Factors Influencing Functional Status Outcomes of Intubated Pediatric Patients

Introduction: Critically ill children are at risk of functional impairments after hospital discharge. We hypothesized patients with longer duration of mechanical ventilation were more likely to have a new functional morbidity at hospital discharge.


Methods: In this single-center retrospective study, pediatric patients requiring invasive mechanical ventilation were identified from 2018-2022. Functional status was defined by the functional status scale (FSS), a measure of independence in daily activities where higher scores indicate greater functional impairment. The FSS was scored at prehospital baseline and hospital discharge. Characteristics and clinical demographics were collected and groups with good outcomes (no change or improvement in FSS) were compared to those with a new morbidity (FSS increase by >/= 3). Data presented as median [interquartile range] and groups compared using chi-square, Mann-Whitney, or Kruskal-Wallace.


Results: In a cohort of 969 intubated patients with median age 4.3 [0.9,13.1] years, majority male (57.5%), with primary indication for intubation being primary respiratory failure (38.1%), those with good outcomes were younger than those with a new morbidity (3.3 vs. 8.7 years, p< 0.01). Patients requiring vasoactive infusions, antipsychotics for delirium, and benzodiazepine infusions for sedation were at a significantly increased risk of a new morbidity at discharge (p < 0.001). Patients with new morbidity had longer duration of mechanical intubation than those with good outcomes [13.3 [6,24] vs. 4.9 [2,10] days (p < 0.01)]. Patients with new morbidity had higher Pediatric Index of Mortality 3 (PIM3) scores (indicating a higher severity of illness) compared to those with good outcomes [3.3 [1.0, 6.9] vs. 1.3 [0.9, 3.4] (p < 0.01)]. Of patients with a new morbidity, the functional category most frequently impacted was feeding (75%.)


Conclusions: In this cohort of pediatric survivors of critical illness, those with longer duration of mechanical ventilation were more likely to have a new morbidity. Given the significant association of vasoactive infusions, antipsychotic administration and benzodiazepine infusions, further investigation is needed to understand the relationship between ICU interventions and other clinical factors on functional outcomes of pediatric critical illness.