Slow and Steady: Optimizing ICU Treatment Weans for Children with Chronic Critical Illness

Objectives: Pediatric chronic critical illness (PCCI) is characterized by prolonged and recurrent hospitalizations, multiorgan conditions, and use of medical technology. Our prior work explored the mismatch between intensive care unit (ICU) acute care models and the chronic needs of patients with PCCI. The objective of this study was to examine whether the number and frequency of treatment weans in ICU care were associated with clinical setbacks and/or length of stay for patients with PCCI. Methods: A retrospective chart review of the electronic medical record for 300 pediatric patients with PCCI was performed at the neonatal ICU (NICU), pediatric ICU (PICU), and cardiac ICU (CICU) of two urban children’s hospitals. Daily patient care data related to weans and setbacks was collected for each ICU Day. Data was analyzed using multi-level mixed multiple logistic regression analysis and a multilevel mixed Poisson regression. Results: The patient-week level adjusted regression analysis revealed a strong correlation between weans and setbacks: ≥3 weekly weans yielded an odds ratio (OR) of 3.35 (95% CI= 2.06-5.44) of having ≥1 weekly setback. There was also a correlation between weans and LOS, ≥3 weekly weans were associated with an incidence rate ratio (IRR) of 1.09 (95% CI= 1.06-1.12). Conclusion: Long-stay pediatric ICU patients had more clinical setbacks and longer hospitalizations if they had more than two treatment weans per week. This suggests that patients with PCCI may benefit from a slower pace of care than is traditionally used in the ICU. Future research to explore the causative nature of the correlation is needed to improve the care of such challenging patients.