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Thirty years of home mechanical ventilation in children: escalating need for pediatric intensive care beds

Fleur M Paulides1, Frans B Plötz, Laura P Verweij-van den Oudenrijn

  • 1Department of Pediatric Intensive Care, VU Medical Center, Amsterdam, The Netherlands.

Intensive Care Medicine
|April 6, 2012
PubMed

Insights

Pediatric home mechanical ventilation (HMV) has significantly increased, especially in young children requiring invasive support. This trend has led to a substantial rise in pediatric intensive care unit (PICU) bed utilization.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory medicine
  • Health services research

Background:

  • Home mechanical ventilation (HMV) enables children with respiratory failure to receive care outside the hospital.
  • Trends in HMV use and its impact on pediatric intensive care unit (PICU) resource utilization are not well-defined.

Purpose of the Study:

  • To describe the trends in pediatric home mechanical ventilation (HMV) over three decades.
  • To analyze the impact of these HMV trends on the utilization of pediatric intensive care unit (PICU) beds.

Main Methods:

  • Retrospective review of all children who initiated HMV at a single center between 1979 and 2009.
  • Analysis of patient demographics, ventilation type (invasive vs. noninvasive), age, underlying diagnoses, and PICU admission data.

Main Results:

  • HMV use increased from 8 patients (1979-1988) to 122 patients (1999-2008), predominantly in males with neuromuscular disorders.
  • The rise in HMV was most pronounced in the 0-5 year age group, particularly for invasive ventilation.
  • HMV initiation in the PICU resulted in extensive admission days, with non-elective invasive HMV accounting for the majority of PICU resource use.

Conclusions:

  • There has been a significant increase in the application of pediatric home mechanical ventilation over the study period.
  • Young children, especially those requiring invasive HMV, drove this increase and were associated with prolonged PICU stays.
  • The growing use of HMV, particularly in younger populations, has substantial implications for PICU resource allocation.
Abstract

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