Predictors of longitudinal outcomes for children using long‐term noninvasive ventilation

Abstract

Background Noninvasive ventilation (NIV) is a first‐line therapy for sleep‐related breathing disorders and chronic respiratory insufficiency. Evidence about predictors that may impact long‐term NIV outcomes, however, is scarce. The aim of this study is to determine demographic, clinical, and technology‐related predictors of long‐term NIV outcomes. Methods A 10‐year multicentred retrospective review of children started on long‐term continuous or bilevel positive airway pressure (CPAP or BPAP) in Alberta. Demographic, technology‐related, and longitudinal clinical data were collected. Long‐term outcomes examined included ongoing NIV use, discontinuation due to improvement in underlying conditions, switch to invasive mechanical ventilation (IMV) or death, patient/family therapy declination, transfer of services, and hospital admissions. Results A total of 622 children were included. Both younger age and CPAP use predicted higher likelihood for NIV discontinuation due to improvement in underlying conditions (p < .05 and p < .01). Children with upper airway disorders or bronchopulmonary dysplasia were less likely to continue NIV (p < .05), while presence of central nervous system disorders had a higher likelihood of hospitalizations (p < .01). The presence of obesity/metabolic syndrome and early NIV‐associated complications predicted higher risk for NIV declination (p < .05). Children with more comorbidities or use of additional therapies required more hospitalizations (p < .05 and p < .01) and the latter also predicted higher risk for being switched to IMV or death (p < .001). Conclusions Demographic, clinical data, and NIV type impact long‐term NIV outcomes and need to be considered during initial discussions about therapy expectations with families. Knowledge of factors that may impact long‐term NIV outcomes might help to better monitor at‐risk patients and minimize adverse outcomes.

Pediatric long‐term noninvasive respiratory support in children with central nervous system disorders

“…During this period, the number of children with CNS disorders treated by NIV/CPAP has been multiplied by 16, from 11 to 182 children 18 . Similar trends have been observed in Canada, Italy, and Spain 23,25–27 …”

“…18 Similar trends have been observed in Canada, Italy, and Spain. 23,[25][26][27] Nocturnal gas exchange recordings were the main investigation performed before NIV/CPAP initiation. In 29% of children, it was the sole investigation.…”

To Wear or Not Wear the Mask: Decline in Positive Airway Pressure Usage in Children with Sleep Disordered Breathing During the COVID-19 Pandemic

“…11 We found that obesity was a risk factor for decreased PAP usage over time, similar to a previous 10-year multicentred retrospective review that evaluated longitudinal PAP adherence among 622 children aged 0-18 years old, which showed that children with obesity or metabolic syndrome were more likely to decline PAP therapy (OR =2.077 [95% CI 1.110-3.888]). 39 The reasons for these findings are unclear; however, there is one study suggesting lack of perceived benefits of PAP in this population may contribute to decreased use. 16 Of concern, obesity is an independent risk factor for susceptibility to and severity of COVID-19 which is related to worsening outcomes including increased risk of hospitalization, critical care admission and mortality.…”

How do we Treat Aberrant Excessive Signaling in FGF3 Receptor Pathway to Cure Achondroplasia in Childhood?

“…Hip and elbow joints cannot be fully extended, while finger, knee and ankle joints are hyperextended. Because of the reduced size of the chest, breathing is often impaired [18,38,39]. The narrowness of the nasopharynx often causes infections, especially of the upper respiratory tract [18,38,39].…”

“…Because of the reduced size of the chest, breathing is often impaired [18,38,39]. The narrowness of the nasopharynx often causes infections, especially of the upper respiratory tract [18,38,39]. Middle ear infections may also occur.…”