Pediatrics |

Hospital Readmission Rates and Clinical Outcomes of Children With Chronic Respiratory Failure Due to Chronic Lung Disease or Congenital Heart Disease FREE TO VIEW

William Wheeler, MD; B Kelly Han, MD; William White, BA; Alison Overman, BA; Yi Lu, BA
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Children's Hospitals and Clinics of Minnesota, Minneapolis, MN

Chest. 2014;146(4_MeetingAbstracts):701A. doi:10.1378/chest.1988099
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SESSION TITLE: Pediatic Pulmonary & Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 27, 2014 at 04:30 PM - 05:30 PM

PURPOSE: We studied the outcomes of age-matched children with congenital heart disease (CHD) and chronic lung disease (CLD) who are ventilator-dependent and experience chronic respiratory failure (CRF) requiring home mechanical ventilation (HMV). Our focus was on survival rates and hospital readmission rates in each group. We hypothesized that CHD would have higher readmission rates,worse survival rates,and reduced weaning rates than children with CLD because of comorbidities of CHD.

METHODS: We retrospectively reviewed our home mechanical ventilation outcomes of infants with CRF due to either CHD or CLD from January 1,2000 to June 30,2013.The cohorts were age and sex matched over this time frame. Statistical analysis was performed using SPSS,version 20.0 (SPSS Inc,Chicago,Ill.).

RESULTS: Parameter (median) CLD CHD p value Number subjects 50 50 Years followed post trach 4.4 4.5 0.36 Survivors (%) 49 (98) 37 (74) 0.01 All Readmissions/pt 7 11 0.21 Medical Readmits/pt 2 3 0.05 Medical Readmit days/pt 6.6 25.9 0.01 Weaned/Decannulated(%) 46 (96) 32(63) 0.001 Decannulation Age (mos) 21.3 19.5 0.41 233 of 406 (57.4%) unplanned medical readmissions were associated with acute infections. 60% were readmitted to intensive care. There were no home airway accidents and only one unexpected death in each group.

CONCLUSIONS: We conclude that children with CHD have greater morbidity than CLD as evidenced by more hospital readmission days, more unexpected readmissions, and less frequent successful decannulations. Despite a higher mortality in CHD versus CLD,survivors are liberated from mechanical ventilation and usually decannulated successfully.

CLINICAL IMPLICATIONS: These data indicate that children with CRF due to CHD or CLD have high survival rates.Outcomes include successful weaning and decannulation of tracheostomies, but hospital readmissions are common despite high-level extended in-home nursing support.These readmissions are often unexpected and are associated with intercurrent infections.

DISCLOSURE: William Wheeler: Consultant fee, speaker bureau, advisory committee, etc.: Medical consultant to Bayada Nursing, a pediatric nursing company in Minnesota. The following authors have nothing to disclose: B Kelly Han, William White, Alison Overman, Yi Lu

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