Publications by authors named "Jeffrey D Edwards"

30 Publications

  • Page 1 of 1

Long-Term Increases in Mental Disorder Diagnoses After Invasive Mechanical Ventilation for Severe Childhood Respiratory Disease: A Propensity Matched Observational Cohort Study.

Pediatr Crit Care Med 2021 Jul 13. Epub 2021 Jul 13.

Department of Pediatrics, Columbia University Irving Medical Center, New York, NY. Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY. Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY. Departments of Anesthesiology and Epidemiology, Columbia University Irving Medical Center and Columbia University Mailman School of Public Health, New York, NY. Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center and Columbia University Mailman School of Public Health, New York, NY. Departments of Anesthesia and Epidemiology, Columbia University Irving Medical Center and Columbia University Mailman School of Public Health, New York, NY.

Objectives: To evaluate neurodevelopmental and mental disorders after PICU hospitalization in children requiring invasive mechanical ventilation for severe respiratory illness.

Design: Retrospective longitudinal observational cohort.

Setting: Texas Medicaid Analytic eXtract data from 1999 to 2012.

Patients: Texas Medicaid-enrolled children greater than or equal to 28 days old to less than 18 years old hospitalized for a primary respiratory illness, without major chronic conditions predictive of abnormal neurodevelopment.

Interventions: We examined rates of International Classification of Diseases, 9th revision-coded mental disorder diagnoses and psychotropic medication use following discharge among children requiring invasive mechanical ventilation for severe respiratory illness, compared with general hospital patients propensity score matched on sociodemographic and clinical characteristics prior to admission. Children admitted to the PICU for respiratory illness not necessitating invasive mechanical ventilation were also compared with matched general hospital patients as a negative control exposure.

Measurements And Main Results: Of 115,335 eligible children, 1,351 required invasive mechanical ventilation and were matched to 6,755 general hospital patients. Compared with general hospital patients, children requiring invasive mechanical ventilation had increased mental disorder diagnoses (hazard ratio, 1.43 [95% CI, 1.26-1.64]; p < 0.0001) and psychotropic medication use (hazard ratio, 1.67 [1.34-2.08]; p < 0.0001) following discharge. Seven-thousand seven-hundred eighty children admitted to the PICU without invasive mechanical ventilation were matched to 38,900 general hospital patients and had increased mental disorder diagnoses (hazard ratio, 1.08 [1.02-1.15]; p = 0.01) and psychotropic medication use (hazard ratio, 1.11 [1.00-1.22]; p = 0.049).

Conclusions: Children without major comorbidity requiring invasive mechanical ventilation for severe respiratory illness had a 43% higher incidence of subsequent mental disorder diagnoses and a 67% higher incidence of psychotropic medication use. Both increases were substantially higher than in PICU patients with respiratory illness not necessitating invasive mechanical ventilation. Invasive mechanical ventilation is a life-saving therapy, and its application is interwoven with underlying health, illness severity, and PICU management decisions. Further research is required to determine which factors related to invasive mechanical ventilation and severe respiratory illness are associated with abnormal neurodevelopment. Given the increased risk in these children, identification of strategies for prevention, neurodevelopmental surveillance, and intervention after discharge may be warranted.
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http://dx.doi.org/10.1097/PCC.0000000000002790DOI Listing
July 2021

The impact of eligibility for primary attendings and nurses on PICU length of stay.

J Crit Care 2021 Apr 15;62:145-150. Epub 2020 Dec 15.

Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA. Electronic address:

Purpose: To examine whether primary attendings and/or nurses impact pediatric intensive care unit (PICU) length of stay (LOS) in long-stay patients (LSP).

Materials And Methods: Retrospective observational cross-sectional study from 2012 to 2016 of 29,170 LSP (LOS ≥ 10 days) admitted to 64 PICUs that participated in the Virtual Pediatric Systems, LLC. Generalized linear mixed models were used to examine the association between being eligible for primary practices and LOS. Secondary outcomes of proportions of limitations and withdrawal of aggressive, life-sustaining interventions were also explored.

Results: After controlling for several factors, being eligible for primary nurses and for primary attendings and nurses were associated with significantly lower mean LOS (8.9% and 9.7% lower, respectively), compared to not being eligible for any primary practice. Being eligible for primary attendings was associated with significantly higher mean LOS (9.6% higher). When the primary attendings were used for larger proportions of LSP, the practice was associated with significantly lower mean LOS. Limitations and withdrawal of aggressive interventions were more common in LSPs cared for in PICUs that utilized primary attendings.

Conclusions: The findings of lower LOS in LSP who were eligible for primary practices should induce more rigorous research on the impact of these primary practices.
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http://dx.doi.org/10.1016/j.jcrc.2020.12.006DOI Listing
April 2021

Development and validation of a novel informational booklet for pediatric long-term ventilation decision support.

Pediatr Pulmonol 2021 May 23;56(5):1198-1204. Epub 2020 Dec 23.

Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Objectives: To provide accessible, uniform, comprehensive, and balanced information to families deciding whether to initiate long-term ventilation (LTV) for their child, we sought to develop and validate a novel informational resource.

Methods: The Ottawa Decision Support Framework was followed. Previous interviews with 44 lay and 15 professional stakeholders and published literature provided content for a booklet. Iterative versions were cognitive tested with six parents facing decisions and five pediatric intensivists. Ten parents facing decisions evaluated the booklet using the Preparation for Decision Making Scale and reported their decisional conflict, which was juxtaposed to the conflict of 21 parents who did not read it, using the Decisional Conflict Scale. Twelve home ventilation program directors evaluated the booklet's clinical sensibility and sensitivity, using a self-designed six-item questionnaire. Data presented using summary statistics.

