Senior Faculty Baylor College of Medicine BELLAIRE, Texas, United States
Disclosure(s):
Cameron Dezfulian, MD: No financial relationships to disclose
Background: Adults with congenital heart disease (ACHD) often require advanced respiratory support (ARS), but their hemodynamics may suffer from positive pressure ventilation. No studies have reported ARS use within the ACHD ICU population. We compared ARS use in ACHD patients and age matched advanced CHF patients in our unique ICU.
Methods: Retrospective analysis of all patients >16 yo admitted to the Texas Children’s Hospital ACHD ICU from 1/2017-2/2024. Encounters were collapsed to patient level combining multiple admissions. ARS was divided into mechanical ventilation (MV), non-invasive positive airway pressure (PAP) or high flow nasal cannula (HFNC), with some patients requiring >1 ARS during their ICU course. Descriptive analyses examined differences in ARS use based on admission reason, demographics, presence of ACHD and its anatomic severity and other comorbidities used Fisher’s exact. Associations between respiratory support and the outcomes of ICU length of stay (LOS), hospital LOS and mortality were performed using univariable linear and logistic regression. We report coefficient, odds ratio (OR) and adjusted OR (aOR) and 95% confidence intervals (95% CI).
Outcome: Of 1005 patients, 520 (52%) did not require ARS. MV (341), PAP (228) and HFNC (188) use were not correlated (Spearman rho > 0.2). Use of ARS differed between procedural vs. medical admissions. In procedural patients, each ARS type was associated with age (aOR 1.02-1.03 per year; all p< 0.05) and ARS used associated with longer hospital (mean 12.2 – 13.7 days) and ICU (mean 5.8 – 8.7 days) LOS. In medical admissions, vasoactive use had the strongest association with need for ARS (aOR 28.8 for MV; aOR 3.0 for PAP; aOR 4.8 for HFNC). Need for MV (OR 9.5, 95% CI 4.6 - 19.8) strongly associated with mortality, less so with PAP (OR 2.9, 95% CI 1.5 – 5.6) and not with HFNC. ACHD patients had greater mortality association with MV (OR 14.0; 95% CI 4.7 – 41.3) than structurally normal hearts and increasing ACHD anatomic severity was associated with need for ARS. Severe anatomic complexity ACHD patients needed 54-66% of ARS use compared to 7-14% in simple anatomical complexity (p < 0.0001) and 20-27% in structurally normal hearts.
Conclusion: ARS is common in ICU patients with ACHD and advanced CHF and greatest in highly complex ACHD anatomy. MV is associated with mortality in ACHD but not structurally normal hearts, whereas HFNC is not. These findings imply HFNC may be a safer form of ARS in ACHD.
