title: Care alternatives for pediatric chronic mechanical ventilation.
abstract: OBJECTIVE
  To determine the impact of transferring a pediatric population to mechanical ventilator dependency units (MVDUs) or to home mechanical ventilation (HMV) on bed availability in the pediatric intensive care unit (ICU).
  
  
  METHODS
  This is a longitudinal, retrospective study of hospitalized children who required prolonged mechanical ventilation at the MVDU located at the Hospital Auxiliar de Suzano, a secondary public hospital in São Paulo, Brazil. We calculated the number of days patients spent at MVDU and on HMV, and analyzed their survival rates with Kaplan-Meier estimator.
  
  
  RESULTS
  Forty-one patients were admitted to the MVDU in 7.3 years. Median length of stay in this unit was 239 days (interquartile range = 102-479). Of these patients, 22 came from the ICU, where their transfer made available 8,643 bed-days (a mean of 14 new patients per month). HMV of eight patients made 4,022 bed-days available in the hospital in 4 years (a mean of 12 new patients per month in the ICU). Survival rates of patients at home were not significantly different from those observed in hospitalized patients.
  
  
  CONCLUSIONS
  A hospital unit for mechanical ventilator-dependent patients and HMV can improve bed availability in ICUs. Survival rates of patients who receive HMV are not significantly different from those of patients who remain hospitalized.
authors.affiliation: Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil. miltonhanashiro@uol.com.br
authors.forename: Milton
authors.initials: M
authors.lastname: Hanashiro
authors.forename: Antonio O C
authors.initials: AO
authors.lastname: Franco
authors.forename: Alexandre A
authors.initials: AA
authors.lastname: Ferraro
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: Troster
mesh_terms: D002648:Child; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000379:methods* / Q000401:mortality; D012124:Respiratory Care Units / Q000706:statistics & numerical data*; D012189:Retrospective Studies