Results: The illustrated booklet (6th-grade reading level) has nine topical sections on chronic respiratory failure and invasive and noninvasive LTV, including the option to forgo LTV. Ten parents who read the booklet rated it as helping "Quite a bit" or more on all items of the Preparation for Decision Making Scale and had seemingly less decisional conflict than 21 parents who did not. Twelve directors rated it highly for clinical sensibility and sensitivity.

Conclusions: The LTV booklet was rigorously developed and favorably evaluated. It offers a resource to improve patient/family knowledge, supplement shared decision-making, and reduce decisional conflict around LTV decisions. Future studies should validate it in other settings and further study its effectiveness.
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http://dx.doi.org/10.1002/ppul.25221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035285PMC
May 2021

Liberation and mortality outcomes in pediatric long-term ventilation: A qualitative systematic review.

Pediatr Pulmonol 2020 11 12;55(11):2853-2862. Epub 2020 Aug 12.

Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Valegos College of Physician and Surgeons, New York, New York.

Objective: To provide a systematic review of liberation from positive pressure ventilation and mortality of children with chronic respiratory failure who used long-term invasive and noninvasive ventilation (LTV).

Methods: Papers published from 1980 to 2018 were identified using Pubmed MEDLINE, Ovid MEDLINE, Embase, and Cochrane databases. Search results were limited to English-language papers with (a) patients less than 22 years at initiation, (b) patients who used invasive ventilation (IV) via tracheostomy or noninvasive ventilation (NIV), and (c) data on mortality or liberation from LTV. Data were presented using descriptive statistics; changes in outcomes over time were explored using linear regression. Follow-up variability, cohort heterogeneity, and insufficient data precluded combining data to estimate incidences or rates.

Results: One hundred and thirty papers with 12 704 patients were included. The median number of patients was 37 (interquartile range [IQR] 17-74, range 6-3802). Twenty-five percent of patients were initiated on IV; 75% on NIV. The maximum follow-up ranged from 0.5 to 31.8 years (median 8.8 years). The median proportion of patients liberated in these papers was 3% (IQR 0%-21%). The median proportion of mortality was 18% (IQR 8%-27%). Proportions of liberation and mortality did not significantly change over time. Progression of underlying disease (44%), respiratory illness (19%), and LTV accident (11%) were the most common causes of death.

Conclusions: These papers collectively show most patients survive for many years using LTV; in many subgroups, death is a more common outcome than liberation. However, the limitations of these papers preclude robust prognostication.
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http://dx.doi.org/10.1002/ppul.25003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891895PMC
November 2020

Decisions for Long-Term Ventilation for Children. Perspectives of Family Members.

Ann Am Thorac Soc 2020 01;17(1):72-80

Division of Pediatric Critical Care, Department of Pediatrics.

The decision whether to initiate or forgo long-term ventilation for children can be difficult and impactful. However, little has been published on the informational and decisional needs of families facing this decision. To assess what families with children with chronic respiratory failure and life-limiting conditions need and want for informed decision-making. English- and Spanish-speaking parents who were facing (contemporaneous decision makers) or had previously faced (former decision makers) a decision regarding invasive or noninvasive long-term ventilation for their children were recruited using convenience sampling. Patients who were older and cognitively capable also were invited to participate. We performed semistructured interviews using an open-ended interview guide developed to assess parents' decisional needs and experiences. Qualitative data analysis used a thematic approach based on framework analysis, and thematic saturation was a goal. A sample of 44 parents and 2 patients from 43 families was interviewed. All contemporaneous decision makers ( = 28) favored or believed that they would choose long-term ventilation. Fifteen of 16 former decision makers chose long-term ventilation. Thematic saturation was achieved from the perspective of parents who favored or chose long-term ventilation. Four domains were identified: parents' emotional and psychological experiences with decision-making, parents' informational needs, parents' communication and decision support needs, and parents' views on the option not to initiate long-term ventilation. For most parents, making a decision regarding long-term ventilation was stressful, even though they articulated goals and values that could/did guide their decision-making. In general, parents wanted comprehensive information, including what life would be like at home for the child and the family. They wanted their medical providers to be honest, tactful, patient, and supportive. Parents reported that they felt being presented with the option not to initiate was acceptable. In this study, we identified specific informational and decision-making needs regarding long-term ventilation that parents facing decisions feel are important. These data suggest that providers should present families with comprehensive, balanced information on the impact of long-term ventilation and, when the child has a profoundly serious and life-limiting condition, explore the option not to initiate long-term ventilation.
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http://dx.doi.org/10.1513/AnnalsATS.201903-271OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944342PMC
January 2020

Cardiovascular disease and other childhood-onset chronic conditions in adults with cerebral palsy.

Dev Med Child Neurol 2019 08 7;61(8):859-860. Epub 2018 Oct 7.

Division of Pediatric Critical Care Medicine, Columbia University Vagelos College of Physician and Surgeons, New York, NY, USA.

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http://dx.doi.org/10.1111/dmcn.14066DOI Listing
August 2019

A multi-institutional analysis of children on long-term non-invasive respiratory support and their outcomes.

Pediatr Pulmonol 2018 04 17;53(4):498-504. Epub 2018 Jan 17.

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, New York.

Objectives: To characterize a multi-institutional cohort of children with chronic respiratory failure that use long-term, non-invasive respiratory support, perform a time-to-event analysis of transitions to transtracheal ventilation and identify factors associated with earlier transition to transtracheal ventilation.

Study Design: A retrospective cohort study of patients less than 21 years of age with diagnoses associated with chronic respiratory failure and discharged on non-invasive respiratory support was performed using data from the Pediatric Health Information System (PHIS) between 2007 and 2015. Demographic and clinical characteristics, as well as times from index discharge on non-invasive support to transtracheal ventilation were presented. A competing risk regression model was fitted to estimate factors associated with earlier transition to transtracheal ventilation.

