Mechanical Ventilation for Children Approaching End of Life: A PHIS Study, 2010-2019.

Objective: To determine the prevalence of invasive and noninvasive mechanical ventilation (IMV and NIV) for children who die in the hospital, to assess for change over time, and to determine the association between mode(s) of ventilation and hospital resource utilization.

Methods: Multicenter retrospective cohort of 37 children's hospitals in the United States participating in Pediatric Health Information Systems Database. Included 41 091 hospitalizations for patients 0 to 21 years who died in hospital January 2010 to December 2019. Univariate and multivariate logistic regression examined IMV and NIV use clustered by hospital, adjusting for demographic and clinical characteristics. χ2, Kruskal-Wallis tests and multivariable regression models measured associations between mode of ventilation and resource utilization.

Results: Over the decade, the percentage exposed to any IMV remained unchanged (∼88.5%), whereas any NIV increased 7.1% (18.8% to 25.9%), with wide interhospital variability in NIV use. Exposure to both IMV + NIV increased 6.0% (16.8% to 22.8%). Compared with only IMV, only NIV had lower odds of ICU admission and death, shorter ICU length of stay (LOS), similar hospital LOS, and lower costs. Both IMV + NIV had higher odds of ICU admission, longer duration of IMV, lower likelihood of ICU death, longer ICU and hospital LOS, and higher costs than IMV alone.

Conclusions: For children who died in the hospital in the past decade, use of NIV has increased without a reciprocal decrease in IMV, because of an increase in exposure to both IMV + NIV, a combination associated with high hospital resource utilization.