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Home mechanical ventilation in children is feasible in developing countries
Aleksandar Sovtic1, Predrag Minic, Miodrag Vukcevic
1Department of Pulmonology, Mother and Child Institute, Belgrade, Serbia. asovtic@eunet.rs
Insights
Pediatric home mechanical ventilation (HMV) is achievable in developing nations, requiring robust reimbursement and healthcare networks for successful implementation. This study highlights its feasibility and challenges in Serbia.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Health Economics
Background:
- Limited data exists on pediatric home mechanical ventilation (HMV) in low-income developing countries.
- National surveys from developed countries are available, but insights from developing nations are scarce.
Purpose of the Study:
- To assess the feasibility and characteristics of pediatric home mechanical ventilation (HMV) in a developing country context.
- To identify key factors influencing the implementation of HMV for children in Serbia.
Main Methods:
- A survey of 29 pediatric patients receiving long-term home mechanical ventilation (HMV) at the Mother and Child Institute of Serbia.
- Inclusion criteria included hypercapnia, nocturnal hypoventilation, or hypoxemia, confirmed by blood gas analysis and sleep monitoring.
- Patients received either invasive HMV via tracheostomy (11 patients) or non-invasive ventilation (18 patients).
Main Results:
- The average age for initiating HMV was 9.3 years, with a mean waiting period of 6.3 months.
- Patients received HMV for an average of 25.06 months, with duration varying significantly by underlying disease (P=0.046).
- Mechanical malfunction was significantly dependent on the duration of HMV (P=0.011).
Conclusions:
- Home mechanical ventilation (HMV) is a feasible intervention in developing countries.
- Effective reimbursement policies and a well-organized healthcare network are crucial for establishing HMV as standard pediatric care.
Background:
The results of many national surveys on pediatric home mechanical ventilation (HMV) in developed countries have been presented elsewhere, but data from developing countries with low national incomes are scarce.
Methods:
Twenty-nine pediatric patients, treated in the Mother and Child Institute of Serbia, who had been receiving long-term ventilatory support at home, were surveyed. The major criterion for initiating HMV was hypercapnia, diagnosed by blood gas analysis, performed in the morning, after awakening. Other criteria were either symptoms of hypoventilation during the night associated with an apnea index of >5, or apnoea-hypopnoea index of >15, or nocturnal hypoxemia, defined as an oxygen saturation rate of <90% for >5% of total sleep time.
Results:
The mean age at initiation of HMV was 9.3 years (range 0.5-17.8 years). Patients waited for HMV initiation either in hospital or at home; the mean period was 6.3 months (range 1-18 months). The subjects received HMV for a mean of 25.06 months (range 3-119 months). There was a significant difference in the duration of HMV for different underlying diseases (P= 0.046), and mechanical malfunction was strongly dependent on the duration of HMV (P= 0.011). Eleven patients underwent invasive HMV via a tracheostomy, and 18 others received non-invasive ventilation, via nasal and full-face masks.
Conclusion:
HMV is feasible in developing countries. Valuable reimbursement policies as well as an organized and functional network are essential for its implementation, as a standard of care in leading national pediatric hospitals.
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