Adherence to Non-Invasive Ventilation in a Provincial Cohort of Children.

BACKGROUND

Non-invasive ventilation (NIV) adherence is critical to its effectiveness, yet no standardized pediatric definition of "optimal" adherence exists, and population-level data are scarce.

RESEARCH QUESTION: What are adherence patterns to NIV in children, and which factors are associated with adherence in a provincial longitudinal cohort?

STUDY DESIGN AND

METHODS

Canadian retrospective longitudinal cohort study linking records from the Ontario Ventilator Equipment Pool to health administrative databases. We identified children <18 years prescribed NIV with telemonitoring (2020 to 2022) and ≥1 month of data. The adherence definitions explored were the adult definition of ≥4 hours/day (primary) and measures of any daily use, daily NIV hours, and data missingness ("days not used" = 0 hours recorded; "days no data" = no signal). Mixed-effects regression models were used to explore adherence factors.

RESULTS

We included 237 children (mean age 12.9 years; 61% male) with 3,685 person-months of NIV data (median 13 [IQR 8-24]). Across person-months, mean adherence by the ≥4-hours/day definition was 69.6%. Child-level monthly mean (SD) adherence was 59% (32%) by this definition, and 68% (26%) for any use. Mean (SD) daily use when used was 7.5 (3.2) hours. Monthly "days not used" and "no data" averaged 5.1 (6.4) and 4.4 (5.0) days, respectively. Greater adherence was associated with younger age (2-percentage-point decrease per year increase; 95% CI, 1-3), having ≥3 complex chronic conditions vs none (14 percentage-points higher; 95% CI, 3-26), and longer time prescribed NIV (2-percentage-point increase per year; 95% CI, 1-3).

INTERPRETATION: NIV adherence was moderate across definitions, with higher adherence among younger children, greater medical complexity, and those using therapy longer, highlighting the need for pediatric-specific adherence targets and home NIV support strategies.