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Thirty years of home mechanical ventilation in children: escalating need for pediatric intensive care bedsOpen access

Fleur M. Paulides| Frans B. Plötz| Laura P. Verweij-van den Oudenrijn| Josephus P. J. van Gestel| Mike J. Kampelmacher
Pediatric Original
Volume 38, Issue 5 / May , 2012

Pages 847 - 852

Abstract

Purpose

To describe trends in pediatric home mechanical ventilation (HMV) and their impact on the use of pediatric intensive care unit (PICU) beds.

Methods

Review of all children who had started HMV in a single center for HMV.

Results

Between 1979 and 2009, HMV was started in 197 patients [100 (51 %) with invasive and 97 with noninvasive ventilation], with a median age of 14.7 (range 0.5–17.9) years. Most patients (77 %) were males with a neuromuscular disorder (66 %). The number of children receiving HMV increased from 8 in the 1979–1988 period to 122 in the 1999–2008 period. This increase occurred foremost in patients aged 0–5 years and was accompanied by a sharp rise in the use of PICU beds. In 150 patients (76 %), HMV was initiated on an ICU with a total of 12,440 admission days, of which 10,385 days (83 %) could be attributed to 67 patients who started non-electively with invasive HMV. Of the latter, 52 patients had been admitted to a PICU with a total of 9,335 admission days. At the end of the study, 134 patients (68 %) were still being ventilated, 43 patients (22 %) had died, 11 patients (6 %) were weaned from HMV, 4 patients (2 %) did not want to continue HMV and 5 patients (3 %) were lost to follow-up.

Conclusions

Over time, there was an impressive increase in the application of HMV in children. This increase was most obvious in the youngest age group with invasive HMV, and these children had very long stays in the PICU.

