Transition From an ICU Ventilator to a Portable Home Ventilator in Children

Abstract

BACKGROUND: The transition from an ICU ventilator to a portable home ventilator (PHV) for children requiring long-term mechanical ventilation is a crucial step in preparing for discharge home and may not be successful on the first attempt. A review of this process at our institution revealed that some children required multiple trials before they were able to tolerate a PHV. A protocol was developed to standardize the transition process and reduce the number of failed attempts. Key features of the protocol included a transition readiness assessment and criteria for changing to the PHV. METHODS: A retrospective chart review was completed to evaluate the process of changing to a PHV before and after the protocol was in place during the time period of 2011-2018. Primary outcome measures included the number of transition attempts and the length of time to achieve successful transition. A successful transition attempt was defined as the ability to tolerate a PHV for 14 d. RESULTS: The study included 56 children^3 years of age with a tracheostomy who required long-term ventilator support. The majority of subjects were from the neonatal ICU and had a diagnosis of bronchopulmonary dysplasia. There was a significant decrease in the number of attempts (P 5 .005) and in the length of time (P 5 .01) to successfully transition to a PHV for those who underwent the protocol. CONCLUSIONS: The process of changing from an ICU ventilator to a PHV in children requiring long-term mechanical ventilation was improved through the use of a standardized protocol. Both the number of failed attempts and the length of time to achieve successful transition were reduced when the protocol was applied. Further study is needed to evaluate other medical and nonmedical factors that may affect successful transition to a PHV.

Tracheostomy in infants with severe bronchopulmonary dysplasia: A review

“…There has not been any study that compared the effectiveness of the different types of home ventilators for ventilator-dependent infants with BPD. However, a quality improvement study published recently reported that using a standard protocol of transitioning from an ICU to a portable ventilator increased the success rate and earlier transition to home ventilator ( 36 ). During transition, tidal volume on the portable ventilator is increased by 5–10 ml, PEEP and peak inspiratory pressure (PIP) may be increased based on patients' tolerance to change, work of breathing, and FiO2 change.…”

NICU discharge preparation and transition planning: editorial

“…There has been increasing evidence of the importance of comprehensive NICU care that incorporates enhanced transition and discharge guidelines as a key component of family-centered NICU care [ 2 – 4 ]. The need is based on the fact that many NICU graduates have special healthcare needs, utilize increased post-discharge medical and social service resources, and are at increased risk of post-discharge emergency room visits and hospitalizations [ 2 , 5 , 6 ]. In addition, a significant percentage of parents of NICU graduates have increased social, environmental, economic, and mental health challenges and experience the effects of disparities that impact discharge readiness and affect parenting [ 7 – 11 ].…”

Ventilator change in children on home mechanical ventilation affected by the Philips respironics trilogy ventilator recall

“…Our institutional protocol could be potentially adapted by clinicians managing children using PPV‐T to transition to a non‐recalled PHV. Although patients in this study tolerated inpatient ventilator transition without complications, vigilant monitoring during this process is warranted 15 . Future multicenter studies are required to evaluate the clinical course, safety, and feasibility of changing PHVs in children using PPV‐T at home or in the outpatient setting.…”