Home Ventilation In Children Research Articles

Depression and anxiety in mothers of home ventilated children before and during COVID-19 pandemic.

BackgroundDue to advances in technology, home ventilation in children has increased in recent years. The provision of proper care for a home‐ventilated (HV) child can have a strong impact on the lifestyle of caregivers. The aim of this study was to evaluate the depression and anxiety levels of the mothers of HV children during the current COVID‐19 pandemic and compare them to those of mothers of healthy peers.MethodsThis cross‐sectional study was conducted on HV children (n = 21) and a control group of healthy peers (n = 32) by means of a questionnaire completed by the mothers of the children of both groups. Psychometric scales, such as the Beck Depression Inventory (BDI), the State‐Trait Anxiety Inventory‐State (STAI‐S), and the State‐Trait Anxiety Inventory‐Trait (STAI‐T), were used to assess participants.ResultsDuring the pandemic signs of depression were present in 8 (38.1%) of the case group and 8 (25%) of the healthy control group. Comparison of the BDI scores from before and during the pandemic showed no difference between mothers of the HV children (p = .09). Scores for BDI and STAI‐T were higher in the case group than in the control group, whereas there was no significant difference in STAI‐S scores.ConclusionDepression and anxiety levels of mothers of HV children were found to be higher during the COVID‐19 pandemic. Economic, medical, and social support resources are needed to reduce levels of depression and anxiety and help mothers of those children dependent on technology.

Section 6: Home ventilation in children with chronic lung diseases

Some children with chronic lung diseases (CLD) may require home mechanical ventilation (HMV). This section will focus on bronchopulmonary dysplasia (BPD) and cystic fibrosis (CF), though other CLDs...

Burdens of home ventilation of children.

Burdens of home ventilation of children.

Thirteen years of invasive and noninvasive home ventilation for children in a developing country: A retrospective study.

Home ventilation (HV) for children is growing rapidly worldwide. The aim was to describe (1) the sociodemographic characteristics of children on HV and (2) the indications for, means and outcome of initiating HV in children from a developing country. This retrospective study included patients sent home on noninvasive or invasive ventilation, over 13 years, by the pediatric respiratory unit in a single center. Children who declined treatment were excluded. Seventy children were initiated on HV: 85.7% on noninvasive ventilation, 14.3% on invasive ventilation. There was about a threefold increase from 2001-2008 (n = 18) to 2009-2014 (n = 52). Median (range) age of initiating HV was 11 (1-169) months and 73% of children were <2 years old. Common indications for HV were respiratory (57.2%), chest/spine anomalies (11.4%), and neuromuscular (10.0%). Fifty-two percent came off their devices with a median (interquartile range) usage duration of 12 (4.8, 21.6) months. Ten children (14.3%) died with one avoidable death. Children with neuromuscular disease were less likely to come off their ventilator (0.0%) compared to children with respiratory disease (62.1%). Forty-one percent of parents bought their equipment, whereas 58.6% borrowed their equipment from the medical social work department and other sources. HV in a resource-limited country is possible. Children with respiratory disease made up a significant proportion of those requiring HV and were more likely to be weaned off. The mortality rate was low. The social work department played an important role in facilitating early discharge. Pediatr Pulmonol. 2017;52:500-507. © 2016 Wiley Periodicals, Inc.

Paediatric tracheostomy and ventilation home care with challenging socio-economic circumstances in South Africa

BackgroundChildren discharged home with a tracheostomy need a safe home environment and access to health care. We described the indications, clinical characteristics, socio-economic circumstances and outcomes of children enroled in a tracheostomy home care programme in South Africa. MethodsWe performed a retrospective chart review of children receiving a tracheostomy and enroled in the Breatheasy programme at the Red Cross War Memorial Children's Hospital, Cape Town. Medical and background characteristics were recorded. Influences of socio-economic variables and underlying medical conditions on length of hospital stay, unplanned readmissions and mortality in the first year after discharge were evaluated. ResultsIn the period 2008–2012, 157 patients were discharged home with a tracheostomy. Median hospital stay after tracheostomy insertion was significantly longer when parents had incomplete schooling compared to completed secondary school or higher education; 30 days (IQR 21–53) versus 23 days (IQR 16–33), respectively. Unplanned readmissions in the first year were documented for 72 patients (45.9%). The risk for unplanned readmission was 2.6 times higher in families with substance abuse the risk of respiratory infections was two-fold in case of household cigarette smoke exposure (OR 2.3.) Tracheostomy-related mortality was low (1.2%). An underlying medical condition was the only independent significant risk factor for mortality (OR 5.1, 95% CI 1.8–14.3). ConclusionThis study demonstrates that despite difficult socio-economic circumstances, home ventilation of children with a tracheostomy is safe, provided caregivers are adequately trained and supported.

