What Outcomes Matter Most to Parents of Ventilated Children
Length of non-ICU hospitalization was ranked less important to families compared to limiting duration of all types of oxygen support—invasive, non-invasive, and nasal cannula.
Journal: Pediatric Critical Care Medicine (IF 4.5)
Article Year: 2025
This prospective, cross-sectional study was conducted at the Children’s Hospital of Philadelphia (PICU), an academic institution in an urban setting, between 2023 and 2024. Responses from fifty families whose children were intubated then placed on either invasive mechanical ventilation (MV) or non-invasive ventilation were ultimately included in this study. Prior to intubation, 56% of the children had 2 or more comorbidities while 26% had none. Families and PICU faculty were separately asked to assess 5 nonmortality outcomes in order of personal priority: duration of MV, duration of MV + NIV, duration of all oxygen support, PICU length-of-stay (LOS), and hospital LOS. The level of agreement among familial and PICU responses were then mathematically assessed. 72% of respondents (i.e., person who filled out the survey) were mothers of patients. 30 PICU faculty also responded to the survey.
Families and PICU faculty both ranked duration of MV and duration of MV +NIV as the highest personal priorities. Interestingly, PICU faculty rated hospital LOS in both the PICU and non-PICU settings as more important than less escalated oxygen delivery methods (e.g., nasal cannula), whereas families were less concerned with LOS in the PICU and non-PICU settings than they were with seeing their children at baseline oxygen support.
The Spin: Notably, non-English-speaking families and those who were receiving palliative care were not included in the study. Regarding the former, non-English speakers may not possess similar priorities to those recorded in the study population; of the ~400 children who were intubated over the above time period, 26% were not of families who spoke English and were therefore did not have preferences formally assessed for study inclusion. Regarding the latter, palliative care involvement may or may not be correlated with worse initial prognoses, and the additional counseling undergone alongside palliative care specialists might alter parental perceptions of non-mortality outcomes from those recorded in this study. Finally, the study was only conducted at CHOP’s PICU whose populations may not reflect those cared for by institutions located in more rural or less academic settings. In any case, it remains a central tenet of patient-centered care to counsel all populations with cultural humility, and this study further highlights the importance of regularly checking in with families whose children has required invasive care to understand parental perception of treatment.
To read more: Shannon, M, Keim, G, Harhay, M and Yehya, N. (2025). Parent and Provider Perspectives on Short-Term Outcomes of Critically Ill Ventilated Children. Pediatric Critical Care Medicine, 26, e1149-e1153. https://doi.org/10.1097/PCC.0000000000003794