Abstract
BackgroundChildren with chronic respiratory failure and/or sleep disordered breathing due to a broad range of diseases may require long-term ventilation to be managed at home. Advances in the use of long-term non-invasive ventilation has progressively leaded to a reduction of the need for invasive mechanical ventilation through tracheostomy. In this study, we sought to characterize a cohort of children using long-term NIV and IMV and to perform an analysis of those children who showed significant changes in ventilatory support management.MethodsWe performed a retrospective cohort study of pediatric (within 18 years old) patients using long-term, NIV and IMV, hospitalized in our center between January 1, 2000 and December 31, 2017. A total of 432 children were included in the study. Long Term Ventilation (LTV) was defined as IMV or NIV, performed on a daily basis, at least 6 h/day, for a period of at least 3 months.Results315 (72.9%) received non-invasive ventilation (NIV); 117 (27.1%) received invasive mechanical ventilation (IMV). Children suffered mainly from neuromuscular (30.6%), upper airway (24.8%) and central nervous system diseases (22.7%). Children on IMV were significantly younger when they start LTV [NIV: 6.4 (1.2–12.8) years vs IMV 2.1 (0.8–7.8) years] (p < 0.001)]. IMV was likely associated with younger age at starting ventilatory support (aOR 0.9428; p = 0.0220), and being a child with home health care (aOR 11.4; p < 0.0001). Overtime 39 children improved (9%), 11 children on NIV (3.5%) received tracheostomy; 62 children died (14.3%); and 74 children (17.1%) were lost to follow-up (17.8% on NIV, 15.4% on IMV).ConclusionsChildren on LTV suffered mainly from neuromuscular, upper airways, and central nervous system diseases. Children invasively ventilated usually started support younger and were more severely ills.
Highlights
Children with chronic respiratory failure and/or sleep disordered breathing due to a broad range of diseases may require long-term ventilation to be managed at home
The median age at the start of mechanical ventilation was significantly different in children on non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV) [NIV: 6.4 (1.2–12.8) years or IMV 2.1 (0.8–7.8) years; (p = 0.0001)]
Multivariate logistic regression (Table 2) showed that IMV was likely associated with younger age at starting ventilatory support, and being a child receiving home health care assistance
Summary
Children with chronic respiratory failure and/or sleep disordered breathing due to a broad range of diseases may require long-term ventilation to be managed at home. Advances in the use of long-term non-invasive ventilation has progressively leaded to a reduction of the need for invasive mechanical ventilation through tracheostomy. The continuous advances in care and technology, has helped to increase survival of more infants, children, and adolescents with chronic (sometimes critical) conditions These patients, in some cases, can survive until adulthood and need to be managed with long-term technological support [1,2,3]. Children with chronic respiratory failure and/or sleep disordered breathing due to a broad range of diseases are part of this group, as they may require long-term ventilation (LTV) to be safely managed at home [1,2,3]. Some studies reported data on children on non-invasive ventilation (NIV), other on children on both NIV and invasive mechanical ventilation (IMV) [4,5,6,7]
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