255: IMPACTS OF MECHANICAL VENTILATION ON PATIENTS AND FAMILIES TWO MONTHS AFTER CRITICAL ILLNESS

Abstract

Introduction: The outcomes of mechanically ventilated children surviving a critical illness remain poorly characterized, and increased knowledge may lead to strategies improving post-PICU care. We compared the outcomes of PICU survivors who received invasive mechanical ventilation (IMV) vs. non-invasive ventilation (NIV) 2 months after PICU discharge. Methods: This is a retrospective cohort study of children admitted for ≥4 days with ≥2 days of IMV or ≥4 days of NIV to the PICU of CHU Sainte-Justine. Two months after PICU discharge, patients were evaluated at the follow-up clinic, and parents were asked to fill out questionnaires (Pediatric Quality of Life Inventory, Hospital Anxiety, and Depression Scale). Continuous and dichotomous data were compared using Mann-Whitney and Fisher’s exact tests. Results: From Oct 2018 to Dec 2021, 152 patients were included. 106 patients received IMV (+/-NIV), and 46 patients exclusively received NIV. Duration of respiratory support (11.8+/-2.3 vs. 8.2 +/-3.1 days, p=0.22) was similar between groups, while duration of PICU stay was longer (34.1+/-9.2 vs 13.0+/-4.2 days, p=0.008) and worst PELOD was higher (10.4+/-0.4 vs 3.2+/-0.4, p=0.001) in IMV patients. The diagnosis was a respiratory illness in 30.2% of IMV vs. 78.3% of NIV patients (p=0.04). Quality of life scores were similar between groups (physical score 77.3+/-21.1% vs. 79.7+/-17.4%, p=0.73 and psychological score 79.7+/-16.0% vs 80.3+/-18.3% p=0.68). At follow-up, more patients in the NIV group had persistent respiratory difficulties (26.7% vs. 10.4%, p=0.01). Reported rates of fatigue (19.0% vs. 8.0%, p= 0.18), voice change (10.4% vs. 6.6%, p=0.44), and sleep disorders (17.1% vs. 8.9%, p=0.11) were similar between groups. There was no difference in parental anxiety (28.9 vs. 35.0%, p=0.83) and depression symptoms (24.7% vs. 23.5%, p=0.94) between groups. Conclusions: PICU survivors and their family experienced physical and neurobehavioral morbidities 2 months after their critical illness, whether they received IMV or NIV. Patients’ quality of life and parental symptoms of anxiety and depression did not differ according to the respiratory support. Persistent respiratory difficulties were more common in the NIV group. These findings suggest that PICU follow-up clinics should include patients receiving NIV.