Morbidity and Mortality Patterns of Ventilator-Dependent Children in a Home Care Program

Abstract

We evaluated the effectiveness of the Home Care Program of Children's Hospital of Winnipeg for ventilator-dependent children by retrospectively examining morbidity and mortality from February 1, 1979, to July 31, 1992. For the 22 study subjects, the cause of chronic respiratory failure was neurologic disorders for 14 (64%) (group A) and pulmonary disorders for eight (36%) (group B). There were no significant differences between groups A and B in the average number of hospital days, readmission rate, or length of stay per admission. Eleven patients have remained ventilator-dependent at home, four no longer require mechanical ventilation, and seven died. Factors such as diagnosis, type of family, home location, age at initiation of mechanical ventilation, and initial duration of hospital stay did not influence morbidity or mortality in either group. Within the overall mortality rate of 32% is a higher rate among patients whose disorders initially carried a poor prognosis. Ventilator-dependent children can be successfully managed at home, with few nonelective hospital readmissions, through a well-organized home care program.

Prolonged mechanical ventilation as a consequence of acute illness

“…However, there are some comparative data that can guide us. In a series of 22 patients where the cause of respiratory failure was neurological in 64% and pulmonary in 31%, Canlas-Yamsuan and colleagues reported an overall mortality rate of 32%, similar to ours 9. Not surprisingly, the reported outcome is closely related to the underlying diagnosis.…”

Paediatric home ventilatory support: Changing milieu, proactive solutions

“…Earlier reviews of this topic were ambivalent regarding the benefits of long‐term home ventilation . In the last 10 years, better information has become available on the long‐term outcomes of children on home ventilation .…”

Inpatient Health Care Utilization for Children Dependent on Long-term Mechanical Ventilation

“…[2][3][4][8][9][10][11][12][13][14][15] A significant proportion of that time has been attributed to finding suitable home nursing care. 2,3 Despite this improvement, frequent admissions occur, with up to 40% of children dependent on LTMV requiring acute care hospitalizations in a 6-month time period and up to one third of patients living in acute or longterm care facilities.…”