Results: A total of 3802 patients were identified. Their median age at index discharge was 10.4 years (interquartile range [IQR] 4.1-14.9). Of these patients, 337 (8.9%) transitioned to transtracheal ventilation and transitioned at a median of 11.5 months (IQR 4.6-26) post-index discharge, or a median age of 9.3 years (IQR 4.2-14.5). Competing risk modeling demonstrated that patients who were older or whose discharge occurred later in the study period had lower hazards of earlier transition to transtracheal ventilation, whereas patients with anoxia/encephalopathy and quadriplegia had higher hazards of earlier transitioning.

Conclusions: Most patients on long-term, non-invasive respiratory support who progress to transtracheal ventilation transition do so within a few years of support initiation. Various characteristics were associated with earlier risk of transitioning to transtracheal ventilation. This information may enhance anticipatory guidance for this population.
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http://dx.doi.org/10.1002/ppul.23925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898633PMC
April 2018

Survey of financial burden of families in the U.S. with children using home mechanical ventilation.

Pediatr Pulmonol 2018 Jan 20;53(1):108-116. Epub 2017 Nov 20.

School of Nursing, Columbia University, New York, New York.

Aim: To describe and quantify the out-of-pocket expenses, employment loss, and other financial impact related to caring for a child using home mechanical ventilation (HMV).

Method: We conducted a cross-sectional survey of U.S. families with children who used HMV. Eligible participants were invited to complete a questionnaire addressing household and child characteristics, out-of-pocket expenses, employment loss/reduction, and financial stress. Participants were recruited with the help of three national patient registries.

Results: Two hundred twenty-six participants from 32 states (152 with children who used invasive ventilation and 74 with children who used noninvasive ventilation) completed the questionnaire. Participants' median reported yearly household income was $90 000 (IQR 70 000-150 000). The median amount paid in out-of-pocket expenses in the previous 3 months to care for their child using HMV totaled $3899 (IQR $2900-4550). Reported levels of financial stress decreased as income increased; 37-60% of participants, depending on income quintile, reported moderate financial stress with "some" of that stress due to their out-of-pocket expenses. A substantial majority reported one or more household members stopped or reduced work and took unpaid weeks off of work to care for their child.

Conclusion: The financial impact of caring for a child using HMV is considerable for some families. Providers need to understand these financial burdens and should inform families of them to help families anticipate and plan for them.
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http://dx.doi.org/10.1002/ppul.23917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737909PMC
January 2018

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs.

Crit Care Med 2017 Aug;45(8):1276-1284

1Division of Pediatric Critical Care, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY.2Department of Statistics, University of California, Berkeley, CA.3Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA.4Department of Medicine, University of California, San Francisco, San Francisco, CA.5Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, CA.6Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.

Objectives: To determine the occurrence rate of unplanned readmissions to PICUs within 1 year and examine risk factors associated with repeated readmission.

Design: Retrospective cohort analysis.

Setting: Seventy-six North American PICUs that participated in the Virtual Pediatric Systems, LLC (VPS, LLC, Los Angeles, CA).

Patients: Ninety-three thousand three hundred seventy-nine PICU patients discharged between 2009 and 2010.

Interventions: None.

Measurements And Main Results: Index admissions and unplanned readmissions were characterized and their outcomes compared. Time-to-event analyses were performed to examine factors associated with readmission within 1 year. Eleven percent (10,233) of patients had 15,625 unplanned readmissions within 1 year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared with index admissions (4.0% vs 2.5% and 2.5 vs 1.6 d; all p < 0.001). Median time to readmission was 30 days for all readmissions, 3.5 days for readmissions during the same hospitalization, and 66 days for different hospitalizations. Having more complex chronic conditions was associated with earlier readmission (adjusted hazard ratio, 2.9 for one complex chronic condition; hazard ratio, 4.8 for two complex chronic conditions; hazard ratio, 9.6 for three or more complex chronic conditions; all p < 0.001 compared no complex chronic condition). Most specific complex chronic condition conferred a greater risk of readmission, and some had considerably higher risk than others.

Conclusions: Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with complex chronic conditions and particular conditions were at much higher risk for readmission.
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http://dx.doi.org/10.1097/CCM.0000000000002439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541898PMC
August 2017

Pediatric intermediate care and pediatric intensive care units: PICU metrics and an analysis of patients that use both.

J Crit Care 2017 10 26;41:268-274. Epub 2017 May 26.

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital, 3959 Broadway, New York, NY 10032, United States. Electronic address:

Purpose: To examine how intermediate care units (IMCUs) are used in relation to pediatric intensive care units (PICUs), characterize PICU patients that utilize IMCUs, and estimate the impact of IMCUs on PICU metrics.

Materials & Methods: Retrospective study of PICU patients discharged from 108 hospitals from 2009 to 2011. Patients admitted from or discharged to IMCUs were characterized. We explored the relationships between having an IMCU and several PICU metrics: physical length-of-stay (LOS), medical LOS, discharge wait time, admission severity of illness, unplanned PICU admissions from wards, and early PICU readmissions.

Results: Thirty-three percent of sites had an IMCU. After adjusting for known confounders, there was no association between having an IMCU and PICU LOS, mean severity of illness of PICU patients admitted from general wards, or proportion of PICU readmissions or unplanned ward admissions. At sites with an IMCU, patients waited 3.1h longer for transfer from the PICU once medically cleared (p<0.001).

