Rapid Response and Code Events in Hospitalized Children on Home Mechanical Ventilation

Abstract

BACKGROUND: There is limited knowledge of rapid-response (RR) events and code events for children receiving home mechanical ventilation (HMV) via a tracheostomy in a non-ICU respiratory care unit. The purpose of this study was to describe the demographic and clinical factors leading to deterioration among these children and to identify the incidence and outcomes following rapid-response and code events. METHODS: A retrospective review was conducted on hospitalized HMV children who had RR/code events in a non-ICU respiratory care unit. RESULTS: There were a total of 50 RR events, and the primary clinical problem was acute respiratory distress, with 27 subjects (54%) needing ventilator adjustments. Twenty (40%) RR events occurred among children who were awaiting initial home discharge. Of 18 total code events, 7 (39%) children needed a tracheostomy-related intervention. There were 10 (56%) codes among children on mechanical ventilation awaiting initial home discharge. Children on HMV had 8.73 RR events per 1,000 patient days, whereas all other hospitalized children had 4.61 RR events per 1,000 patient days. In addition, children on HMV had 3.14 codes per 1,000 patient days, whereas all other hospitalized children had 0.74 codes per 1,000 patient days. All children were discharged from the hospital, and no deaths were associated with RR/code events for the index hospitalization. CONCLUSIONS: The overall incidence of RR/code events in children on HMV was higher than among non-HMV hospitalized children. Children on HMV preparing for their initial hospital discharge had the greatest number of RR/code events. The most prevalent interventions among children with RR events were ventilator setting adjustments, and among children with codes the most frequent actions were tracheostomy-related interventions. Developing strategies to predict risk factors for RR/code events may help decrease harm among children on HMV.

Effects of the Discharge Education Program on Family Caregivers Caring for Patients on Mechanical Home Ventilation in Korea: A Pilot Test

“…9 In Korea, 83.3% of them stay at home. 10 Most patients who are discharged slowly recover their normal function, have high mortality, 11 and experience frequent readmission. 12,13 Patients can thus anticipate lower medical expenses, lower pulmonary complications, improvement of symptoms, longer survival time, and higher quality of life.…”

Components of Risk and Modifiable Factors in Chronically Mechanically Ventilated Patients: Have We Fully Defined Them?

“…In this issue of RESPIRATORY CARE, Kun and colleagues present rapid response team utilization rates and outcomes in this vulnerable population. 6 In a detailed retrospective chart review of children requiring positive-pressure ventilation via tracheostomy while hospitalized in a non-ICU respiratory care unit, they assessed the rates of rapid response and code events. They note an increase in event rates when compared to the general hospital rapid response/ code rates.…”

“…They note an increase in event rates when compared to the general hospital rapid response/ code rates. Although the article by Kun et al 6 provides an excellent initial assessment of a complex patient population, it does not elucidate the unique features that led to the event, nor does it identify possible modifiable causes or interventions that could be implemented to assist in this disparity.…”

“…As the article notes, children on HMV awaiting initial hospital discharge were at greatest risk for rapid response/code events despite being "stable" on the portable home ventilator for a period of days. 6 It would be interesting to note whether there is a minimum number of days on home ventilation prior to transfer to the respiratory care unit that may affect rapid response/code events, and whether adjustments to the ventilator settings had been made on the respiratory care unit that may have precipi-…”

“…We commend Kun and co-workers 6 for highlighting the unique needs of this HMV population, which is only increasing in size and in the burden it places on our modern health care system. The selection of such a large non-ICUbased HMV population adds to the strengths of this study.…”