Oxygenation Severity Categories and Long-Term Quality of Life among Children who Survive Septic Shock

Joseph G. Kohne; Erin F. Carlton; Stephen M. Gorga; Acham Gebremariam; Michael W. Quasney; Jerry Zimmerman; Sarah L. Reeves; Ryan P. Barbaro

doi:10.1055/s-0042-1756307

Journal of Pediatric Intensive Care, Table of Contents

J Pediatr Intensive Care 2024; 13(04): 408-414
DOI: 10.1055/s-0042-1756307

Original Article

Oxygenation Severity Categories and Long-Term Quality of Life among Children who Survive Septic Shock

Joseph G. Kohne

¹Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States

²Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan, United States

,

Erin F. Carlton

¹Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States

²Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan, United States

,

Stephen M. Gorga

¹Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States

,

Acham Gebremariam

²Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan, United States

,

Michael W. Quasney

¹Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States

,

Jerry Zimmerman

³Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington, United States

,

Sarah L. Reeves

²Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan, United States

⁴Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States

,

Ryan P. Barbaro

¹Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States

²Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan, United States

› Author Affiliations

Abstract

Objectives This study aimed to test whether early oxygenation failure severity categories (absent/mild/moderate/severe) were associated with health-related quality of life (HRQL) deterioration among children who survived sepsis-related acute respiratory failure.

Methods We performed a secondary analysis of a study of community-acquired pediatric septic shock, Life After Pediatric Sepsis Evaluation. The primary outcome was an adjusted decline in HRQL ≥ 25% below baseline as assessed 3 months following admission. Logistic regression models were built to test the association of early oxygenation failure including covariates of age and nonrespiratory Pediatric Logistic Organ Dysfunction-2 score. Secondarily, we tested if there was an adjusted decline in HRQL at 6 and 12 months and functional status at 28 days.

Results We identified 291 children who survived to discharge and underwent invasive ventilation. Of those, that 21% (61/291) had mild oxygenation failure, 20% (58/291) had moderate, and 17% (50/291) had severe oxygenation failure. Fifteen percent of children exhibited a decline in HRQL of at least 25% from their baseline at the 3-month follow-up time point. We did not identify an association between the adjusted severity of oxygenation failure and decline in HRQL ≥ 25% at 3-, 6-, or 12-month follow-up. Children with oxygenation failure were more likely to exhibit a decline in functional status from baseline to hospital discharge, but results were similar across severity categories.

Conclusion Our findings that children of all oxygenation categories are at risk of HRQL decline suggest that those with mild lung injury should not be excluded from comprehensive follow-up, but more work is needed to identify those at the highest risk.

Keywords

shock, septic - health-related quality of life - acute hypoxemic respiratory failure - respiratory distress syndrome, pediatric - postintensive care syndrome - functional status

