title: Risk factors for prolonged mechanical ventilation for children on ventricular assist device support.
abstract: BACKGROUND
  Patients with end-stage heart failure possess many attributes that place them at risk for prolonged mechanical ventilation (MV). However, there are only limited data on MV support among children after ventricular assist device (VAD) implantation. We report the duration of MV after VAD placement, indications for respiratory support in the postimplantation period, and associated patient factors.
  
  
  METHODS
  This single-center retrospective study included 43 consecutive children (aged <18 years) with end-stage heart failure who were supported with a VAD as a bridge to transplantation from January 2005 to December 2011. Multivariable analysis was performed using the multiple Poisson regression model for the duration of MV.
  
  
  RESULTS
  Overall, 33% (n = 14) remained on MV until heart transplant or death. Of those requiring pre-VAD extracorporeal membrane oxygenation (ECMO) support, 63% (n = 12 of 19) remained on MV until heart transplant or death compared with 8% (n = 2 of 24) among those not on ECMO before VAD (p < 0.001). Patients with moderate or severe mitral regurgitation while on VAD support had 1.7-times more MV days compared with those with none or trivial on-VAD mitral regurgitation. In addition, previous support on ECMO, those with moderate or severe tricuspid regurgitation, and those with only left VAD implants had an increased risk of prolonged MV.
  
  
  CONCLUSIONS
  Our results suggest that VAD recipients previously supported on ECMO, those with moderate or severe mitral regurgitation, moderate or severe tricuspid regurgitation, and those with only left VAD implants had an increased risk of prolonged MV. Future studies in larger cohorts are necessary to confirm the findings from this single-institutional experience.
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas. Electronic address: prodhanparthak@uams.edu.
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Florida Hospitals, Gainesville, Florida.
authors.forename: Giridhar
authors.initials: G
authors.lastname: Kalikivenkata
authors.affiliation: Division of Biostatistics, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas.
authors.forename: Kassandra
authors.initials: K
authors.lastname: Thomas
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Childrens Hospital, Cincinnati, Ohio.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrnes
authors.affiliation: Division of Cardiovascular Surgery, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Duke Medical Center, Durham, North Carolina.
authors.forename: Robert D B
authors.initials: RD
authors.lastname: Jaquiss
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas.
authors.forename: Xiomara
authors.initials: X
authors.lastname: Garcia
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Frazier
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Maryland, Baltimore, Maryland.
authors.forename: Adnan T
authors.initials: AT
authors.lastname: Bhutta
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; Division of Pediatric Cardiology, Department of Pediatrics, University of Chicago, Chicago, Illinois.
authors.forename: Umesh
authors.initials: U
authors.lastname: Dyamenahalli
mesh_terms: D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome