(307) Impairments at 2.5 Years Post-Discharge in Critically Ill Children Requiring Mechanical Ventilation

Introduction: Children requiring mechanical ventilation are at risk of long-term functional and health-related quality of life (HRQL) impairments, however little is known about persistence of impairments beyond the post-discharge year. We examined impairments at 2.5 years post-discharge and hypothesized that >50% of new impairments at one year relative to pre-illness baseline would persist 2.5 years post-discharge.

Methods: In a prospective cohort study of children requiring >3 days of invasive ventilation for acute respiratory failure, we surveyed caregivers at admission for pre-illness baseline and at 1-year post-discharge to collect HRQL (PedsQL), functional status (Functional Status Scale [FSS]), and health resource use. At 2.5 years post-discharge, we surveyed patients (>18 years-old) or guardians to collect the same information. Functional impairment was defined as >3 points worsening in total FSS score or >2 in a specific domain relative to pre-illness baseline. Decreased HRQL was defined as >4.5 points below pre-illness baseline.

Results: Of the 124 eligible, 72 (58%) completed surveys a median 2.7 years (interquartile range [IQR] 2.3-3.2) post-discharge. Median enrollment age was 2.6 years (IQR 0.7-10.8), 55 (76%) had no baseline functional impairments (FSS 6-7), and respiratory failure etiology was most often lung disease (n=27; 38%), neurologic (n=14; 19%), or septic shock (n=9; 13%). Of 32 patients with lower 1 year HRQL relative to pre-illness, 23 (72%) remained lower at 2.5 years. Of 14 with new functional impairments at 1 year, 8 (57%) remained impaired at 2.5-years. Of 9 newly supported by alternate forms of nutrition (tube feeds or parenteral) at 1 year, 6 (67%) required alternate nutrition at 2.5 years. Of 5 who newly required respiratory support at 1 year, 1 (20%) required respiratory support at 2.5 years. Of patients who newly required therapy services (physical [n=20], occupational [n=14], or speech therapy [n=16]) at 1 year, 12 (60%), 11 (79%), and 16 (100%) continued to receive physical, occupational, and speech therapy at 2.5 years.

Conclusions: Among children mechanically ventilated for >3 days, most functional and HRQL impairments and therapy needs acquired after admission and present at 1 year persisted through 2.5 years post-discharge.