Conclusions: There was no association between having an IMCU and most measures of PICU efficiency. At hospitals with an IMCU, patients spent more time in the PICU once they were cleared for discharge. Other ways that IMCUs might affect PICU efficiency or particular patient populations should be investigated.
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http://dx.doi.org/10.1016/j.jcrc.2017.05.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633493PMC
October 2017

Decisions around Long-term Ventilation for Children. Perspectives of Directors of Pediatric Home Ventilation Programs.

Ann Am Thorac Soc 2017 Oct;14(10):1539-1547

5 Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, New York; and.

Rationale: The decision of whether to initiate or forgo long-term ventilation (LTV) for children with life-limiting conditions can be complex and impactful. Providers are responsible for helping families to understand the consequences of their options and guiding them through shared decision-making, but little has been published on how to do this.

Objectives: To assess how directors of pediatric home ventilation programs facilitate shared decision-making with families facing decisions of whether to initiate or forgo LTV for their children with life-limiting conditions. In addition, to assess directors' perspectives on these families' decisional needs.

Methods: Purposeful recruiting of directors/codirectors of pediatric home ventilation programs at children's hospitals was used. We performed semistructured interviews using an open-ended interview guide developed de novo to assess their approach to informed, shared decision-making around LTV and their perspectives on these decisions. Qualitative data analysis was conducted using a thematic approach based on framework analysis in which thematic saturation was achieved.

Results: A sample of 15 experienced physician directors across North America was interviewed. All (15/15) inform families of the potential benefits and burdens/risks of LTV for the child and of the option to forgo LTV. All stress to families the physical, emotional, and social impact of caring for a child using LTV on the family; 12 directors also highlight the financial impact. All recommend that decision-making around LTV should be interdisciplinary, initiated early, and not rushed; nine described their approach as guided by the family's goals for the child and their family. All recommend that providers be transparent, candid, active listeners, and supportive. All directors believe that the family's decision should be respected, but vary in the extent to which they recommend an option to families. They described barriers to decision-making that stem from families, providers, and other sources.

Conclusions: As providers who follow children using LTV, directors of pediatric home ventilation programs have perspectives regarding the decisional needs of these families and how to meet them that can help inform and shape the practices of other providers who assist families facing this decision.
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http://dx.doi.org/10.1513/AnnalsATS.201612-1002OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718568PMC
October 2017

One ring to rule them all: education in ICU palliative care : Discussion on "Ten key points about ICU palliative care".

Intensive Care Med 2017 05 20;43(5):720-721. Epub 2017 Feb 20.

Critical Care Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, USA.

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http://dx.doi.org/10.1007/s00134-017-4719-yDOI Listing
May 2017

Anticipatory Guidance on the Risks for Unfavorable Outcomes among Children with Medical Complexity.

J Pediatr 2017 01 28;180:247-250. Epub 2016 Oct 28.

Division of Pediatric Critical Care Medicine, Columbia University College of Physician and Surgeons, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jpeds.2016.10.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722216PMC
January 2017

Ten key points about ICU palliative care.

Intensive Care Med 2017 Jan 9;43(1):83-85. Epub 2016 Aug 9.

Critical Care Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, USA.

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http://dx.doi.org/10.1007/s00134-016-4481-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5203954PMC
January 2017

Children and Young Adults Who Received Tracheostomies or Were Initiated on Long-Term Ventilation in PICUs.

Pediatr Crit Care Med 2016 08;17(8):e324-34

1Division of Pediatric Critical Care, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY. 2Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA. 3Department of Statistics, University of California, Berkeley, CA. 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY. 5Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY. 6Division of Pediatric Pulmonology, Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, CA. 7Division of Pulmonary Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 8Division of Pulmonary and Critical Care, Department of Pediatrics, University of California, San Francisco, CA. 9Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.

Objectives: To characterize patients who received tracheostomies for airway compromise or were initiated on long-term ventilation for chronic respiratory failure in PICUs and to examine variation in the incidence of initiation, patient characteristics, and modalities across sites.

Design: Retrospective cross-sectional analysis.

Settings: Seventy-three North American PICUs that participated in the Virtual Pediatric Systems, LLC.

Patients: PICU patients admitted between 2009 and 2011.

Interventions: None.

Measurements And Main Results: Among 115,437 PICU patients, 1.8% received a tracheostomy or were initiated on long-term ventilation; 1,034 received a tracheostomy only, 717 were initiated on invasive ventilation, and 381 were initiated on noninvasive ventilation. Ninety percent had substantial chronic conditions and comorbidities, including more than 50% with moderate or worse cerebral disability upon discharge. Seven percent were initiated after a catastrophic injury/event. Across sites, there was variation in incidence of tracheotomy and initiation of long-term ventilation, ranging from 0% to 4.6%. There also was variation in patient characteristics, time to tracheotomy, number of extubations prior to tracheostomy, and the use of invasive ventilation versus noninvasive ventilation.

Conclusions: Although the PICU incidence of initiation of tracheostomies and long-term ventilation was relatively uncommon, it suggests that thousands of children and young adults receive these interventions each year in North American PICUs. The majority of them have conditions and comorbidities that impose on-going care needs, beyond those required by artificial airways and long-term ventilation themselves.
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http://dx.doi.org/10.1097/PCC.0000000000000844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113027PMC
August 2016

Central line-associated blood stream infections in pediatric intensive care units: Longitudinal trends and compliance with bundle strategies.

Am J Infect Control 2015 May;43(5):489-93

Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY; Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, NY.

Background: Knowing the temporal trend central line-associated bloodstream infection (CLABSI) rates among U.S. pediatric intensive care units (PICUs), the current extent of central line bundle compliance, and the impact of compliance on rates is necessary to understand what has been accomplished and can be improved in CLABSI prevention.

