SESSION TITLE: Pediatric Critical Care
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AM
PURPOSE: Identify factors that influence weaning from ventilator support among children with bronchopulmonary dysplasia (BPD) and airway malacia requiring home mechanical ventilation (HMV).
METHODS: Retrospective chart review of invasively ventilated patients with initial discharge with HMV from 2000 to 2008. Inclusion criteria: < 4 years, sent home with HMV and followed at University of Michigan Mott Children's Hospital. Data were evaluated from two time points: program entry and 24 months later. Degree of ventilator support was measured utilizing the Weaning Severity Index (WSI). Multivariable logistic regression analysis was used to determine predictors of clinically significant change (3 point or greater decrease) on WSI. Potential predictors were gestational age, weight, length, both measured as z-score, number of pulmonary exacerbations and number of acute hospitalizations.
RESULTS: 62 children met inclusion criteria and 67% were male. 24 of the subjects were ventilated for airway malacia, 38 for BPD. Average gestational age 32.8 weeks. Average age at first measure 9.6 months. Average WSI at time 1 was 4.3, with 95% of subjects with a WSI of 4 or higher. Of all predictors, only z-score for weight at program entry and 24 months later were significantly associated with decrease in WSI score.
CONCLUSIONS: Weight gain is independently and significantly associated with decrease in WSI score and thus, faster wean from mechanical ventilation. These findings are consistent with other studies demonstrating improved lung function in children with somatic growth.
CLINICAL IMPLICATIONS: The results of this study demonstrate the critical importance of growth in weaning from chronic ventilation. These results support clinical interventions to promote optimal weight gain as adjunct therapy to achieve timely wean from mechanical ventilation.
DISCLOSURE: The following authors have nothing to disclose: Ann Marie Ramsey, Leila Covrigaru, Kathleen Barnum, Brian Benneyworth, Susan Murphy, Amy Filbrun
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