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Predictors for Invasive Home Mechanical Ventilation Duration in Chronic Lung Disease of Prematurity
  • +6
  • Carolyn Foster,
  • Paige Noreen,
  • Jennifer Grage,
  • Soyang Kwon,
  • Lindsey P. Hird-McCorry,
  • Angela Janus,
  • Matthew M. Davis,
  • Denise Goodman,
  • Theresa Laguna
Carolyn Foster
Northwestern University Department of Pediatrics

Corresponding Author:ccfoster@luriechildrens.org

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Paige Noreen
Ann and Robert H Lurie Children's Hospital of Chicago
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Jennifer Grage
Ann and Robert H Lurie Children's Hospital of Chicago
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Soyang Kwon
Ann and Robert H Lurie Children's Hospital of Chicago
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Lindsey P. Hird-McCorry
Ann and Robert H Lurie Children's Hospital of Chicago
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Angela Janus
Ann and Robert H Lurie Children's Hospital of Chicago
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Matthew M. Davis
Northwestern University Department of Pediatrics
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Denise Goodman
Northwestern University Department of Pediatrics
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Theresa Laguna
Northwestern University Department of Pediatrics
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Abstract

Background Children with chronic lung disease (CLD) of prematurity who require invasive home mechanical ventilation (iHMV) are medically vulnerable and experience high caregiving and healthcare costs. Predictors for duration of iHMV remain unclear, which can make prognostication and decision-making challenging. Methods A retrospective cohort study of children with CLD of prematurity requiring invasive iHMV was conducted from an independent children’s hospital records (2005-2021). The primary outcome was iHMV duration, defined as time from initial discharge home on iHMV until cessation of positive pressure ventilation (day and night). Two new variables were included: corrected tracheostomy age (CTA) (chronological age at discharge minus age at tracheotomy) and level of ventilator support at discharge (minute ventilation per kg per day). Univariable Cox regression was performed with variables of interest compared to iHMV duration. Significant nonlinear factors (P<0.05) were included in the multivariable analysis. Results One-hundred-and-nineteen patients used iHMV primarily for CLD of prematurity. Patient median index hospitalization lasted 12 months (IQR 8.0,14.4). Once home, half of patients were weaned off iHMV by 36.0 months and 90% by 52.2 months. Being Hispanic/Lantix ethnicity (HR 0.14 (95% CI 0.04, 0.53), p<0.01) and having a higher CTA were associated with increased iHMV duration (HR 0.66 (CI 0.43, 0.98), p<0.05). Conclusions Disparity in iHMV duration exists among patients using iHMV after prematurity. Prospective multisite studies that further investigate new analytic variables, such as CTA and level of ventilator support, and address standardization of iHMV care are needed to create more equitable iHMV management strategies.
29 Nov 2022Submitted to Pediatric Pulmonology
29 Nov 2022Submission Checks Completed
29 Nov 2022Assigned to Editor
29 Nov 2022Review(s) Completed, Editorial Evaluation Pending
06 Dec 2022Reviewer(s) Assigned
03 Jan 2023Editorial Decision: Revise Major
24 Feb 20231st Revision Received
24 Feb 2023Assigned to Editor
24 Feb 2023Submission Checks Completed
24 Feb 2023Review(s) Completed, Editorial Evaluation Pending
24 Feb 2023Reviewer(s) Assigned
20 Mar 2023Editorial Decision: Revise Minor
24 Mar 20232nd Revision Received
30 Mar 2023Review(s) Completed, Editorial Evaluation Pending
30 Mar 2023Submission Checks Completed
30 Mar 2023Assigned to Editor
30 Mar 2023Reviewer(s) Assigned
03 Apr 2023Editorial Decision: Accept