Methods: This is a longitudinal study of PICUs in National Healthcare Safety Network hospitals and a cross-sectional survey of directors and managers of infection prevention and control departments regarding PICU CLABSI prevention practices, including self-reported compliance with elements of central line bundles. Associations between 2011-2012 PICU CLABSI rates and infection prevention practices were examined.

Results: Reported CLABSI rates decreased during the study period, from 5.8 per 1,000 line days in 2006 to 1.4 in 2011-2012 (P < .001). Although 73% of PICUs had policies for all central line prevention practices, only 35% of those with policies reported ≥95% compliance. PICUs with ≥95% compliance with central line infection prevention policies had lower reported CLABSI rates, but this association was statistically insignificant.

Conclusion: There was a nonsignificant trend in decreasing CLABSI rates as PICUs improved bundle policy compliance. Given that few PICUs reported full compliance with these policies, PICUs increasing their efforts to comply with these policies may help reduce CLABSI rates.
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http://dx.doi.org/10.1016/j.ajic.2015.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430334PMC
May 2015

Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units.

J Crit Care 2015 Feb 25;30(1):201-6. Epub 2014 Oct 25.

Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA; Division of General Pediatrics, Department of Pediatrics, University of California, San Francisco, CA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA.

Purpose: The purpose of the study is to compare demographics, intensive care unit (ICU) admission characteristics, and ICU outcomes among adults with childhood-onset chronic conditions (COCCs) admitted to US pediatric and adult ICUs.

Materials And Methods: Retrospective cross-sectional analyses of 6088 adults aged 19 to 40 years admitted in 2008 to 70 pediatric ICUs that participated in the Virtual Pediatric Intensive Care Unit Performance Systems and 50 adult ICUs that participated in Project IMPACT.

Results: Childhood-onset chronic conditions were present in 53% of young adults admitted to pediatric units, compared with 9% of those in adult units. The most common COCC in both groups were congenital cardiac abnormalities, cerebral palsy, and chromosomal abnormalities. Adults with COCC admitted to pediatric units were significantly more likely to be younger, have lower functional status, and be nontrauma patients than those in adult units. The median ICU length of stay was 2 days, and the intensive care unit mortality rate was 5% for all COCC patients with no statistical difference between pediatric or adult units.

Conclusions: There are marked differences in characteristics between young adults with COCC admitted to pediatric ICUs and adult ICUs. Barriers to accommodating these young adults may be reasons why many such adults have not transitioned from pediatric to adult critical care.
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http://dx.doi.org/10.1016/j.jcrc.2014.10.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268241PMC
February 2015

Multidisciplinary Critical Care and Intensivist Staffing: Results of a Statewide Survey and Association With Mortality.

J Intensive Care Med 2016 Jun 12;31(5):325-32. Epub 2014 May 12.

Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA.

Purpose: The role of multidisciplinary teams in improving the care of intensive care unit (ICU) patients is not well defined, and it is unknown whether the use of such teams helps to explain prior research suggesting improved mortality with intensivist staffing. We sought to investigate the association between multidisciplinary team care and survival of medical and surgical patients in nonspecialty ICUs.

Materials And Methods: We conducted a community-based, retrospective cohort study of data from 60 330 patients in 181 hospitals participating in a statewide public reporting initiative, the California Hospital Assessment and Reporting Taskforce (CHART). Patient-level data were linked with ICU organizational data collected from a survey of CHART hospital ICUs between December 2010 and June 2011. Clustered logistic regression was used to evaluate the independent effect of multidisciplinary care on the in-hospital mortality of medical and surgical ICU patients. Interactions between multidisciplinary care and intensity of physician staffing were examined to explore whether team care accounted for differences in patient outcomes.

Results: After adjustment for patient characteristics and interactions, there was no association between team care and mortality for medical patients. Among surgical patients, multidisciplinary care was associated with a survival benefit (odds ratio 0.79; 95% confidence interval (CI), 0.62-1.00; P = .05). When stratifying by intensity of physician staffing, although the lowest odds of death were observed for surgical patients cared for in ICUs with multidisciplinary teams and high-intensity staffing (odds ratio, 0.77; 95% CI, 0.55-1.09; P = .15), followed by ICUs with multidisciplinary teams and low-intensity staffing (odds ratio 0.84, 95% CI 0.65-1.09, p = 0.19), these differences were not statistically significant.

Conclusions: Our results suggest that multidisciplinary team care may improve outcomes for critically ill surgical patients. However, no relationship was observed between intensity of physician staffing and mortality.
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http://dx.doi.org/10.1177/0885066614534605DOI Listing
June 2016

Frequency, risk factors, and outcomes of early unplanned readmissions to PICUs.

Crit Care Med 2013 Dec;41(12):2773-83

1Division of Pediatric Critical Care, Columbia University College of Physician and Surgeons, New York, NY. 2Department of Mathematics, Mills College, Oakland, CA. 3Columbia University School of Nursing, Columbia University, New York, NY. 4Center for Health Policy, Columbia University, New York, NY. 5Department of Epidemiology and Biostatistics, University of California, San Francisco, CA. 6Department of Medicine, University of California, San Francisco, CA. 7Division of Pulmonary and Critical Care, University of California, San Francisco, CA. 8Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.

Objectives: To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions.

Design: Retrospective cohort analysis.

Setting: Ninety North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Systems.

Patients: One hundred five thousand four hundred thirty-seven admissions between July 2009 and March 2011.

Interventions: None.

