Invasive mechanical ventilation, functional decline at pediatric intensive care unit discharge, and post-discharge mortality in critically ill pediatric cancer patients: a retrospective cohort study.
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OBJECTIVE: To evaluate the association between invasive mechanical ventilation use, functional capacity, and 12-month mortality in critically ill children with cancer after a pediatric intensive care unit stay. METHODS: We conducted a single-center, retrospective cohort study of critically ill children with cancer admitted to the pediatric intensive care unit from January 2018 to December 2022. We applied the Functional Status Scale to classify functional capacity before pediatric intensive care unit admission and at discharge, and to determine the onset of new morbidities. We assessed the association between invasive mechanical ventilation use and the development of new morbidity (defined as an increase of at least three points in the Functional Status Scale at discharge, and as an increase of at least two points in any domain of Functional Status Scale at discharge), between invasive mechanical ventilation use and 12-month mortality after pediatric intensive care unit discharge, and of the onset of new morbidities and mortality during the same period. RESULTS: We included 423 patients, of whom 176 (41%) used invasive mechanical ventilation. The frequency of new morbidities was higher in the mechanically ventilated patients (39.2% versus 4.8%; p < 0.001). Invasive mechanical ventilation use was associated with the development of new morbidity (adjusted OR = 13; 95%CI = 6.6 - 27.3; p < 0.001). New morbidity was associated with increased mortality at 12 months after pediatric intensive care unit discharge (adjusted OR = 2.1; 95%CI = 1.2 - 3.7; p = 0.013), but mechanical ventilation was not. CONCLUSION: Critically ill children with cancer who required invasive mechanical ventilation during pediatric intensive care unit stay had 13-fold higher odds of developing new morbidities. The onset of new morbidity was associated with doubled odds of death within 12 months after pediatric intensive care unit discharge. However, invasive mechanical ventilation use was not directly associated with 12-month mortality.