Outcomes and causes of death in children on home mechanical ventilation via tracheostomy: an institutional and literature review.
OBJECTIVE
To describe outcomes and causes of death in children on chronic positive-pressure ventilation via tracheostomy.


METHODS
We conducted a retrospective observational cohort analysis of 228 children enrolled in an university-affiliated home mechanical ventilation (HMV) program over 22 years (990 person-years). Cumulative incidences of survival and liberation from HMV are presented. Time-to-events were compared by reason for chronic respiratory failure (CRF) and age and date of HMV initiation with Kaplan-Meier and Cox regression analyses. Circumstances of death are described.


RESULTS
Of our cohort, 47 of 228 children died, and 41 children were liberated from HMV. The 5-year cumulative incidences of survival and liberation were 80% and 24%, respectively. Being placed on HMV for chronic pulmonary disease was independently associated with liberation from HMV (hazard ratio, 7.38; 95% CI, 3.0-18.2; P < .001). Neither age nor reasons for CRF were associated with shortened survival. Progression of underlying condition accounted for only 34% of deaths; 49% of deaths were unexpected.


CONCLUSIONS
Most children on HMV survive or were weaned off. However, a sizable number of children in our cohort died, and many deaths were unexpected and from causes not directly related to their primary reason for CRF.
Edwards
Jeffrey D
JD
Division of Pediatric Critical Care, Department of Pediatrics, University of California, San Francisco, CA, USA. edwardsj@peds.ucsf.edu
Kun
Sheila S
SS
Keens
Thomas G
TG
D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007223:Infant; D011175:Positive-Pressure Respiration; D012189:Retrospective Studies; D014139:Tracheostomy; D016896:Treatment Outcome