Factors Associated With Mechanical Ventilation Use in Children With Sickle Cell Disease and Acute Chest Syndrome

Objectives: Acute chest syndrome is the leading cause of death in children with sickle cell disease and is generally due to respiratory failure. Epidemiologic factors for a need for mechanical ventilation in children with acute chest syndrome require further clarification. Design: Retrospective observational study. Setting: Nationally representative pediatric inpatient records in the United States by using the Kids’ Inpatient Database for the years 2003, 2006, 2009, and 2012. Patients: Patients age less than 20 years old with a discharge diagnosis of acute chest syndrome. Measurements and Marin Results: Data were weighted to estimate annual hospitalizations according to hospital characteristics in the United States. Multivariable logistic regression was conducted to ascertain factors associated with use of mechanical ventilation, after adjusting for patient and hospital characteristics. Total hospitalizations for acute chest syndrome were 5,018 in 2003, 6,058 in 2006, 6,072 in 2009, and 6,360 in 2012. Mechanical ventilation use was associated with comorbidities of obesity (odds ratio, 3.35; 95% CI, 1.94–5.78), obstructive sleep apnea (odds ratio, 3.72; 95% CI, 2.23–6.20), and heart disease (odds ratio, 2.19; 95% CI, 1.47–3.27). In addition, nonblack compared with black children (odds ratio, 1.53; 95% CI, 1.02–2.31) and the fall season (p = 0.018) were associated with mechanical ventilation use. Conclusions: Comorbidity of obesity, obstructive sleep apnea, or heart disease could be potentially associated with mechanical ventilation use during an episode of acute chest syndrome. Prospective observational studies would be required to confirm these findings and infer potential interventions for preventing illness severity. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). Dr. Okubo was supported by grants from the Ministry of Health, Labor and Welfare, Japan. Dr. Miller’s institution received funding from the National Institutes of Health/Heart, Lung, and Blood Institute (investigator), Pfizer/Paraxel (investigator, clinical trial), and Emmaus Pharmaceutical (investigator, clinical trial). The other authors have no research or project support, including internal funding. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: sunning_dale@yahoo.co.jp ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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