Care alternatives for pediatric chronic mechanical ventilation

Abstract

Objective: To determine the impact of transferring a pediatric population to mechanical ventilator dependency units (MVDUs) or to home mechanical ventilation (HMV) on bed availability in the pediatric intensive care unit (ICU).Methods: This is a longitudinal, retrospective study of hospitalized children who required prolonged mechanical ventilation at the MVDU located at the Hospital Auxiliar de Suzano, a secondary public hospital in São Paulo, Brazil. We calculated the number of days patients spent at MVDU and on HMV, and analyzed their survival rates with KaplanMeier estimator.Results: Forty-one patients were admitted to the MVDU in 7.3 years. Median length of stay in this unit was 239 days (interquartile range = 102-479). Of these patients, 22 came from the ICU, where their transfer made available 8,643 bed-days (a mean of 14 new patients per month). HMV of eight patients made 4,022 bed-days available in the hospital in 4 years (a mean of 12 new patients per month in the ICU). Survival rates of patients at home were not significantly different from those observed in hospitalized patients. Conclusion:A hospital unit for mechanical ventilator-dependent patients and HMV can improve bed availability in ICUs. Survival rates of patients who receive HMV are not significantly different from those of patients who remain hospitalized. J Pediatr (Rio J) IntroduçãoAs crianças dependentes de ventilação mecânica são um grupo de pacientes pediátricos com necessidades complexas de tratamento, devido ao uso contínuo de aparelhos para fornecer ventilação mecânica e às hospitalizações prolongadas. Essa população vem crescendo nos últimos anos 1 , como resultado dos avanços tecnológicos no tratamento de pacientes crônicos graves, e também do aumento do acesso público aos recursos médicos.Mesmo quando os pacientes estão clinicamente estáveis, muitos permanecem hospitalizados em unidades de terapia

Liberation and mortality outcomes in pediatric long‐term ventilation: A qualitative systematic review

“…Linear Thirty-four papers reported survival rate, time to death, or related analyses. 2,[4][5][6]14,17,19,21,25,[27][28][29]31,32,37,39,41,42,46,51,54,55,57,59,60,70,78,[82][83][84][85][86][87][88] Reported 5-year survival rates for cohorts with diverse diagnoses that used IV were 76% to 94%. 2,27,42 Five-year survival rates for cohorts with diverse diagnoses that combined patients that used IV and NIV were 53% to 94%.…”

“…Proportions of mortality did not significantly change over the decades for these subgroups. Thirty‐four papers reported survival rate, time to death, or related analyses 2,4‐6,14,17,19,21,25,27‐29,31,32,37,39,41,42,46,51,54,55,57,59,60,70,78,82‐88 . Reported 5‐year survival rates for cohorts with diverse diagnoses that used IV were 76% to 94% 2,27,42 .…”

Análise de indicadores assistenciais em uma Unidade de Terapia Intensiva Pediátrica na cidade de Fortaleza/CE

“…No presente estudo, a idade média dos pacientes internados na UTI Pediátrica foi de 10,63 ± 0,50 anos, no entanto, essa média ficou acima dos estudos realizados por Hanashiro et al 7 que foi de 5,4 ± 5,0 anos, e de Khan et al 8 que apresentou uma média de 4,07 ± 4,42 anos. Todavia, as amostras desses estudos abordam patologias diversas e incapacitantes como: doenças neuromusculares, neurológicas e síndromes genéticas, apontando comprometimentos mais precoces, diferentemente da principal causa que acomete o presente público, sendo acometidos principalmente por traumas, sejam eles diretos ou indiretos, tratando-se de um grupo claramente exposto a situações de risco, estabelecendo assim uma diferenciação de causas e idades.…”

Rehabilitation Considerations for Children Dependent on Long-Term Mechanical Ventilation

“…In recent years, the locus of inpatient care for children dependent on long-term MV has shifted from acute care hospital neonatal and pediatric intensive care units (ICUs) to "ventilator wards" in acute care hospitals [43][44][45] and postacute inpatient pulmonary rehabilitation programs [18,24,[46][47][48]. ICUs are referring children to rehabilitation units where they can spend longer periods of time at a lower financial cost.…”