Higher mortality, improved disease severity in children on noninvasive ventilation
There appears to be no increase in complication burden and breathing abnormality severity in children receiving noninvasive ventilation (NIV), reflecting the increasing prevalence of its use, a recent study has shown.
Researchers performed a retrospective cohort study of 622 children starting long-term NIV and found that between 2005 and 2008, the rate of NIV use increased from 1.65 to 8.01 per 100,000 children. This was followed by periods of stability at 7.9 per 100,000 children initiating NIV from 2008–2011 and 2011–2014 (p<0.001 for trend).
Discontinuation of NIV due to improvements in underlying conditions increased significantly from 84.2 per 1,000 children in 2005–2008 to 123.2 per 1,000 children in 2008–2011 and 292.1 per 1,000 children in 2011–2014 (p<0.001 for trend).
The same increasing trend was observed for discontinuations due to family decisions (74.1 per 1,000 children in 2005–2008 to 245.4 per 1,000 children in 2011–2014; p<0.001) and transfer to adult services (74.1 per 1,000 children in 2005–2008 to 105.2 per 1,000 cases in 2011–2014; p<0.001).
However, mortality rates also significantly grew. From 3.4 deaths per 1,000 children in 2005–2008, the mortality increased to 39.2 per 1,000 children in 2008–2011 and 142.1 per 1,000 children in 2011–2014 (p<0.001 for trend). Age at death remained statistically constant throughout the study period.
Subgroup analysis showed that particular diagnoses were more associated with lower survival than others. For instance, patients with central nervous system (CNS) and cardiorespiratory conditions tended to have poorer survival than those with upper airway and musculoskeletal and neuromuscular disorders. Mortality rates grew over time for CNS conditions and remained constant for the others.