children’s National Health System and the George Washington School of Medicine and Health Sciences, Washington, DC.

2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.

3Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI.

4Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

5Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA.

6Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.

7Department of Child Health, Phoenix Children’s Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ.

8Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health, Bethesda, MD.

This content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health.

Current address for Dr. Dalton: Inova Fairfax Hospital, Pediatrics, 3300 Gallows Road, Falls Church, VA 22042.

Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, and Department of Health and Human Services: U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063106, U10HD063114, and U01HD049934.

Drs. Heneghan, Reeder, Dean, Meert, Berg, Carcillo, Tamburro, and Pollack received support for article research from the National Institutes of Health (NIH). Drs. Reeder, Dean, Meert, and Berg’s institutions received funding from the NIH. Drs. Carcillo and Pollack’s institutions received funding from the National Institute of Child Health and Human Development. Dr. Newth received funding from Philips Research North America. Dr. Dalton received funding from Innovative ECMO Concepts. Dr. Tamburro’s institution received funding from the U.S. Food and Drug Administration Office of Orphan Product Development and ONY; he received funding from Springer-Verlag Publishing; and he disclosed government work. Dr. Pollack received Philanthropic support from Mallinckrrodt Pharmaceuticals.

Address requests for reprints to: Murray M. Pollack, MD, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010. E-mail: mpollack@childrensnational.org

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies