Children Requiring 3 or More Days of Invasive Ventilation: Secondary Analysis of Post-Discharge Change in Caregiver Employment

Pediatr Crit Care Med. 2025 Apr 1;26(4):e473-e481. doi: 10.1097/PCC.0000000000003676. Epub 2024 Dec 19.

Abstract

Objectives: To describe frequency of, and risk factors, for change in caregiver employment among critically ill children with acute respiratory failure.

Design: Preplanned secondary analysis of prospective cohort dataset, 2018-2021.

Setting: Quaternary Children's Hospital PICU.

Patients: Children who required greater than or equal to 3 days of invasive ventilation, survived hospitalization, and completed greater than or equal to 1 post-discharge survey.

Interventions: None.

Measurements and main results: We measured change in caregiver employment 1 and 12 months post-discharge relative to pre-admission and, when present, change in caregiver identity defined by relationship to the patient. Data were collected by survey. We used logistic regression to identify factors associated with these changes. We evaluated 130 children, median age 6.4 years (interquartile range, 1.10-13.3 yr), 40 (30.8%) with a complex chronic condition (CCC), and 99 (76.2%) with normal pre-illness Functional Status Scale scores. Of 123 with 1-month post-discharge data, 25 of 123 (20.3%) experienced a change in caregiver employment and an additional 14 of 123 (11.4%) had a change in caregiver(s). Of 115 with 12-month post-discharge data, 33 of 115 (28.7%) experienced a change in caregiver employment and an additional 16 of 115 (13.9%) had a change in caregiver(s). After controlling for age, CCC, baseline caregiver employment, new morbidity at discharge, and social and economic index; higher maximum Pediatric Logistic Organ Dysfunction-2 score (odds ratio [OR], 1.19 [95% CI, 1.01-1.41]) and government insurance (OR, 3.85 [95% CI, 1.33-11.11]) were associated with the composite outcome of change in caregiver employment or caregiver(s) at 1-month post-discharge.

Conclusions: At 1 and 12 months post-discharge, more than one-in-five children who survived greater than or equal to 3 days of invasive ventilation had a change in caregiver employment and one-in-ten had a change in caregiver(s). Identification of risk factors, such as illness severity and social determinants of health, associated with a significant family change may improve our support of these families.

Keywords: caregiver; critical care outcome; pediatric intensive care unit; pediatric post-intensive care syndrome; social determinants of health.

MeSH terms

  • Adolescent
  • Caregivers* / statistics & numerical data
  • Child
  • Child, Preschool
  • Critical Illness
  • Employment* / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Intensive Care Units, Pediatric / statistics & numerical data
  • Logistic Models
  • Male
  • Patient Discharge / statistics & numerical data
  • Prospective Studies
  • Respiration, Artificial* / statistics & numerical data
  • Respiratory Insufficiency* / therapy
  • Risk Factors