Care Utilization for Acute Respiratory Infections in Children Requiring Invasive Long-Term Mechanical Ventilation

Authors

• Carolyn C Foster
• Todd A Florin
• Derek J Williams
• Katherine L Freundlich
• Rebecca L Steuart
• Julia A Heneghan
• Cara Cecil
• Nathan M Pajor
• Robert J Graham
• Sriram Ramgopal

Language

English

Publication Date

3-1-2025

Journal

Pediatric Pulmonology

DOI

10.1002/ppul.71026

PMID

40042159

PMCID

PMC11881213

PubMedCentral® Posted Date

3-5-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Introduction: Children who use invasive long-term mechanical ventilation (LTMV) are a rare, clinically heterogenous population with relatively high hospitalization rates, most commonly for acute respiratory infection (ARI). We sought to describe patterns of ARI-related utilization and mortality in pediatric patients with LTMV, evaluating the association of a pre-existing neurologic diagnoses with outcomes.

Methods: We studied a longitudinal retrospective cohort across 40 U.S. children's hospital emergency department (ED) and hospital encounters for patients (< 21 years) with LTMV and an ARI diagnosis code (10/1/2016-6/30/2023). We examined mortality and ED/hospital utilization outcomes, defining short-stay hospitalizations as ≤ 2 calendar days. We stratified analyses by high intensity neurologic impairment (HINI) using a validated coding algorithm.

Results: We included 4866 patients (median age 4.5 years; 58.6% male) with LTMV and ≥ 1 ARI encounter. Most (95.1%) were hospitalized on their index encounter, and among those most received intensive care (71.7%). 4.1% died during the index hospitalization (5.3% with HINI vs. 1.3% without HINI, p < 0.001). Median hospital length of stay was 6 days (interquartile range 3-12). Short stay hospitalizations occurred in 16.9% overall but were as high as 26.6% in children without HINI. ED return visits within 1 year occurred in 60.7%; ARI was the most common reason (40.1%).

Conclusions: Pediatric patients using LTMV presenting for ED care with ARI are almost always hospitalized, usually in an intensive care setting. Overall, outcomes were poorer for those with HINI than those without HINI. More precision is needed to align resources with illness severity and comorbidities to improve ARI outcomes.

Keywords

Humans, Male, Female, Retrospective Studies, Respiration, Artificial, Child, Child, Preschool, Respiratory Tract Infections, Infant, Longitudinal Studies, Adolescent, Emergency Service, Hospital, Hospitalization, Length of Stay, United States, Acute Disease, acute respiratory infection, children with medical complexity, home mechanical ventilation, long‐term mechanical ventilation, neurologic impairment

Published Open-Access

yes

Recommended Citation

Foster, Carolyn C; Florin, Todd A; Williams, Derek J; et al., "Care Utilization for Acute Respiratory Infections in Children Requiring Invasive Long-Term Mechanical Ventilation" (2025). Faculty, Staff and Student Publications. 4154.
https://digitalcommons.library.tmc.edu/uthmed_docs/4154