Full Text

References

References
1 Khemani RG, Smith LS, Zimmerman JJ, Erickson S. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05, Suppl 1): S23-S40
2 Yehya N, Thomas NJ, Khemani RG. Risk stratification using oxygenation in the first 24 hours of pediatric acute respiratory distress syndrome. Crit Care Med 2018; 46 (04) 619-624
3 Flori HR, Glidden DV, Rutherford GW, Matthay MA. Pediatric acute lung injury: prospective evaluation of risk factors associated with mortality. Am J Respir Crit Care Med 2005; 171 (09) 995-1001
4 Quasney MW, López-Fernández YM, Santschi M, Watson RS. Pediatric Acute Lung Injury Consensus Conference Group. The outcomes of children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05, Suppl 1): S118-S131
5 Khemani RG, Smith L, Lopez-Fernandez YM. et al; Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med 2018; 2600 (18) 1-14
6 Zimmerman JJ, Banks R, Berg RA. et al; Life After Pediatric Sepsis Evaluation (LAPSE) Investigators. Critical illness factors associated with long-term mortality and health-related quality of life morbidity following community-acquired pediatric septic shock. Crit Care Med 2020; 48 (03) 319-328
7 Simon TD, Cawthon ML, Stanford S. et al; Center of Excellence on Quality of Care Measures for Children with Complex Needs (COE4CCN) Medical Complexity Working Group. Pediatric medical complexity algorithm: a new method to stratify children by medical complexity. Pediatrics 2014; 133 (06) e1647-e1654
8 Zimmerman JJ, Banks R, Berg RA. et al; Life After Pediatric Sepsis Evaluation (LAPSE) Investigators. Trajectory of mortality and health-related quality of life morbidity following community-acquired pediatric septic shock. Crit Care Med 2020; 48 (03) 329-337
9 Starr MC, Banks R, Reeder RW. et al; Life After Pediatric Sepsis Evaluation (LAPSE) Investigators. Severe acute kidney injury is associated with increased risk of death and new morbidity after pediatric septic shock. Pediatr Crit Care Med 2020; 21 (09) e686-e695
10 Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr 2003; 3 (06) 329-341
11 Stein REK, Jessop DJ. Functional status II(R). A measure of child health status. Med Care 1990; 28 (11) 1041-1055
12 Pollack MM, Holubkov R, Funai T. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Pediatric intensive care outcomes: development of new morbidities during pediatric critical care. Pediatr Crit Care Med 2014; 15 (09) 821-827
13 Pollack MM, Holubkov R, Glass P. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Functional Status Scale: new pediatric outcome measure. Pediatrics 2009; 124 (01) e18-e28
14 Leclerc F, Duhamel A, Deken V, Le Reun C, Lacroix J, Leteurtre S. Groupe Francophone de Réanimation et d'Urgences Pédiatriques. Nonrespiratory Pediatric Logistic Organ Dysfunction-2 score is a good predictor of mortality in children with acute respiratory failure. Pediatr Crit Care Med 2014; 15 (07) 590-593
15 Leteurtre S, Duhamel A, Salleron J, Grandbastien B, Lacroix J, Leclerc F. Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP). PELOD-2: an update of the Pediatric Logistic Organ Dysfunction score. Crit Care Med 2013; 41 (07) 1761-1773
16 Pinto NP, Rhinesmith EW, Kim TY, Ladner PH, Pollack MM. Long-term function after pediatric critical illness: results from the survivor outcomes study. Pediatr Crit Care Med 2017; 18 (03) e122-e130
17 Slomine BS, Silverstein FS, Page K. et al; Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators. Relationships between three and twelve month outcomes in children enrolled in the therapeutic hypothermia after pediatric cardiac arrest trials. Resuscitation 2019; 139: 329-336
18 Watson RS, Asaro LA, Hutchins L. et al. Risk factors for functional decline and impaired quality of life after pediatric respiratory failure. Am J Respir Crit Care Med 2019; 200 (07) 900-909
19 Killien EY, Farris RWD, Watson RS, Dervan LA, Zimmerman JJ. Health-related quality of life among survivors of pediatric sepsis. Pediatr Crit Care Med 2019; 20 (06) 501-509
20 Manning JC, Pinto NP, Rennick JE, Colville G, Curley MAQ. Conceptualizing post intensive care syndrome in children-the PICS-p Framework. Pediatr Crit Care Med 2018; 19 (04) 298-300
21 Kohne JG, Flori HR. Risk factors and etiologies of pediatric acute respiratory distress syndrome. In: Shein SL, Rotta AT. eds. Pediatric Acute Respiratory Distress Syndrome: A Clinical Guide. Switzerland AG: Springer; 2020: 33-46
22 Howe CJ, Cole SR, Lau B, Napravnik S, Eron Jr JJ. Selection bias due to loss to follow up in cohort studies. Epidemiology 2016; 27 (01) 91-97
23 Ibrahim JG, Molenberghs G. Missing data methods in longitudinal studies: a review. Test 2009; 18 (01) 1-43
24 Nunna K, Al-Ani A, Nikooie R. et al. Participant retention in follow-up studies of acute respiratory failure survivors. Respir Care 2020; 65 (09) 1382-1391
25 Wilcox ME, Ely EW. Challenges in conducting long-term outcomes studies in critical care. Curr Opin Crit Care 2019; 25 (05) 473-488

Supplementary Material

Supplementary Material