Measurements And Main Results: Unplanned PICU readmission within 48 hours of index discharge was the primary outcome. Summary statistics, bivariate analyses, and mixed-effects logistic regression model with random effects for each hospital were performed.There were 1,161 readmissions (1.2%). The readmission rate varied among PICUs (0-3.3%), and acute respiratory (56%), infectious (35%), neurological (28%), and cardiovascular (20%) diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions (adjusted odds ratio, 1.72; p < 0.001), unscheduled index admission (adjusted odds ratio, 1.37; p < 0.001), and transfer to an intermediate unit (adjusted odds ratio, 1.29; p = 0.004, compared with ward). Trauma patients had a decreased risk of readmission (adjusted odds ratio, 0.67; p = 0.003). Gender, race, insurance, age more than 6 months, perioperative status, and nighttime transfer were not associated with readmission. Compared with index admissions, readmissions had longer median PICU length of stay (3.1 vs 1.7 d, p < 0.001) and higher mortality (4% vs 2.5%, p = 0.002).

Conclusions: Unplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates.
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http://dx.doi.org/10.1097/CCM.0b013e31829eb970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327890PMC
December 2013

Measuring hospital quality using pediatric readmission and revisit rates.

Pediatrics 2013 Sep 26;132(3):429-36. Epub 2013 Aug 26.

Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.

Objective: To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high- and low-performing hospitals.

Methods: In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1-20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level risk-standardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean.

Results: Thirty-day readmission rates were low (<10.0%) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2% (appendicitis) to 11.0% (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0%-82.8% of hospitals had <25 visits). The only condition with >1% of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2% of hospitals [n = 15], range of hospital performance 6.3%-15.9%).

Conclusions: We found that when comparing hospitals' performances to the average, few hospitals that care for children are identified as high- or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement.
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http://dx.doi.org/10.1542/peds.2012-3527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876751PMC
September 2013

Multi-institutional profile of adults admitted to pediatric intensive care units.

JAMA Pediatr 2013 May;167(5):436-43

Division of Pediatric Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.

Importance: Growing numbers of persons with childhood-onset chronic illnesses are surviving to adulthood. Many use pediatric hospitals for their inpatient needs. To our knowledge, the prevalence and characteristics of adult pediatric intensive care unit patients have not been reported.

Objectives: To estimate the proportion of adults admitted to pediatric intensive care units (PICUs), characterize them, and compare them with older adolescents.

Design: One-year cross-sectional analysis.

Setting: Pediatric intensive care units in the United States that participated in the Virtual Pediatric Intensive Care Unit Systems.

Participants: Pediatric intensive care unit patients 15 years or older admitted in 2008.

Main Outcome Measures: We compared adults with adolescents across clinical characteristics and outcomes. Mixed-effects logistic regression was used to estimate the independent association of age with PICU mortality.

Results: Seventy PICUs had 67 629 admissions; 1954 admissions (2.7%) were patients 19 years or older; and 9105 admissions (13.5%) were patients aged 15 to 18 years. The proportion of adults (≥19 years) varied considerably by PICU (range, 0%-9.2%). As age increased, the proportion of patients who had a complex chronic condition and planned or perioperative admissions increased; the proportion of trauma-related admissions decreased. Patients aged 21 to 29 years had a 2 times (95% CI, 1.3-3.2; P = .004) greater odds of PICU mortality compared with adolescent patients, after adjusting for Paediatric Index of Mortality score, sex, trauma, and having a complex chronic condition. Being 30 years or older was associated with a 3.5 (95% CI, 1.3-9.7; P = .01) greater odds of mortality.

Conclusions And Relevance: In this multi-institutional study, adults constituted a small but high-risk proportion of patients in some PICUs, suggesting that these PICUs should have plans and protocols specifically focused on this group.
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http://dx.doi.org/10.1001/jamapediatrics.2013.1316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3700534PMC
May 2013

End-of-life discussions and advance care planning for children on long-term assisted ventilation with life-limiting conditions.

J Palliat Care 2012 ;28(1):21-7

Division of Pediatric Critical Care, University of California, San Francisco, and Moffitt Hospital, Box 0106, 505 Parnassus Avenue, San Francisco, California 94143-0106, USA.

Families of children with life-limiting conditions who are on long-term assisted ventilation need to undertake end-of-life advance care planning (ACP) in order to align their goals and values with the inevitability of their child's condition and the risks it entails. To discuss how best to conduct ACP in this population, we performed a retrospective analysis of end-of-life discussions involving our deceased ventilator-assisted patients between 1987 and 2009. A total of 34 (72 percent) of 47 study patients were the subject of these discussions; many discussions occurred after acute deterioration. They resulted in directives to forgo or limit interventions for 21 children (45 percent). We surmise that many families were hesitant to discuss end-of-life issues during periods of relative stability. By offering anticipatory guidance and encouraging contemplation of patients' goals both in times of stability and during worsening illness, health care providers can better engage patients' families in ACP. As the child's condition progresses, the emphasis can be recalibrated. How families respond to such encouragement can also serve as a gauge of their willingness to pursue ACP.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682656PMC
July 2012

Chronic conditions among children admitted to U.S. pediatric intensive care units: their prevalence and impact on risk for mortality and prolonged length of stay*.

Crit Care Med 2012 Jul;40(7):2196-203

Division of Pediatric Critical Care, Department of Pediatrics, University of California, San Francisco, CA 94143-0106 , USA.

Objective: To estimate the prevalence of chronic conditions among children admitted to U.S. pediatric intensive care units and to assess whether patients with complex chronic conditions experience pediatric intensive care unit mortality and prolonged length of stay risk beyond that predicted by commonly used severity-of-illness risk-adjustment models.

Design, Setting, And Patients: Retrospective cohort analysis of 52,791 pediatric admissions to 54 U.S. pediatric intensive care units that participated in the Virtual Pediatric Intensive Care Unit Systems database in 2008.