Keywords

References

  1. Ward S, Chatwin M, Heather S, Simonds AK (2005) Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax 60:1019–1024
    • View reference on PubMed
    • View reference on publisher's website
  2. Dohna-Schwake C, Podlewski P, Voit T, Mellies U (2008) Non-invasive ventilation reduces respiratory tract infections in children with neuromuscular disorders. Pediatr Pulmonol 43:67–71
    • View reference on PubMed
    • View reference on publisher's website
  3. Windisch W (2008) Impact of home mechanical ventilation on health-related quality of life. Eur Respir J 32:1328–1336
    • View reference on PubMed
    • View reference on publisher's website
  4. Tzeng AC, Bach JR (2000) Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest 118:1390–1396
    • View reference on PubMed
    • View reference on publisher's website
  5. Jeppesen J, Green A, Steffensen BF, Rahbek J (2003) The Duchenne muscular dystrophy population in Denmark, 1977–2001: prevalence, incidence and survival in relation to the introduction of ventilator use. Neuromusc Disord 13:804–812
    • View reference on PubMed
    • View reference on publisher's website
  6. Windisch W, Walterspacher S, Siemon K, Geiseler J, Sitter H (2010) Guidelines for non-invasive and invasive mechanical ventilation for treatment of chronic respiratory failure. Published by the German Society for Pneumology (DGP). Pneumologie 64:640–652
    • View reference on PubMed
    • View reference on publisher's website
  7. Graham RJ, Fleegler EW, Robinson WM (2007) Chronic ventilator need in the community: a 2005 pediatric census of Massachusetts. Pediatrics 119:1280–1287
    • View reference on publisher's website
  8. Tibballs J, Henning R, Robertson CF, Massie J, Hochmann M, Carter B, Osborne A, Stephens RA, Scoble M, Jones S, White J, Bryan D (2010) A home respiratory support programme for children by parents and layperson carers. J Pediatr Child Health 46:57–62
    • View reference on publisher's website
  9. Wallis C, Paton JY, Beaton S, Jardine E (2011) Children on long-term ventilatory support: 10 years of progress. Arch Dis Child 96:998–1002
    • View reference on PubMed
    • View reference on publisher's website
  10. Edwards EA, Hsiao K, Nixon GM (2005) Paediatric home ventilatory support: the Auckland experience. J Pediatr Child Health 41:652–658
    • View reference on publisher's website
  11. Dyer C (2006) Judge rules that baby boy should not be allowed to die. BMJ 332:685
    • View reference on PubMed
    • View reference on publisher's website
  12. Chatwin M, Bush A, Simonds AK (2011) Outcome of goal-directed non-invasive ventilation and mechanical insufflation/exsufflation in spinal muscular atrophy type I. Arch Dis Child 96:426–432
    • View reference on PubMed
    • View reference on publisher's website
  13. Edwards EA, O’Toole M, Wallis C (2004) Sending children home on tracheostomy dependent ventilation: pitfalls and outcomes. Arch Dis Child 89:251–255
    • View reference on PubMed
    • View reference on publisher's website
  14. De Witt PK, Jansen MT, Davidson Ward SL, Keens TG (1993) Obstacles to discharge of ventilator-assisted children from the hospital to home. Chest 103:1560–1565
    • View reference on publisher's website
  15. Edwards JD, Kun SS, Keens TG (2010) Outcomes and causes of death in children on home mechanical ventilation via tracheostomy: an institutional and literature review. J Pediatr 157:955–959
    • View reference on PubMed
    • View reference on publisher's website
  16. Ambrosio IU, Woo MS, Jansen MT, Keens TG (1998) Safety of hospitalized ventilator-dependent children outside of the intensive care unit. Pediatrics 101:257–259
    • View reference on PubMed
    • View reference on publisher's website
  17. MacIntyre NR, Epstein SK, Carson S, Scheinhorn D, Christopher K, Muldoon S (2005) Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest 128:3937–3954
    • View reference on PubMed
    • View reference on publisher's website
  18. Dasgupta A, Rice R, Mascha E, Litaker D, Stoller JK (1999) Four-year experience with a unit for long-term ventilation (respiratory special care unit) at the Cleveland Clinic Foundation. Chest 116:447–455
    • View reference on PubMed
    • View reference on publisher's website
  19. Appierto L, Cori M, Bianchi R, Onofri A, Catena S, Ferrari M, Villani A (2002) Home care for chronic respiratory failure in children: 15 years experience. Pediatr Anaesthesia 12:345–350
    • View reference on publisher's website
  20. Gowans M, Keenan HT, Bratton SL (2007) The population prevalence of children receiving invasive home ventilation in Utah. Pediatr Pulmonol 42:231–236
    • View reference on PubMed
    • View reference on publisher's website
  21. Racca F, Berta G, Sequi M, Bignamini E, Capello E, Cutrera R, Ottonello G, Ranieri VM, Salvo I, Testa R, Wolfler A, Bonati M (2011) Long-term home ventilation of children in Italy: a national survey. Pediatr Pulmonol 46:566–572
    • View reference on PubMed
    • View reference on publisher's website
  22. Kamm M, Burger R, Rimensberger P, Knoblauch A, Hammer J (2001) Survey of children supported by long-term mechanical ventilation in Switzerland. Swiss Med Wkly 131:261–266
    • View reference on PubMed
  23. Fauroux B, Boffa C, Desguerre I, Estournet B, Trang H (2003) Long-term noninvasive mechanical ventilation for children at home: a national survey. Pediatric Pulmonol 35:119–125
    • View reference on publisher's website
  24. Oktem S, Ersu R, Uyan ZS, Cakir E, Karakoc F, Karadag B, Kiyan G, Dagli E (2008) Home ventilation for children with chronic respiratory failure in Istanbul. Respiration 76:76–81
    • View reference on PubMed
    • View reference on publisher's website
  25. Fauroux B, Lavis JF, Nicot F, Picard A, Boelle PY, Clément A, Vazquez MP (2005) Facial side effects during noninvasive positive pressure ventilation in children. Intensive Care Med 31:965–969
  26. Leboulanger N, Picard A, Soupre V, Aubertin G, Denoyelle F, Galliani E, Roger G, Garabedian EN, Fauroux B (2010) Physiological and clinical benefits of noninvasive respiratory support in infants with Pierre Robin sequence. Pediatrics 126:1056–1063
    • View reference on publisher's website
  27. Fauroux B, Leboulanger N, Roger G, Denoyelle F, Picard A, Garabedian EN, Aubertin G, Clément A (2010) Noninvasive positive-pressure ventilation avoids recannulation and facilitates early weaning from tracheotomy in children. Pediatr Crit Care Med 11:31–37
    • View reference on PubMed
    • View reference on publisher's website

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