Home mechanical ventilation in children: retrospective survey of a pediatric population.
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.


CONCLUSIONS
Although home care ventilation is not yet widely diffused, it represents a valid alternative to long hospitalization for children with stable chronic respiratory failure.
Anaesthesia and Intensive Care, IRCCS G Gaslini, Genoa, Italy. giancarloottonello@ospedale-gaslini.ge.it
Giancarlo
G
Ottonello
Ilaria
I
Ferrari
Ines Maria Grazia
IM
Pirroddi
Maria Cristina
MC
Diana
Giovanna
G
Villa
Laura
L
Nahum
Pietro
P
Tuo
Andrea
A
Moscatelli
Gilberto
G
Silvestri
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004180:Direct Service Costs; D018575:Home Care Services, Hospital-Based / Q000191:economics; D006801:Humans; D007223:Infant; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies