Abstract Background and Rationale The number of children needing chronic invasive ventilator support is rising. These children visit the emergency department (ED) and require hospitalization, often with longer stays and higher mortality than children with other complex conditions who are not ventilator dependent. We compared demographic and clinical information associated with medically attended acute respiratory illness (ARI) in children with and without chronic invasive ventilator dependency. Methods We analyzed data from 2016-2024 obtained from the New Vaccine Surveillance Network (NVSN), a 7-site, prospective, population-based surveillance system that enrolls children with medically-attended ARI. Upper respiratory specimens from enrollees were tested for respiratory pathogens using rt-PCR; clinical and demographic data were obtained by parent interview and/or medical record abstraction. We included three patient groups: tracheostomy-ventilator dependent (group 1); lung/airway disease without ventilator dependence (group 2); and without lung disease or ventilator dependence (may have other underlying conditions (group 3). We excluded patients with known immunosuppression and when home ventilator use was unknown. We compared categorical variables using Chi-square tests and Kruskal-Wallis tests for continuous variables; odds ratios were calculated using logistic regression for binary variables. Results We included 85,468 children: 1,009 (1.2%) in group 1, 14,456 (16.9%) in group 2, 70,003 (81.9%) in group 3. Children were predominantly male and publicly insured, with notable differences in median age between groups (Table); group 1 and 2 patients were older compared to group 3. Respiratory viruses were detected in two-thirds of patients regardless of group, with rhinovirus/enterovirus most frequently detected, followed by RSV (32.1% and 16.9%, respectively). Viral co-detection occurred in 32.7% of participants. Compared to groups 2 and 3, children in group 1 more frequently required escalation of oxygen support and hospitalization. When hospitalized, they had longer lengths of stay and more frequently required critical level care with increased need for ECMO (Extracorporeal Membrane Oxygenation). Group 1 had 4 times greater odds of prolonged hospitalization (5 days) (Odds Ratio 4.28 (95% CI: 3.68, 4.99)) compared to group 3. Mortality was low across all groups, but was notably higher in group 1 compared to group 3. Conclusions Patients with chronic tracheostomy and ventilator dependence have higher inpatient healthcare utilization, morbidity in the setting of acute respiratory illness compared to patients without chronic invasive ventilatory dependence with or without underlying respiratory/airway disease. Patients with chronic invasive ventilatory dependence, even though older, have higher mortality compared to patients without any underlying respiratory conditions. This abstract is funded by: CDC New Vaccine Surveillance Network Grant
Mangat et al. (Fri,) studied this question.