Table 4.
Outcomes According to Model 1 Propensity Score Quintile and Group
| Outcomes | Quintile 5 (Highest Risk of Early HFOV) |
Quintile 4 |
||||
|---|---|---|---|---|---|---|
| Early HFOV (n = 99) | CMV/Late HFOV (n = 114) | P Value* | Early HFOV (n = 50) | CMV/Late HFOV (n = 163) | P Value* | |
| Duration of mechanical ventilation, median (IQR), d† | 14.9 (9.7–28.0) | 10.8 (5.8–24.9) | 0.08 | 14.7 (9.6–28.0) | 8.7 (4.8–15.1) | <0.001 |
| Time to recovery from acute respiratory failure, median (IQR), d‡ | 10.0 (6.2–12.9) | 5.6 (3.0–10.8) | 0.04 | 9.8 (7.0–17.9) | 4.0 (2.5–8.0) | <0.001 |
| Duration of weaning from mechanical ventilation, median (IQR), d§ | 2.2 (1.1–4.9) | 2.2 (1.2–5.2) | 0.59 | 3.0 (1.1–4.4) | 2.3 (1.1–4.4) | 0.59 |
| In-hospital mortality at 90 d, n (%) | 25 (25) | 19 (17) | 0.09 | 5 (10) | 20 (12) | 0.49 |
| ECMO, n (%) | 11 (11) | 16 (14) | 0.12 | 6 (12) | 8 (5) | 0.04 |
| Neuromuscular blockade used to facilitate mechanical ventilation, median (IQR), % ventilator days | 53 (33–75) | 25 (0–56) | <0.001 | 52 (25–70) | 20 (0–43) | <0.001 |
| Peak daily opioid dose, median (IQR), mg/kg | 6.3 (3.6–11.1) | 5.1 (3.0–8.2) | 0.03 | 8.7 (5.8–10.9) | 3.8 (2.0–6.4) | <0.001 |
| Cognitive impairment (PCPC >1) at hospital discharge, n (%)|| | 33 (46) | 30 (33) | 0.007 | 16 (39) | 50 (36) | 0.98 |
| Functional impairment (POPC >1) at hospital discharge, n (%)|| | 43 (61) | 42 (46) | 0.048 | 19 (46) | 64 (46) | 0.75 |
| Discharged home by 90 d, n (%)|| | 54 (73) | 78 (82) | 0.16 | 34 (76) | 119 (83) | 0.28 |
Definition of abbreviations: CMV = conventional mechanical ventilation; ECMO = extracorporeal membrane oxygenation; HFOV = high-frequency oscillatory ventilation; IQR = interquartile range; PCPC = Pediatric Cerebral Performance Category; POPC = Pediatric Overall Performance Category.
Within each quintile, P values for the comparison of outcomes between groups were calculated using proportional hazards, logistic, and linear regression accounting for PICU as a cluster variable using generalized estimating equations for time-to-event, binary, and continuous variables, respectively. Peak daily opioid dose was log-transformed.
Patients were assigned 28 days of mechanical ventilation if they remained intubated or were transferred or died before Day 28 without remaining extubated for 24 h, therefore making the outcome equivalent to ventilator-free days.
Time to recovery from acute respiratory failure was defined as the duration from Day 0 start (endotracheal intubation, initiation of assisted breathing for chronically trached patients, or PICU admission for patients intubated at an outside hospital) to the time that the patient first met criteria to be tested for extubation readiness (spontaneously breathing and oxygenation index ≤6). Excludes nonsurvivors who did not meet criteria before death. For survivors who never met criteria, the duration of recovery was set equal to the duration of mechanical ventilation if the patient was successfully extubated or to 28 days if the patient was still intubated on Day 28 or transferred to another PICU still intubated. Within quintile 5, calculated for 76 early HFOV and 98 CMV/late HFOV patients. Within quintile 4, calculated for 45 early HFOV and 147 CMV/late HFOV patients.
Duration of weaning from mechanical ventilation was defined as the duration from the time that the patient first met criteria to be tested for extubation readiness to successful endotracheal extubation (remained extubated for >24 h) or successful removal of assisted breathing for trached patients. Excludes nonsurvivors who were not extubated for >24 hours before death. Also excludes survivors who never met criteria or were still intubated on Day 28. Within quintile 5, calculated for 63 early HFOV and 82 CMV/late HFOV patients. Within quintile 4, calculated for 34 early HFOV and 122 CMV/late HFOV patients.
PCPC, POPC, and location at hospital discharge exclude nonsurvivors. Within quintile 5, PCPC and POPC at hospital discharge known for 71 early HFOV and 92 CMV/late HFOV survivors. Within quintile 4, known for 41 early HFOV and 140 CMV/late HFOV survivors.