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Feasibility of a pediatric long-term Home Ventilation Program in Argentina: 11 years' experience
Vivian Leske1, María J Guerdile1, Adriana Gonzalez2
1Sleep Unit, Department of Pulmonology, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina.
Insights
This study shows that a Home Ventilation Program (HVP) in Argentina successfully managed pediatric patients with complex conditions. The program demonstrated feasibility in an emerging country, highlighting the importance of home ventilation for children.
Area of Science:
- Pulmonology
- Pediatrics
- Critical Care Medicine
Background:
- Pediatric home ventilation (HV) is increasingly utilized globally.
- The Home Ventilation Program (HVP) at Argentina's largest pediatric referral center was established in 2007.
- Limited research exists on pediatric HV in Latin America.
Purpose of the Study:
- To describe and analyze the cohort of pediatric patients admitted to the HVP over an 11-year period.
- To evaluate the characteristics and outcomes of children receiving home ventilation.
- To assess the feasibility of a national pediatric HVP in an emerging economy.
Main Methods:
- A longitudinal study analyzing a prospective database of patients admitted to the HVP between 2007 and 2018.
- Inclusion criteria: all patients admitted to the HVP.
- Data collected included demographics, clinical variables, sleep studies, and ventilation settings.
Main Results:
- 244 pediatric patients were admitted, with a median age of 9.41 years at ventilation initiation.
- Neuromuscular disease (43%) and genetic syndromes (23%) were the most common underlying conditions.
- Noninvasive ventilation was used in 86.1% of cases, initiated in a general pediatric ward for 83.6% of patients.
Conclusions:
- The HVP successfully served patients from across Argentina, with significant distances to the referral center.
- Ventilation initiation was guided by clinical and objective sleep measures.
- This 11-year experience confirms the feasibility and effectiveness of establishing a pediatric HVP in an emerging country.
Background:
Pediatric home ventilation (HV) has increased worldwide. A Home Ventilation Program (HVP) was started in the Pulmonary Department of the "Hospital de Pediatría Prof. Dr. J. P. Garrahan," Argentina, in 2007. This is the largest Argentine national pediatric tertiary care referral center. Limited studies on pediatric HV from Latin American countries have been published.
Objective:
This study describes and analyzes the cohort of children admitted to the HVP during an 11 years period.
Methods:
Longitudinal study.
Population:
all patients (pts) admitted to the HVP between 2007 and 2018. We analyzed demographic and clinical variables, sleep study results, ventilation setting, and start manner collected in a prospective data base.
Results:
A total of 244 pts were admitted. Median age at ventilation start was 9.41 (3.47-14.08) years, 84% of pts had health insurance. The most frequent underlying diseases were neuromuscular disease (43%) and genetic syndromes (23%). Home-hospital distance was 100-500 km in 16% of cases and greater than 500 km in 34%. Seventy percent of pts had sleep studies before ventilation initiation. Ventilation was started in our general pediatric ward in 83.6%. Noninvasive ventilation was used in 86.1%. The actual number of pts still on follow up is 133 of 244 (54.5%), 16.8% dropped out, 16.4% were transitioned to adult care, 5.32% resolved their sleep-disordered breathing, and 5.32% died.
Conclusions:
The HVP admitted pts from all the country. Ventilation was started on the basis of clinical and objective sleep measures. This long-term experience underlines the feasibility of a HVP in an emergent country.
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