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Home mechanical ventilation in children: retrospective survey of a pediatric population
Giancarlo Ottonello1, Ilaria Ferrari, Ines Maria Grazia Pirroddi
1Anaesthesia and Intensive Care, IRCCS G Gaslini, Genoa, Italy. giancarloottonello@ospedale-gaslini.ge.it
Insights
Home care mechanical ventilation is a viable option for stable pediatric patients with chronic respiratory failure, reducing lengthy hospital stays. This approach offers effective long-term management for children requiring ventilatory support at home.
Area of Science:
- Pediatric Pulmonology
- Home Healthcare
- Respiratory Medicine
Background:
- Home care support is crucial for clinically stable children requiring mechanical ventilation.
- Long-term home ventilation management is explored for pediatric chronic respiratory failure.
Purpose of the Study:
- To analyze the long-term home ventilation management in a pediatric population with chronic respiratory failure.
- To evaluate the feasibility and outcomes of home care ventilation for children.
Main Methods:
- Retrospective analysis of 20 ventilator-dependent children.
- Categorization by age (under 1, 2-5, 6-12, >12 years) and diagnosis (myopathic, CCHS, chest wall, CF, PH, diaphragmatic paralysis).
- Assessment of ventilation modes (non-invasive, tracheostomy) and support duration (nocturnal, full-day).
Main Results:
- 65% used non-invasive ventilation (NIMV), 35% used tracheostomy.
- 70% required nocturnal ventilatory support (12-18h or full-day).
- 18 children were enrolled in home care; two deaths occurred (disease progression, septic shock).
Conclusions:
- Home care ventilation is a valid alternative to prolonged hospitalization for stable pediatric patients.
- Despite limited current diffusion, home ventilation offers a beneficial option for managing chronic respiratory failure in children.
- The study highlights the potential of home care ventilation for improving quality of life and reducing healthcare burdens.
Background:
Home care support is beneficial for children needing mechanical ventilation, when clinically stable.
Methods:
A retrospective analysis was carried out of the long-term home ventilation management of a pediatric population with chronic respiratory failure composed of 20 ventilator-dependent children categorized according to age, diagnosis and ventilation support. Age groups consisted of 10% under 1 year, 30% between 2 and 5 years, 30% between 6 and 12 years, and 30% older than 12 years. Diagnostic categories included myopathic disorder, n = 5; congenital central hypoventilation syndrome, n = 6; chest wall disorder, n = 5; cystic fibrosis, n = 1; pulmonary hypertension, n = 1; and diaphragmatic paralysis, n = 2.
Results:
Sixty-five percent were ventilated using non-invasive mode (NIMV): eight with nasal mask, five with full-face mask, and two children in NIMV also used negative pressure mode; 35% were ventilated using tracheostomy, one of them also used a diaphragmatic pacer. Seventy percent needed nocturnal ventilatory support, (20% 12-18 h, 10% full-day). A total of 18 children were included in the home care and follow-up program. Two children died: one because of worsening of his chronic disease and one because of septic shock.
Conclusion:
Although home care ventilation is not yet widely diffused, it represents a valid alternative to long hospitalization for children with stable chronic respiratory failure.
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