Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome

Pavone, Martino; Verrillo, Elisabetta; Onofri, Alessandro; Caggiano, Serena; Testa, Maria Beatrice Chiarini; Cutrera, Renato

doi:10.1186/s13052-020-0778-8

Cited by 29 publications

(37 citation statements)

References 19 publications

(65 reference statements)

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“…However, a high proportion of invasively ventilated patients remain, despite all efforts to shift from invasive ventilation to NIV. In most centers across developed countries, a vast majority of patients had been ventilated noninvasively (5,(16)(17)(18)(19), while the strategy of administrating HMV in less developed counties differs among centers (6,9,10). In our center, the two groups were almost even, with a slightly higher number of invasively ventilated subjects.…”

Section: Discussionmentioning

confidence: 71%

Evolution of Pediatric Home Mechanical Ventilation Program in Serbia—What Has Changed in the Last Decade

et al. 2020

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Home mechanical ventilation (HMV) is a method of treatment in children with sleep-disordered breathing (SDB) and alveolar hypoventilation regardless of primary disease. The goal of the study was to describe the changes in the HMV program in Serbia during the last two decades. Cross-sectional retrospective study included data from the national HMV database from 2001 until 2019. HMV was initiated in clinically stable patients after the failure to wean from mechanical ventilation succeeded acute respiratory deterioration or electively after the confirmation of SDB and alveolar hypoventilation by sleep study or continuous transcutaneous capnometry and oximetry. The study included 105 patients (50 ventilated noninvasively and 55 ventilated invasively via tracheostomy). The median age at the time of HMV initiation was 6.2 years (range: 0.3-18 years). Invasive ventilation had been initiated significantly earlier than noninvasive ventilation (NIV) (p < 0.01), without difference in duration of ventilatory support (p = 0.95). Patients on NIV were significantly older (p < 0.01) than those ventilated invasively (13 and 1.5 years, respectively). Average waiting time on equipment had been shortened significantly-from 6.3 months until 2010 to 1 month at the end of the study (p < 0.01). Only 6.6% of patients had obstructive sleep apnea syndrome (OSAS) requiring HMV. During the study period, 24% patients died, mostly due to uncontrolled infection or progression of underlying disease. Availability and shortened waiting time for the equipment accompanied by advanced overall health care led to substantial improvements in the national HMV program. However, future improvements should be directed to systematic evaluation of SDB in patients with OSAS, early diagnosis of nocturnal hypoventilation, and subsequent timely initiation of chronic ventilation.

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Section: Discussionmentioning

confidence: 71%

Evolution of Pediatric Home Mechanical Ventilation Program in Serbia—What Has Changed in the Last Decade

et al. 2020

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“…Conversely, if needed, home ventilation is usually provided via tracheostomy in infants with severe bronchopulmonary dysplasia, most often with pulmonary arterial hypertension (33,34,55). And while bronchopulmonary dysplasia is listed as a potential indication, including as a bridge from invasive ventilation to spontaneous ventilation without respiratory support, extensive review of the literature finds very few infants with this diagnosis in reports on home LT-NIV (17,56,57). Lastly, morbid obesity associated with upper-airway obstruction, restrictive lung disease, and central hypoventilation (obesity-hypoventilation syndrome) can necessitate LT-NIV (33).…”

Section: Medical Conditions Treated By Long-term Non-invasive Ventilamentioning

confidence: 99%

Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications

Praud

2020

Front. Pediatr.

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This review focuses on the delivery of non-invasive ventilation-i.e., intermittent positive-pressure ventilation-in children lasting more than 3 months. Several recent reviews have brought to light a dramatic escalation in the use of long-term non-invasive ventilation in children over the last 30 years. This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT-NIV equipment that can be used at home. While significant gaps in availability persist for smaller children and especially infants, home LT-NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care. While long-term NIV is usually delivered during sleep, it can also be delivered 24 h a day in selected patients. Close collaboration between the hospital complex-care team, the home LT-NIV program, and family caregivers is of the utmost importance for successful home LT-NIV. Long-term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation, with the aim to increase life expectancy and maximize quality of life. LT-NIV is considered for conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall anomalies). Relative contraindications for LT-NIV include the inability of the local medical infrastructure to support home LT-NIV and poor motivation or inability of the patient/caregivers to cooperate or understand recommendations. Anatomic abnormalities that interfere with interface fitting, inability to protect the lower airways due to excessive airway secretions and/or severely impaired swallowing, or failure of LT-NIV to support respiration can lead to considering invasive ventilation via tracheostomy. Of note, providing home LT-NIV during the COVID 19 pandemic has become more challenging. This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS-CoV-2 during NIV. Delay in initiating LT-NIV, decreased frequency of home visits by the home ventilation program, and decreased availability of polysomnography and oximetry/transcutaneous PCO 2 monitoring are observed. Teleconsultations and telemonitoring are being developed to mitigate these challenges.

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“…Recent studies described the expanded use of pediatric home NIV 7–14,19–24 . However, the majority of them focused on children receiving care from highly specialized pediatric pulmonary centers 7–10,12–14,19,20,22,23 .…”

Section: Introductionmentioning

confidence: 99%

Feasibility of long‐term home noninvasive ventilation program in a general pediatric unit: 21 years' experience in Hong Kong

Tsang

Tsui

et al. 2021

Pediatric Pulmonology

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Background Long‐term home noninvasive ventilation (NIV) is increasingly employed in children with sleep‐disordered breathing and chronic respiratory failure. While studies suggest its successful implementation in tertiary care centers, little is known about the situation in a general care setting. Hence, we aim to evaluate the clinical profiles of these children in a general pediatric unit over the past two decades. Methods Data collected retrospectively on patients younger than 18 years old receiving long‐term home NIV from January 1, 1997 to December 31, 2017 in a Hong Kong regional general pediatric unit were reviewed. Results The number of children on home NIV increased more than 10‐fold over the past two decades. In total, 114 children were commenced on NIV during the 21‐year period. Upper airway obstruction was the most common cause (77%), followed by neuromuscular diseases (16%), pulmonary disorders (4%), and abnormal ventilatory control (3%). Continuous positive airway pressure was the most common NIV type (59%). To date, 46% of the children remained in our NIV program, while 18% discontinued NIV support. NIV adherence increased significantly with follow‐up (median of 78.6% and 82.5% at baseline and last follow‐up, respectively). Sixty‐five percent of the children used NIV for at least 4 h on 70% of the days monitored. Higher body mass index was associated with lower adherence. Conclusion Pediatric home NIV is feasible in the general care setting with good outcomes and adherence. As the demand for NIV service grows, input from local hospitals will be of increasing importance and should be considered upon healthcare planning.

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Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome

Cited by 29 publications

References 19 publications

Evolution of Pediatric Home Mechanical Ventilation Program in Serbia—What Has Changed in the Last Decade

Evolution of Pediatric Home Mechanical Ventilation Program in Serbia—What Has Changed in the Last Decade

Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications

Feasibility of long‐term home noninvasive ventilation program in a general pediatric unit: 21 years' experience in Hong Kong

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