Children Requiring 3 or More Days of Invasive Ventilation: Secondary Analysis of Post-Discharge Change in Caregiver Employment

Kathryn E Kalata; Kristen R Miller; Yamila L Sierra; Tellen D Bennett; R Scott Watson; Peter M Mourani; Aline B Maddux

doi:10.1097/PCC.0000000000003676

Children Requiring 3 or More Days of Invasive Ventilation: Secondary Analysis of Post-Discharge Change in Caregiver Employment

Pediatr Crit Care Med. 2024 Dec 19. doi: 10.1097/PCC.0000000000003676. Online ahead of print.

Authors

Kathryn E Kalata¹, Kristen R Miller¹, Yamila L Sierra², Tellen D Bennett^{3

4

5}, R Scott Watson⁶, Peter M Mourani⁷, Aline B Maddux^{3

4}

Affiliations

¹ Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
² Child Health Research Enterprise, Pediatric Critical Care Medicine, Children's Hospital Colorado, Aurora, CO.
³ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO.
⁴ Section of Pediatric Critical Care Medicine, Children's Hospital Colorado, Aurora, CO.
⁵ Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO.
⁶ Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Washington School of Medicine and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA.
⁷ Department of Pediatrics, Section of Critical Care, University of Arkansas for Medical Sciences and Arkansas Children's, Little Rock, AR.

PMID: 39700030
DOI: 10.1097/PCC.0000000000003676

Abstract

Objectives: To describe frequency of, and risk factors, for change in caregiver employment among critically ill children with acute respiratory failure.

Design: Preplanned secondary analysis of prospective cohort dataset, 2018-2021.

Setting: Quaternary Children's Hospital PICU.

Patients: Children who required greater than or equal to 3 days of invasive ventilation, survived hospitalization, and completed greater than or equal to 1 post-discharge survey.

Interventions: None.

Measurements and main results: We measured change in caregiver employment 1 and 12 months post-discharge relative to pre-admission and, when present, change in caregiver identity defined by relationship to the patient. Data were collected by survey. We used logistic regression to identify factors associated with these changes. We evaluated 130 children, median age 6.4 years (interquartile range, 1.10-13.3 yr), 40 (30.8%) with a complex chronic condition (CCC), and 99 (76.2%) with normal pre-illness Functional Status Scale scores. Of 123 with 1-month post-discharge data, 25 of 123 (20.3%) experienced a change in caregiver employment and an additional 14 of 123 (11.4%) had a change in caregiver(s). Of 115 with 12-month post-discharge data, 33 of 115 (28.7%) experienced a change in caregiver employment and an additional 16 of 115 (13.9%) had a change in caregiver(s). After controlling for age, CCC, baseline caregiver employment, new morbidity at discharge, and social and economic index; higher maximum Pediatric Logistic Organ Dysfunction-2 score (odds ratio [OR], 1.19 [95% CI, 1.01-1.41]) and government insurance (OR, 3.85 [95% CI, 1.33-11.11]) were associated with the composite outcome of change in caregiver employment or caregiver(s) at 1-month post-discharge.

Conclusions: At 1 and 12 months post-discharge, more than one-in-five children who survived greater than or equal to 3 days of invasive ventilation had a change in caregiver employment and one-in-ten had a change in caregiver(s). Identification of risk factors, such as illness severity and social determinants of health, associated with a significant family change may improve our support of these families.