title: Outcomes of children treated with tracheostomy and positive-pressure ventilation at home.
abstract: BACKGROUND
  Long-term outcomes for children who survive on tracheostomy and positive-pressure ventilation (TPPV) at home are not well known.
  
  
  METHODS
  A retrospective review of 20 years of clinical data at a single institution was performed. Outcome measures included 5-year survival, decannulation rate, and neurocognition.
  
  
  RESULTS
  A total of 91 children were categorized under neuromotor dysfunction (52%), chronic lung disease (29%), and congenital anomalies (20%). The 5-year survival rates for these categories were 89% (95% confidence interval [CI] = 80%-99%), 76% (95% CI = 57%-100%), and 94% (95% CI = 83%-100%), respectively. Overall, the 5-year decannulation rate was 25% (95% CI = 14%-35%), with children with chronic lung disease having the highest rate (51%). It was found that 14% were extremely delayed in neurocognition.
  
  
  CONCLUSIONS
  Most children on TPPV at home survive beyond 5 years, and a significant number are decannulated. Primary care physicians and communities should be prepared to accommodate the increasing number of children on TPPV at home.
authors.affiliation: University of Alabama-Birmingham, Birmingham, AL, USA. comgulnur@uams.edu
authors.forename: Gulnur
authors.initials: G
authors.lastname: Com
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.forename: Martin L
authors.initials: ML
authors.lastname: Bauer
authors.forename: Claire V
authors.initials: CV
authors.lastname: Lenker
authors.forename: Maria M
authors.initials: MM
authors.lastname: Melguizo-Castro
authors.forename: Todd G
authors.initials: TG
authors.lastname: Nick
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Makris
mesh_terms: D002493:Central Nervous System Diseases / Q000401:mortality* / Q000628:therapy*; D002675:Child, Preschool; D002908:Chronic Disease; D000013:Congenital Abnormalities / Q000401:mortality; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000401:mortality / Q000628:therapy*; D008297:Male; D011175:Positive-Pressure Respiration / Q000401:mortality; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D014139:Tracheostomy / Q000401:mortality