[Home ventilatory assistance in Chilean children: 12 years' experience]

Home ventilatory support systems are a treatment option for patients with severe chronic respiratory failure. The objective of the present study was to characterize the children admitted to a home ventilatory assistance program.

The home ventilation program was created by our hospital to coordinate professional and technological support for chronic ventilator-dependent children. We revised and updated information on patient characteristics, type of assisted ventilation, respiratory morbidity, and equipment failures between 1993 and 2004.

Follow-up of 35 children (18 male) was carried out by our hospital staff. Median age upon admission to the program was 12 months (range, 5 months to 14 years). Median length of time in the program was 21 months and we were able to wean 40% of patients from ventilators. Six patients died. The main indications for assisted ventilation were neuromuscular disease (12 cases), airway abnormality (11 cases), cardiopulmonary disease (7 cases), and hypoventilation syndrome (5 cases). The types of assisted ventilation used were continuous positive airway pressure (in 17 cases), bilevel positive pressure (in 8 cases), and synchronized intermittent mandatory ventilation (in 10 cases). Invasive ventilation via a tracheostomy was used in 26 cases. The use of noninvasive ventilation increased in the last 4 years. Respiratory morbidity (pneumonia and bacterial tracheitis) was the most frequent cause of hospitalization and the annual rate of such episodes was 1.6 per child. The annual rate of hospitalization due to equipment failures was 0.1 per child.

The program provides safe and necessary home ventilatory assistance for children with severe chronic respiratory failure. The professional support that home hospitalization offers had a positive effect on outcome in these children. It is important to take our experience into account in creating a Chilean national home ventilatory assistance program.