Rambod Amirnovin1, Sara Aghamohammadi2, Carley Riley3, Marlyn S Woo4, Sylvia Del Castillo5. 1. Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles. ramirnovin@chla.usc.edu. 2. Division of Pediatric Critical Care Medicine, University of California Davis, Sacramento. 3. Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 4. Division of Pediatric Pulmonology and Sleep Medicine, University of California Los Angeles Mattel Children's Hospital, UCLA David Geffen School of Medicine, Los Angeles. 5. Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles.
Abstract
BACKGROUND: The population of children requiring home mechanical ventilation has evolved over the years and has grown to include a variety of diagnoses and needs that have led to changes in the care of this unique population. The purpose of this study was to provide a descriptive analysis of pediatric patients requiring home mechanical ventilation after hospitalization and how the evolution of this technology has impacted their care. METHODS: A retrospective, observational, longitudinal analysis of 164 children enrolled in a university-affiliated home mechanical ventilation program over 26 years was performed. Data included each child's primary diagnosis, date of tracheostomy placement, duration of mechanical ventilation during hospitalization that consisted of home mechanical ventilator initiation, total length of pediatric ICU stay, ventilator settings at time of discharge from pediatric ICU, and disposition (home, facility, or died). Univariate, bivariate, and regression analysis was used as appropriate. RESULTS: The most common diagnosis requiring the use of home mechanical ventilation was neuromuscular disease (53%), followed by chronic pulmonary disease (29%). The median length of stay in the pediatric ICU decreased significantly after the implementation of a ventilator ward (70 d [30-142] vs 36 d [18-67], P = .02). The distribution of subjects upon discharge was home (71%), skilled nursing facility (24%), and died (4%), with an increase in the proportion of subjects discharged on PEEP and those going to nursing facilities over time (P = 0.02). CONCLUSIONS: The evolution of home mechanical ventilation has allowed earlier transition out of the pediatric ICU and with increasing disposition to skilled nursing facilities over time. There has also been a change in ventilator management, including increased use of PEEP upon discharge, possibly driven by changes in ventilators and in-patient practice patterns.
BACKGROUND: The population of children requiring home mechanical ventilation has evolved over the years and has grown to include a variety of diagnoses and needs that have led to changes in the care of this unique population. The purpose of this study was to provide a descriptive analysis of pediatric patients requiring home mechanical ventilation after hospitalization and how the evolution of this technology has impacted their care. METHODS: A retrospective, observational, longitudinal analysis of 164 children enrolled in a university-affiliated home mechanical ventilation program over 26 years was performed. Data included each child's primary diagnosis, date of tracheostomy placement, duration of mechanical ventilation during hospitalization that consisted of home mechanical ventilator initiation, total length of pediatric ICU stay, ventilator settings at time of discharge from pediatric ICU, and disposition (home, facility, or died). Univariate, bivariate, and regression analysis was used as appropriate. RESULTS: The most common diagnosis requiring the use of home mechanical ventilation was neuromuscular disease (53%), followed by chronic pulmonary disease (29%). The median length of stay in the pediatric ICU decreased significantly after the implementation of a ventilator ward (70 d [30-142] vs 36 d [18-67], P = .02). The distribution of subjects upon discharge was home (71%), skilled nursing facility (24%), and died (4%), with an increase in the proportion of subjects discharged on PEEP and those going to nursing facilities over time (P = 0.02). CONCLUSIONS: The evolution of home mechanical ventilation has allowed earlier transition out of the pediatric ICU and with increasing disposition to skilled nursing facilities over time. There has also been a change in ventilator management, including increased use of PEEP upon discharge, possibly driven by changes in ventilators and in-patient practice patterns.
Authors: Mary Lou Clark Fornehed; Radion Svynarenko; Jessica Keim-Malpass; Melanie J Cozad; Kerri A Qualls; Whitney L Stone; Lisa C Lindley Journal: South Med J Date: 2022-03 Impact factor: 0.954
Authors: Janet Mattson; Johan Lunnelie; Tim Löfholm; Elina Scheers Andersson; Ragnhild E Aune; Gunilla Björling Journal: SAGE Open Nurs Date: 2022-04-26