Predictors of Longitudinal Outcomes for Children Using Long-term
Background: Non-invasive ventilation (NIV) is a first-line therapy for
sleep-related breathing disorders and chronic respiratory insufficiency.
Evidence about predictors that may impact long-term NIV outcomes,
however, is scarce. The aim of this study is to determine demographic,
clinical, and technology-related predictors of long-term NIV outcomes.
Methods: A ten-year multi-centred retrospective review of children
started on long-term continuous or bilevel positive airway pressure
(CPAP, BPAP) in Alberta. Demographic, technology-related, and
longitudinal clinical data was collected. Long-term outcomes examined
included ongoing NIV use, discontinuation due to improvement in
underlying condition, switch to invasive mechanical ventilation (IMV) or
death, patient/family therapy declination, transfer of services, and
hospital admissions. Results: 622 children were included. Both younger
age and CPAP use predicted higher likelihood for NIV discontinuation due
to improvement in underlying conditions. Children with upper airway
disorders or bronchopulmonary dysplasia were less likely to require NIV
continuation while presence of central nervous system (CNS) disorders
resulted in higher likelihood of hospitalizations and switch to IMV or
death. The presence of obesity/metabolic syndrome and early
NIV-associated complications predicted higher risk for NIV declination.
Children with more co-morbidities or use of additional therapies
required more hospitalizations and the latter also predicted higher risk
to be switched to IMV or death. Conclusions: Demographic, clinical data,
and NIV type impact long-term NIV outcomes and need to be considered
during the initial discussions about therapy expectations with families.
Knowledge of factors that may impact long-term NIV outcomes might help
to better monitor at-risk patients and minimize adverse outcomes.