Introduction: Advances in pediatric critical care have shifted the pediatric intensive care (PICU) patient population to include more patients with chronic critical illness (CCI). The CCI population is known to have high PICU resource use, morbidity and mortality compared to non-CCI children. However, there are limited studies examining factors associated with increased resource use within the CCI cohort. This study aims to examine markers associated with increased PICU use for children with CCI requiring respiratory technology. Methods: A single center retrospective chart review of pediatric patients with CCI requiring respiratory technology (tracheostomy, invasive or non-invasive ventilation) was performed. Patients receiving respiratory support for strictly OSA were excluded. Patient charts were identified using the CHDI – OHDSI ATLAS program and categorized by previously published ICD – 10 codes associated with respiratory CCI. Data collected included demographic characteristics, Child Opportunity Index (COI) scores, comorbidities, respiratory technology used, and duration of technology use during a defined first index admission. Patients re-admitted after one-year from the first index admission but within the study period (2018-2023) were included as a separate index case. PICU days admitted and admissions within one year following all index admissions were calculated. A cumulative logistic mixed-effects regression was used to model predictors of PICU days utilized within one year of index admission. Results: Fifty-nine patients and eighty-eight index admissions were analyzed. After adjusting for age, gender, race, ethnicity, discharge location, type and duration of respiratory technology used, and number of comorbidities, patients with high COI demonstrated a significant 94% reduction in odds of having a higher number of utilized PICU days (>15days) within one year of index admission compared to patients with very low COI (OR = 0.06, p< 0.05]. However, this trend did not extend to those with very high COI. Conclusions: This study suggests that different levels of COI may impact PICU resource utilization. However, further investigation is warranted to further clarify this finding.
Calautti et al. (Sun,) studied this question.