title: Home mechanical ventilation in children is feasible in developing countries.
abstract: BACKGROUND
  The results of many national surveys on pediatric home mechanical ventilation (HMV) in developed countries have been presented elsewhere, but data from developing countries with low national incomes are scarce.
  
  
  METHODS
  Twenty-nine pediatric patients, treated in the Mother and Child Institute of Serbia, who had been receiving long-term ventilatory support at home, were surveyed. The major criterion for initiating HMV was hypercapnia, diagnosed by blood gas analysis, performed in the morning, after awakening. Other criteria were either symptoms of hypoventilation during the night associated with an apnea index of >5, or apnoea-hypopnoea index of >15, or nocturnal hypoxemia, defined as an oxygen saturation rate of <90% for >5% of total sleep time.
  
  
  RESULTS
  The mean age at initiation of HMV was 9.3 years (range 0.5-17.8 years). Patients waited for HMV initiation either in hospital or at home; the mean period was 6.3 months (range 1-18 months). The subjects received HMV for a mean of 25.06 months (range 3-119 months). There was a significant difference in the duration of HMV for different underlying diseases (P= 0.046), and mechanical malfunction was strongly dependent on the duration of HMV (P= 0.011). Eleven patients underwent invasive HMV via a tracheostomy, and 18 others received non-invasive ventilation, via nasal and full-face masks.
  
  
  CONCLUSIONS
  HMV is feasible in developing countries. Valuable reimbursement policies as well as an organized and functional network are essential for its implementation, as a standard of care in leading national pediatric hospitals.
authors.affiliation: Department of Pulmonology, Mother and Child Institute, Belgrade, Serbia. asovtic@eunet.rs
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Sovtic
authors.forename: Predrag
authors.initials: P
authors.lastname: Minic
authors.forename: Miodrag
authors.initials: M
authors.lastname: Vukcevic
authors.forename: Gordana
authors.initials: G
authors.lastname: Markovic-Sovtic
authors.forename: Milan
authors.initials: M
authors.lastname: Rodic
authors.forename: Milan
authors.initials: M
authors.lastname: Gajic
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012121:Respiration, Artificial / Q000379:methods* / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D055771:Serbia