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.