Invasive Home Mechanical Ventilation: 10-Year Experience of a Pediatric Home Care Service

Abstract

BACKGROUND: Children dependent on invasive home mechanical ventilation (HMV) represent a growing population worldwide. The objective of this study was to assess the experience of 10 years of medical assistance given to pediatric patients on continuous invasive HMV at a Brazilian Home Care Service (HCS), specifically patient characteristics and predictors of outcome (ie, hospital readmission, death, and location of death). METHODS: Medical records for children on invasive HMV at the HCS between 2007 and 2016 were evaluated to collect the following data: age at admission to HCS, sex, principal diagnosis, length of hospital admission and home care period, number and cause of hospital readmissions, number of procedures, death and location of death. The odds ratio was used to understand the likelihood of death for each diagnosis, hospital readmission, and admission age, using a binary logistic regression model. RESULTS: Twenty-seven children were evaluated. The most prevalent diagnosis was cerebral palsy (37.0%). The mean duration of home care was higher than the mean hospital length of stay (955.0 6 4.6 d versus 341.0 6 0.5 d, respectively). First hospital readmission mean was at 392.6 6 548.9 d, and the main cause was respiratory tract infection (45.9%), especially tracheitis. Of the total number of deaths (13), 76.9% occurred in hospital units. There was no statistically significant result observed for greater odds of death for any of the diagnoses and admission age on HCS. However, children who had a hospital readmission < 6 months after hospital discharge presented 10% greater chance of death (P 5 .02). CONCLUSIONS: The most prevalent diagnosis of children on continuous invasive HMV was cerebral palsy. The main cause of hospital readmission was respiratory tract infection, especially tracheitis. Having the first hospital readmission at < 6 months after discharge was shown to be a risk factor associated with mortality.

Tracheostomy and long‐term mechanical ventilation in children after veno‐venous extracorporeal membrane oxygenation

“…Additionally, a new requirement for long-term mechanical ventilation was not rare (6% of all patients, 9% of patients surviving to ICU discharge), particularly given the challenges, burdens, and risks that can be associated with discharge on long-term mechanical ventilation. [23][24][25][26][27] Patients receiving a tracheostomy were older and weighed more than those who did not receive a tracheostomy. They also required Several studies have sought to identify factors associated with worse long-term outcomes and functional status in pediatric patients supported on ECMO.…”

“…When compared to the overall rate of all PICU patients receiving a tracheostomy (about 6%), 13 our data would suggest that ECMO for respiratory failure is associated with an increased requirement for tracheostomy during the PICU stay. Additionally, a new requirement for long‐term mechanical ventilation was not rare (6% of all patients, 9% of patients surviving to ICU discharge), particularly given the challenges, burdens, and risks that can be associated with discharge on long‐term mechanical ventilation 23–27 …”

Building a home ventilation programme: population, equipment, delivery and cost

“…Brazil, 32 Iran, 33 South Africa, 34 Tunisia, 35 Malaysia, 36 Turkey, 37 Argentina, 38 Serbia, 39 India 40 and Pakistan. 41 Evolution of the prevalence of HMV Figure 4 illustrates the evolution over time of HMV in 15 areas, where estimates of prevalence of HMV were available at different periods.…”

“…These countries were, therefore, not included in figures 2 and 3 . By decreasing order of GDP per capita, middle and low-income countries developing HMV include Thailand, 30 China, 31 Brazil, 32 Iran, 33 South Africa, 34 Tunisia, 35 Malaysia, 36 Turkey, 37 Argentina, 38 Serbia, 39 India 40 and Pakistan. 41 …”

Examining Characteristics and Service Utilization of South Korean Home Health Care Patients: Secondary Analysis of 10-Year Data From a Tertiary Hospital

“…14 Furthermore, research highlights the burden of informal caregivers due to the increase in self-quarantine arising from the recent COVID-19 pandemic. 15,16 Lastly, a study in Brazil 17 attempted to analyze the period, frequency and reasons for re-hospitalization at home using the 10-year EHR data of HHC child patients on ventilators. However, few South Korean studies have examined the status and distribution of HHC in tertiary hospitals using the longitudinal 10-year EHR data.…”