Compliance with noninvasive home ventilation in children with obstructive sleep apnoea

This study aimed to determine compliance with noninvasive home ventilation in children with obstructive sleep apnoea and the factors affecting this compliance. We retrospectively reviewed 51 children who were prescribed noninvasive home ventilation for the management of obstructive sleep apnoea from 1 January 2000 until 31 May 2008. Noninvasive ventilation was started based on positive polysomnogram, i.e. obstructive apnoea hypopnea index ≥ 1/hr. Compliance was defined as the use of noninvasive ventilation ≥ 4 days/week. Noninvasive home ventilation was started at a median age of 11.5 years. In all, 21 (41.2 %) children were reported to be compliant with treatment. Univariate analysis revealed that the female gender (p = 0.017), presence of asthma (p = 0.023), presence of genetic syndromes (p = 0.023), use of bi-level ventilation versus continuous positive airway pressure (p = 0.027), and funding from the social work department (p = 0.049) were associated with compliance with noninvasive home ventilation. Logistic regression revealed the presence of asthma (p = 0.008) and female gender (p = 0.047) to be significantly associated with compliance with treatment. However, factors such as counselling prior to initiation of treatment, severity of obstructive sleep apnoea before initiation of treatment, obesity, use of humidification, and polysomnogram indices were not found to be associated with treatment compliance. Only 41.2% of the children in this study were reported to be compliant with noninvasive home ventilation. The female gender and the presence of asthma were associated with treatment compliance. Future research focusing on effective methods to improve compliance with noninvasive home ventilation in children should be undertaken.

Compliance to non-invasive home ventilation in children with obstructive sleep apnoea in a tertiary pediatric hospital, Singapore

While positive airway pressure (PAP) is effective for treating sleep-disordered breathing (SDB) in children, adherence is poor. Studies evaluating predictors of PAP adherence have inconsistent findings, and no rigorous reviews have been conducted. This systematic review aims to summarize the literature on predictors of PAP therapy adherence in children.Studies evaluating baseline predictors of PAP therapy adherence in children (≤20 years) with SDB were included. We searched MEDLINE, Embase, CENTRAL, CINAHL, Clinicaltrials.gov, and the last four years of conference abstracts. Results were described narratively, with random-effects meta-analyses performed where feasible. Risk of bias and confidence in the evidence were assessed.We identified 50 factors evaluated across 28 studies (21 full text articles, seven abstracts). The highest rates of PAP therapy adherence were most consistently found with female sex, younger age, Caucasian race, higher maternal education, greater baseline apnea-hypopnea index (AHI), and presence of developmental delay. Pooled estimates included odds ratios of 1.48 (95%CI: 0.75–2.93) favoring female sex, 1.26 (95%CI: 0.68–2.36) favoring Caucasian race, and a mean difference in AHI of 4.32 (95%CI: −0.61-9.26) events/hour between adherent and non-adherent groups. There was low quality evidence to suggest that psychosocial factors like health cognitions and family environment may predict adherence.In this novel systematic review, we identified several factors associated with increased odds of PAP therapy adherence in children. These findings may help guide clinicians to identify and support children less likely to adhere to PAP therapy and should be considered when developing interventions to improve adherence.

