P2A225: Pediatric Intensive Care Unit Admissions in Children with Respiratory Technology Dependence: A Single-centre Retrospective Cohort Study

Background: Children with medical complexity (CMC) utilize a significant amount of healthcare resources. Compared to other children, CMC are more likely to be admitted and readmitted to the Pediatric Intensive Care Unit (PICU), have longer PICU lengths of stay, and are more likely to require invasive therapies including mechanical ventilation and other specialized care interventions. Although many of these children are dependent on respiratory technology in outpatient settings, few studies have focused on exploring PICU resource utilization in this sub-group. This study examined the prevalence of chronic respiratory technology dependence in children admitted to PICU, and described reasons for admission, severity-of-illness, nursing workload, and length of stay in comparison to children without respiratory technology dependence.

Methods: Retrospective database analysis of patients admitted to PICU at a Canadian tertiary care hospital between June 2016 and May 2022.

Results: CMC with respiratory technology dependence accounted for 128 (5.7%) of 2245 PICU admissions and 580 (5.9%) of 9895 PICU bed days. Median (interquartile range) age at admission was 4.9 years (2.4-10.4 years). The most common reason for unplanned admission was respiratory decompensation (n=62; 81.6%). Postoperative management accounted for 52 (40.6%) admissions. Underlying conditions were categorized as genetic / metabolic / syndromic (n=51; 39.8%), cerebral palsy (n=36; 28.1%), neuromuscular disease (n=23; 18%), and other (n=18; 14.1%) Types of RTD included home oxygen (n=28; 21.9%), non-invasive positive pressure ventilation (n=32; 25%), tracheostomy without ventilation (n=53; 41.4%), and tracheostomy with ventilation (n=15; 11.7%). Compared to other children admitted to PICU, children with respiratory technology dependence had significantly lower Pediatric Risk of Mortality (PRISM III) scores (18 vs 14, p< 0.0001) and day 1 Therapeutic Intervention Scoring System (TISS-C) scores (25 vs 22, p< 0.0001). PICU length of stay was similar in children with respiratory technology dependence (median 3 days; interquartile range 2-5 days) than for other children (median 2 days; interquartile range 2-4 days), p=0.8. Mortality in CMC with RTD was less than 1%.

Conclusion: CMC with respiratory technology dependence accounted for comparable proportions of all PICU admissions and bed days. Measures of predicted mortality and nursing workload within 24 hours of PICU admission were significantly lower for children with respiratory technology dependence compared to all other PICU admissions. More detailed exploration of the types of interventions these children require is needed to guide resource allocation.