Pediatric invasive long‐term ventilation—A 10‐year review

Abstract

Introduction The number of children with complex physical and developmental pathologies, including chronic respiratory insufficiency, surviving and growing beyond early childhood continues to rise. No study has examined the clinical pathway of children on invasive long‐term mechanical ventilation (LTMV) in an Irish setting. Our data over a 10‐year period were reviewed to see if our demographics and outcomes are in line with global trends. Methods Children's Health Ireland (CHI) at Crumlin, Dublin is Ireland's largest tertiary pediatric hospital. A retrospective review analyzed data from children in our center commenced on LTMV via a tracheostomy over 10 years (2009–2018). This data was subdivided into two epochs for statistical analysis of longitudinal trends. Results Forty‐six children were commenced on LTMV from 2009 to 2018. Many had complex medical diagnoses with associated comorbidities. Far less children, 30.4% (n = 14) commenced LTMV in the latter half of the 10‐year period, they also fared better in all aspects of their treatment course. Focusing solely on children who have needed LTMV over this timeframe we have been able to isolate trends specific to this cohort. Less patients commenced LTMV on a year‐on‐year basis, and for those that require tracheostomy and LTMV, their journey to decannulation tends to be shorter. Conclusion Over the period reviewed, less patients over time necessitated LTMV, and those patients are being weaned and decannulated with ever more success. This has implications in terms of predicting numbers transitioning to adult services and allocation of hospital and community care resources.

Weaning strategies for children on home invasive mechanical ventilation

“…Nine percent (6 of 66) of children who were invasively ventilated via a tracheostomy had successful weaning. 24 26 The data from Korea gathered from 2016 to 2018 reported that 5 of 43 children (12%) were weaned from HMV.…”

“…Over time, 6 of 117 (5%) improved and discontinued HMV 25 . A 10‐year review from Ireland (2009−2018) reported that 46 children, who were commenced on long‐term HMV, are being weaned and decannulated more successful in the latter period (2014−2018) 26 . The data from Korea gathered from 2016 to 2018 reported that 5 of 43 children (12%) were weaned from HMV.…”

Development of a factorial survey for use in an international study examining clinicians’ likelihood to support the decision to initiate invasive long-term ventilation for a child (the TechChild study)

“…LTV is one of the most wellestablished forms of life sustaining medical technology dependence and dominates the research literature in this area [8]. While there has been an increase in children receiving non-invasive long-term ventilation (NI-LTV) the number of children initiated on ILTV has either remained static or decreased [9,10]. Situations wherein ILTV is considered for a child living with complex medical needs are frequently the most medically challenging cases for clinicians to navigate with the child and family.…”

Year in review 2021: Neuromuscular diseases

“…Walsh et al4 completed a retrospective review describing the evolving outcomes and demographics of long-term pediatric invasive ventilation in their center in Dublin, Ireland. They included patients that were initiated on long-term mechanical ventilation via tracheostomy between 2009 and 2018.…”