Measurements: Hierarchical logistic regression models, clustered by pediatric intensive care unit site, for pediatric intensive care unit mortality and length of stay >15 days. Standardized mortality ratios adjusted for severity-of-illness score alone and with complex chronic conditions.

Main Results: Fifty-three percent of pediatric intensive care unit admissions had complex chronic conditions, and 18.5% had noncomplex chronic conditions. The prevalence of these conditions and their organ system subcategories varied considerably across sites. The majority of complex chronic condition subcategories were associated with significantly greater odds of pediatric intensive care unit mortality (odds ratios 1.25-2.9, all p values < .02) compared to having a noncomplex chronic condition or no chronic condition, after controlling for age, gender, trauma, and severity-of-illness. Only respiratory, gastrointestinal, and rheumatologic/orthopedic/psychiatric complex chronic conditions were not associated with increased odds of pediatric intensive care unit mortality. All subcategories were significantly associated with prolonged length of stay. All noncomplex chronic condition subcategories were either not associated or were negatively associated with pediatric intensive care unit mortality, and most were not associated with prolonged length of stay, compared to having no chronic conditions. Among this group of pediatric intensive care units, adding complex chronic conditions to risk-adjustment models led to greater model accuracy but did not substantially change unit-level standardized mortality ratios.

Conclusions: Children with complex chronic conditions were at greater risk for pediatric intensive care unit mortality and prolonged length of stay than those with no chronic conditions, but the magnitude of risk varied across subcategories. Inclusion of complex chronic conditions into models of pediatric intensive care unit mortality improved model accuracy but had little impact on standardized mortality ratios.
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http://dx.doi.org/10.1097/CCM.0b013e31824e68cfDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378726PMC
July 2012

Hospital readmissions for newly discharged pediatric home mechanical ventilation patients.

Pediatr Pulmonol 2012 Apr 7;47(4):409-14. Epub 2011 Sep 7.

Division of Pediatric Pulmonology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 94143-0106, USA.

Background: Ventilator-dependent children have complex chronic conditions that put them at risk for acute illness and repeated hospitalizations.

Objectives: To determine the 12-month incidence of and risk factors for non-elective readmission in children with chronic respiratory failure (CRF) after initiation on home mechanical ventilation (HMV) via tracheostomy.

Methods: A retrospective cohort study of 109 HMV patients initiated and followed at an university-affiliated children's hospital between 2003 and 2009. Patient characteristics are presented using descriptive statistics; generalized estimated equations are used to estimate adjusted odds ratios of select predictor variables for readmission.

Results: The 12-month incidence of non-elective readmission was 40%. Close to half of these readmissions occurred within the first 3 months post-index discharge. Pneumonia and tracheitis were the most common reasons for readmission; 64% were pulmonary- or tracheostomy-related. Most demographic and clinical patient characteristics were not statistically associated with non-elective readmissions. Although, a change in the child's management within 7 days before discharge was associated readmissions shortly after index discharge.

Conclusion: Non-elective readmissions of newly initiated pediatric HMV patients were common and likely multifactorial. Many of these readmissions were airway-related, and some may have been potentially preventable.
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http://dx.doi.org/10.1002/ppul.21536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694986PMC
April 2012

Costs of hospitalized ventilator-dependent children: differences between a ventilator ward and intensive care unit.

Pediatr Pulmonol 2011 Apr 24;46(4):356-61. Epub 2010 Nov 24.

Division of Pediatric Critical Care, Department of Pediatrics, University of California, San Francisco, California 94143-0106, USA.

Hospitalizing clinically stable patients in critical care settings results in unnecessary healthcare costs and thwarts timely patient throughput. Some pediatric hospitals care for their stable ventilator-dependent children outside of pediatric intensive care units (PICUs). To date, no analysis of the costs of these pediatric ventilator units compared to PICUs has been performed. We conducted a retrospective comparison of PICU and ventilator ward costs of hospitalizations for 103 admissions in which ventilator-dependent children served as their own matched controls between 2004 and 2007. For included admissions, patients were hospitalized in both units during the same admission and spent more than 1 day in their initial unit. Comparisons of costs were made using the last full PICU day and first full ward day. For the study period, the mean PICU cost of hospitalization per day was $3,565 (standard deviation [SD] ± 716.50). The mean ward cost was $2,052 (SD ± 617). The mean PICU cost was significantly larger than the mean ward cost (paired t-test, P < 0.0001). Ventilator ward total and variable costs were significantly less than those in the PICU, and such units represent a potential cost saving measure for hospitals that care for ventilator-dependent children.
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http://dx.doi.org/10.1002/ppul.21371DOI Listing
April 2011

Costs of hospitalized ventilator-dependent children: differences between a ventilator ward and intensive care unit.

Pediatr Pulmonol 2011 Apr 24;46(4):356-61. Epub 2010 Nov 24.

Division of Pediatric Critical Care, Department of Pediatrics, University of California, San Francisco, California 94143-0106, USA.

Hospitalizing clinically stable patients in critical care settings results in unnecessary healthcare costs and thwarts timely patient throughput. Some pediatric hospitals care for their stable ventilator-dependent children outside of pediatric intensive care units (PICUs). To date, no analysis of the costs of these pediatric ventilator units compared to PICUs has been performed. We conducted a retrospective comparison of PICU and ventilator ward costs of hospitalizations for 103 admissions in which ventilator-dependent children served as their own matched controls between 2004 and 2007. For included admissions, patients were hospitalized in both units during the same admission and spent more than 1 day in their initial unit. Comparisons of costs were made using the last full PICU day and first full ward day. For the study period, the mean PICU cost of hospitalization per day was $3,565 (standard deviation [SD] ± 716.50). The mean ward cost was $2,052 (SD ± 617). The mean PICU cost was significantly larger than the mean ward cost (paired t-test, P < 0.0001). Ventilator ward total and variable costs were significantly less than those in the PICU, and such units represent a potential cost saving measure for hospitals that care for ventilator-dependent children.
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http://dx.doi.org/10.1002/ppul.21371DOI Listing
April 2011

Pediatric resident attitudes toward caring for children with severe disabilities.

