Risk Factors Associated with Readmission and Mortality Among Children Requiring Long-term Mechanical Ventilation: A Systematic Review Protocol

Abstract

Abstract Background: With advancements in technology and clinical care, the number of children receiving long-term mechanical ventilation (LTMV) in their homes is rapidly growing worldwide. Home environments provide children on LTMV with a better quality of life, psychosocial development, autonomy, and fewer infections. However, unexpected hospital readmission and death are significant concerns despite home care benefits. Risk factors associated with readmission and mortality have not been fully examined in existing systematic reviews. This systematic review aims to examine modifiable and non-modifiable risk factors associated with readmission and mortality in infants, children, and adolescents on LTMV. Methods: This systematic review will use the PRISMA P 2015 guidelines.The literature search will include five electronic databases (PubMed, CINAHL, Web of Science, Embase, and Epistemonikos). All quantitative study designs examining risk factors associated with readmission and/or mortality in pediatric patients less than 21 years of age on LTMV will be included. Articles will be limited to peer-reviewed journals and the English language. Covidence software will be used for data management, study screening, and data extraction. The Joanna Briggs Institute critical appraisal tools will be used to assess risk bias in individual studies. The results of a narrative synthesis will be presented in tables and text descriptions. Discussion: This systematic review, to our knowledge, is the first synthesis of risk factors associated with readmission and mortality among children on LTMV. We use systematic review methodology to decrease risk of bias and increase reproducibility. Findings from this review will provide insight into health outcomes after discharge and identify knowledge gaps in current research. Examining risk factors can shape clinical and policy work to identify and support patients and their families with unique and complex clinical, social, and healthcare needs. Establishing such support can reduce hospitalizations and helps ensure children on LTMV can continue to grow healthy in the home environment with families. Systematic review registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD42024492773.