title: Liberation from home mechanical ventilation and decannulation in children.
abstract: The prevalence of children requiring outpatient invasive long-term mechanical ventilation is increasing. For some children, liberation from home mechanical ventilation (HMV) and decannulation is the desired outcome. This study describes our experience liberating tracheostomy and HMV (T-HMV) dependent children from respiratory technologies.
  
  
  
  We reviewed charts of T-HMV dependent children who were cared for at our institution and decannulated between July 1999 and December 2011. Patient characteristics, diagnoses, and important steps leading to decannulation were recorded.
  
  
  
  Forty-six children achieved HMV independence and decannulation. The most common indications for T-HMV were lower airway and parenchymal lung disease. The median ages at tracheotomy, initiation of HMV, initiation of tracheostomy collar (TC) trials, HMV independence, and decannulation were 3.5, 6.0, 12.0, 25.5, and 40.5 months, respectively. Twenty-five children (54%) skipped either using a speaking valve, tracheostomy capping, or both without increased likelihood of recannulation. (P = 0.03). Common procedures prior to decannulation were airway surgery, bronchoscopy, and polysomnography (n = 30, 46, and 46 children, respectively). A median of 9.5 clinic visits and 5 hospitalizations occurred from initial hospital discharge to just prior to decannulation. HMV was primarily weaned as an outpatient.
  
  
  
  Liberation from respiratory technology is a complex, multi-step process that can be accomplished in medically complex children with varying underlying disease processes at relatively young ages. Five major steps (tracheotomy, initiation of HMV, initiation of TC trials, HMV independence, and decannulation) performed in conjunction with clinic visits, procedures, and home nursing support were integral in the successful decannulation process. Pediatr Pulmonol. 2016;51:838-849. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, 53226, Wisconsin.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Henningfeld
authors.affiliation: National Outcomes Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kristyn
authors.initials: K
authors.lastname: Maletta
authors.affiliation: National Outcomes Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Bixiang
authors.initials: B
authors.lastname: Ren
authors.affiliation: National Outcomes Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kathie L
authors.initials: KL
authors.lastname: Richards
authors.affiliation: Respiratory Care Services, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Carole
authors.initials: C
authors.lastname: Wegner
authors.affiliation: Department of Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, 53226, Wisconsin.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: D'Andrea
mesh_terms: D000553:Ambulatory Care; D001999:Bronchoscopy; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000628:therapy; D008297:Male; D017286:Polysomnography; D012189:Retrospective Studies; D014139:Tracheostomy / Q000295:instrumentation*; D014140:Tracheotomy / Q000295:instrumentation*; D015300:Ventilator Weaning
keywords: pediatrics; tracheostomy; tracheotomy; ventilator weaning