Am J Phys Med Rehabil 2010 Sep;89(9):765-71

Division of Pediatric Critical Care, Department of Pediatrics, University of California, San Francisco, California 94143-0106, USA.

Objective: To survey pediatric residents' attitudes toward caring for children with severe disabilities.

Design: A cross-sectional survey of residents in a university-affiliated pediatric residency program between October and December 2005. Residents were asked to complete a newly designed, 13-item survey. For each item, participants selected the degree to which they did or did not agree with a statement about disabilities or caring for children with severe disabilities.

Results: Fifty-five (43%) of 129 eligible residents participated. Eighty-nine percent felt that caring for children with severe disabilities was as rewarding as caring for other children. Ninety-two percent felt that there is a societal responsibility to care for such children; 98% felt families of children with disabilities love their children as much as other families. Two-thirds (66%) admitted frustration related to caring for children who cannot be cured or function independently, and 71% questioned the aggressive treatment of such children. Residents in their second and third postgraduate years were more likely to question the aggressive treatment compared with their junior colleagues.

Conclusions: Although pediatric residents had positive attitudes toward children with severe disabilities, emotional and moral tensions did arise around their care.
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http://dx.doi.org/10.1097/PHM.0b013e3181ec9936DOI Listing
September 2010

Outcomes and causes of death in children on home mechanical ventilation via tracheostomy: an institutional and literature review.

J Pediatr 2010 Dec 14;157(6):955-959.e2. Epub 2010 Aug 14.

Division of Pediatric Critical Care, Department of Pediatrics, University of California, San Francisco, CA, USA.

Objective: To describe outcomes and causes of death in children on chronic positive-pressure ventilation via tracheostomy.

Study Design: We conducted a retrospective observational cohort analysis of 228 children enrolled in an university-affiliated home mechanical ventilation (HMV) program over 22 years (990 person-years). Cumulative incidences of survival and liberation from HMV are presented. Time-to-events were compared by reason for chronic respiratory failure (CRF) and age and date of HMV initiation with Kaplan-Meier and Cox regression analyses. Circumstances of death are described.

Results: Of our cohort, 47 of 228 children died, and 41 children were liberated from HMV. The 5-year cumulative incidences of survival and liberation were 80% and 24%, respectively. Being placed on HMV for chronic pulmonary disease was independently associated with liberation from HMV (hazard ratio, 7.38; 95% CI, 3.0-18.2; P < .001). Neither age nor reasons for CRF were associated with shortened survival. Progression of underlying condition accounted for only 34% of deaths; 49% of deaths were unexpected.

Conclusion: Most children on HMV survive or were weaned off. However, a sizable number of children in our cohort died, and many deaths were unexpected and from causes not directly related to their primary reason for CRF.
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http://dx.doi.org/10.1016/j.jpeds.2010.06.012DOI Listing
December 2010

Children with corrected or palliated congenital heart disease on home mechanical ventilation.

Pediatr Pulmonol 2010 Jul;45(7):645-9

Department of Anesthesiology Critical Care Medicine, Childrens Hospital of Los Angeles, Los Angeles, CA, USA.

Infants and children with surgically corrected or palliated congenital heart disease (CHD) are at risk for chronic respiratory failure, necessitating home mechanical ventilation (HMV) via tracheostomy. However, very little data exists on this population or their outcomes. We conducted a retrospective chart review of all children with CHD enrolled in the Childrens Hospital Los Angeles HMV program between 1994 and 2009. Data were collected on type of heart lesion, surgeries performed, number of failed extubations, timing of tracheostomy, mortality, length of time on HMV, weaning status, associated co-morbidities, and Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) category. Thirty-five children were identified; six with single ventricle anatomy, who received palliative procedures. Twenty-three (66%) patients are alive; 8 (23%) living patients have been weaned off HMV. Twelve (34%) patients are deceased. The incidence of mortality for single ventricle patients was 50%, and only one of the surviving children has received final palliation and weaned off HMV. Eight of nine patients (89%) with a RACHS score > or =4 died, and none have been weaned off of HMV. The 5-year survival for all CHD HMV patients was 68%; 90% for patients with RACHS < or =3; and 12% for patients with score > or =4. Children with more complex lesions, as demonstrated by single ventricle physiology or greater RACHS scores, had higher mortality rates and less success weaning off HMV. This case series suggests that caregivers should give serious consideration to the type of heart defect as they advise families considering HMV in children with CHD.
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http://dx.doi.org/10.1002/ppul.21214DOI Listing
July 2010

Accidental deaths due to inhalant misuse in North Carolina: 2000-2008.

Subst Use Misuse 2010 Jul;45(9):1330-9

Department of Behavioral Science, University of Kentucky, Lexington, Kentucky 40536-0086, USA.

This study describes the number and characteristics of accidental deaths associated with recreational inhalant misuse in North Carolina from 2000 to 2008. Inhalant-related deaths were identified via an electronic search of records of the North Carolina Office of the Chief Medical Examiner. Thirty deaths were attributed to recreational inhalant use, and nearly a third involved the inhalation of compressed-air products. Polydrug use and comorbid psychiatric disorders were common among decedents. The types of inhalants most often resulting in death differed from previous studies, as did the somewhat older mean age of decedents. Further research on inhalant-related mortality is warranted.
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http://dx.doi.org/10.3109/10826081003682289DOI Listing
July 2010
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