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

Abstract

RATIONALE\nPoor outcomes of adults surviving critical illness are well-documented, but data in children are limited.\n\n\nOBJECTIVES\nTo identify factors associated with worse post-discharge function and health-related quality of life (HRQL) after pediatric acute respiratory failure.\n\n\nMETHODS\nWe assessed functional status at baseline, discharge, and six months post-pediatric intensive care unit discharge and HRQL 6 months post-discharge in 2 week to 17 year olds mechanically ventilated for acute respiratory failure in the Randomized Evaluation of Sedation Titration for Respiratory Failure trial. We assessed HRQL via Infant and Toddler Quality of Life Questionnaire-97 (ITQOL; <2 years old) or Pediatric Quality of Life Inventory (PedsQL; ≥2 years old). We categorized patients with normal baseline function as having impaired HRQL if scores were >1 standard deviation below mean norms for ITQOL growth and development or PedsQL total score.\n\n\nMEASUREMENTS AND MAIN RESULTS\nOne-fifth (n=192) of 949 patients declined in function from baseline to post-discharge; 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% 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, cancer, and inadequate sedation management (OR 3.15; 95% CI 1.74-5.72).\n\n\nCONCLUSIONS\nPost-discharge morbidity after respiratory failure is common and associated with admission factors, exposure to critical care therapies, and pain and sedation management.