Long‐term home ventilation of children in Italy: A national survey

Improved technology, as well as professional and parental awareness, enable many ventilator-dependent children to live at home. However, the profile of this growing population, the quality and adequacy of home care, and patients' needs still require thorough assessment. To define the characteristics of Italian children receiving long-term home mechanical ventilation (HMV) in Italy. A detailed questionnaire was sent to 302 National Health Service hospitals potentially involved in the care of HVM in children (aged <17 years). Information was collected on patient characteristics, type of ventilation, and home respiratory care. A total of 362 HMV children was identified. The prevalence was 4.2 per 100,000 (95% CI: 3.8-4.6), median age was 8 years (interquartile range 4-14), median age at starting mechanical ventilation was 4 years (1-11), and 56% were male. The most frequent diagnostic categories were neuromuscular disorders (49%), lung and upper respiratory tract diseases (18%), hypoxic (ischemic) encephalopathy (13%), and abnormal ventilation control (12%). Medical professionals with nurses (for 62% of children) and physiotherapists (20%) participated in the patients' discharge from hospital, though parents were the primary care giver, and in 47% of cases, the sole care giver. Invasive ventilation was used in 41% and was significantly related to young age, southern regional residence, longer time spent under mechanical ventilation, neuromuscular disorders, or hypoxic (ischemic) encephalopathy. Care and technical assistance of long-term HMV children need assessment, planning, and resources. A wide variability in pattern of HMV was found throughout Italy. An Italian national ventilation program, as well as a national registry, could be useful in improving the care of these often critically ill children.

Long-term follow-up of home mechanical ventilation in young children with spinal cord injury and neuromuscular conditions

Objectives To provide outcomes of two decades of experience in home ventilation of children with spinal cord injury and neuromuscular conditions. Study design Data were collected through chart review and interviews on 39 children who had become ventilator-dependent before their 6th birthday; 23 children had neuromuscular diseases and 16 had spinal cord injuries. Results Patients required an average of 0.7 rehospitalizations per year. There were 8 deaths. Survival rates were 97% at 1 year, 97% at 3 years, 84% at 5 years, and 71% at 10 years. Thirty children attended school, 13 were in regular school (1 at university level), 5 were home-schooled, 5 were in special education schools, and 5 were in regular school with some special education classes. One graduated high school, and another graduated university and received a graduate degree. Three children had progressive weakness. Two gained significant muscle strength. Conclusions Our experience showed that these patients can be discharged to home with low morbidity and mortality rates and successful reintegration into the community. (J Pediatr 2003;142:476-80)

Tracheostomy and home ventilation in children

The last 30 years have brought a significant emphasis on home care for ventilator-dependent children. While the movement was driven by the desire to minimize healthcare costs, the advancements in medical knowledge and technology, and the change in the perception of a ventilator-dependent child have offered a fertile environment for the development of programs that support the chronic care of ventilator-dependent children at home (N. Engl. J. Med. 309(21) (1983) 1319; J. Pediatr. 106(5) (1985) 850; N. Engl. J. Med. 310(17) (1984) 1126; JAMA 258(23) (1987) 3398). In addition, the advances in medical and nursing care have led to the steady increase in the number of children with chronic respiratory failure and development of multi-disciplinary teams experienced and dedicated to the care of these children. Another trend that has also contributed to the rise in the number of pediatric patients using long-term mechanical ventilation is the parental expectation of long-term survival of their child. This parental expectation continues to grow as the effect of long-term mechanical ventilation on quality of life and longer survival becomes more evident. The primary indication for use of home mechanical ventilation is chronic respiratory failure (CRF) as indicated by hypoxemia and or hypercapnia. CRF is considered to be a condition persisting for greater than 1 month and requiring mechanical ventilation during part or all of the day to provide adequate gas exchange for the support of vital function (Chest 103(5) (1993) 1463).

An Unreported Risk in the Use of Home Nasal Continuous Positive Airway Pressure and Home Nasal Ventilation in Children

We report the case of a 15-year-old boy with obstructive sleep apnea and obesity who was treated since the age of 5 with nasal continuous positive airway pressure. Due to the long-term use of a nasal mask, the child developed a mid-face hypoplasia. Chronic use of a nasal mask for home ventilation in children should always be associated with regular evaluations of maxillomandibular growth.