Thirty years of home mechanical ventilation in children: escalating need for pediatric intensive care beds

Frans B Plötz,Mike J Kampelmacher,Fleur M Paulides,Josephus P J Van Gestel,Laura P Verweij-Van Den Oudenrijn

doi:10.1007/s00134-012-2545-9

Abstract

PurposeTo describe trends in pediatric home mechanical ventilation (HMV) and their impact on the use of pediatric intensive care unit (PICU) beds.MethodsReview of all children who had started HMV in a single center for HMV.ResultsBetween 1979 and 2009, HMV was started in 197 patients [100 (51 %) with invasive and 97 with noninvasive ventilation], with a median age of 14.7 (range 0.5–17.9) years. Most patients (77 %) were males with a neuromuscular disorder (66 %). The number of children receiving HMV increased from 8 in the 1979–1988 period to 122 in the 1999–2008 period. This increase occurred foremost in patients aged 0–5 years and was accompanied by a sharp rise in the use of PICU beds. In 150 patients (76 %), HMV was initiated on an ICU with a total of 12,440 admission days, of which 10,385 days (83 %) could be attributed to 67 patients who started non-electively with invasive HMV. Of the latter, 52 patients had been admitted to a PICU with a total of 9,335 admission days. At the end of the study, 134 patients (68 %) were still being ventilated, 43 patients (22 %) had died, 11 patients (6 %) were weaned from HMV, 4 patients (2 %) did not want to continue HMV and 5 patients (3 %) were lost to follow-up.ConclusionsOver time, there was an impressive increase in the application of HMV in children. This increase was most obvious in the youngest age group with invasive HMV, and these children had very long stays in the PICU.

Highlights

Introduction immense success ofHMV and a greater awareness among physicians and patients; improvements in tech-In patients with chronic respiratory failure the aims of nology and medical care; and by an increased patient home mechanical ventilation (HMV) include prolonging autonomy and a different moral-ethical attitude with life, while maintaining or improving the quality of life, respect to treatment decisions
HMV was started in 197 patients [100 sions: Over time, there was an
In the past decades the trend in adults, we got the impression that HMV was number of adults that benefitted from HMV seems to have being applied in children more often, at an increasingly increased steadily

Summary

PEDIATRIC ORIGINAL

Received: 10 June 2011 Accepted: 2 March 2012 Published online: 5 April 2012 Ó The Author(s) 2012. This article is published with open access at Springerlink.com. B. Plotz Department of Pediatric Intensive Care, VU Medical Center, Amsterdam, The Netherlands. J. van Gestel Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands. Plotz Department of Pediatrics, Tergooi Hospitals, Blaricum, The Netherlands admission days, of which 10,385 days (83 %) could be attributed to 67 patients who started non-electively with invasive HMV. Of the latter, 52 patients had been admitted to a PICU

Results

Age of HMV onset All patients

Changes over time

All patients

PICU length of stay