Timeline of Weaning in Pediatric Long-Term Mechanical Ventilator Dependent Children: A Longitudinal Cohort Study.

Abstract

Background: Children with invasive long-term mechanical ventilation (LTMV) dependence are a complex, heterogeneous population with wide variability in respiratory outcomes. Limited data exist on their ventilator weaning trajectories and respiratory characteristics as they progress toward liberation from the ventilator.

Objective: To describe a population of children with invasive LTMV dependence who have successfully liberated from ventilator support, focusing on ventilator parameters as potential early predictors of liberation.

Methods: This was a retrospective study of children who initiated chronic ventilator support at < 12 months of age at our institution, received ventilator support through a tracheostomy tube, were followed through our outpatient clinic, and were fully liberated from mechanical ventilation. Our primary outcome was age at liberation from ventilator support. Multiple covariates were described, including baseline descriptors, health system utilization descriptors, disease markers, and care milestones.

Results: Seventy-eight patients were identified. The median age of tracheostomy was 3.8 [IQR: 3.0-4.8] months. The median age of first hospital discharge to home care was 9.3 months [IQR: 7.5-12], with a median of 44 hospital encounters after initial discharge. These patients were liberated at a median age of 23.9 [18.3-32.2] months. Age at liberation from the ventilator was highly variable within our institution.

Conclusion: The most significant variation in outcome was introduced after hospital discharge and appears to be largely independent of lung disease severity as indicated by ventilatory support. No single covariate was strongly correlated with liberation outcome. Further studies are needed to identify underlying pathophysiology that may contribute to the varied weaning trajectories to better define objective weaning strategies.