Discharge Practice Variability in Pediatric Chronic Home Invasive Ventilation

The Pediatric Mechanical Ventilation Society is a collaboration of pediatric pulmonologists with a focus on pediatric chronic home invasive ventilation (PCHIV). Since the initial discharge on PCHIV is not always directed by pediatric pulmonologists, we sought to understand how this variability between centers impact adherence to American Thoracic Society (ATS) guidelines for PCHIV.

A survey was distributed to pediatric pulmonologists across multiple platforms inquiring about discharging practices for PCHIV and adherence to six of the nine ATS recommendations for PCHIV. Two subgroups were created based on common practices - discharge by pediatric pulmonologists from a non-ICU unit (pulmonary group) and discharge by ICU team from an ICU unit (ICU group).

A total of 107 surveys were completed, 90 from the US. Among the US centers, the ATS recommendations with lowest adherence were offering ongoing education to caregivers and the utilization of standardized criteria for discharge. Despite better adherence, the requirement of two caregivers for discharge was often made an exception for. When comparing the pulmonary and ICU groups, the number of annual discharges (p < 0.001), caregiver length of training (p = 0.003), and the utilization of standardized discharge criteria (p = 0.04) were significantly different.

Our study demonstrates variable adherence to expert consensus recommendations outlined by the ATS. A significant proportion of PCHIV patients were discharged directly from the ICU and by ICU teams. Practice variability was evident between institutions and discharging teams; therefore, the identification of barriers to guideline implementation and multidisciplinary collaboration is paramount to optimizing care.