Asistencia ventilatoria no invasiva domiciliaria en niños: impacto inicial de un programa nacional en Chile

Abstract

At-home non-invasive ventilatory assistance for children: initial impact of a national program in Chile Introduction: Prolonged mechanical ventilation may be provided to children with chronic ventilatory failure as non-invasive ventilatory assistance at home (NIVA). Objective: To describe clinical characteristics, evolution outcomes and Health Related Quality of Life (HRQOL) of pediatric patients admitted into the Chilean NIVA program. Patients and Methods: Medical fi les of patients included in the program, were reviewed during a period of 24 months (2006-2008), using follow-up protocols. Results: There were a total of 177 children, with an average age of 9.7 ± 4.7 years. Fourteen patients died of non-related causes. Diagnoses were: neuromuscular disease (NMD) 64%, myelomeningocele 6%, obstructive sleep apnea syndrome 6%, lung disease 20% and miscellaneous 4%. Compared to the previous year, hospitalization decreased from 60 to 21% (p < 0.00001) and from 1.3 hospitalizations/patient/year to 0.3 (p < 0.00001). HRQOL improved signifi cantly, AUQUEI 17.2 ± 5.6 (p < 0.05), IRS 26.4 ± 8.2 points (p < 0.05) in 82 patients. In 21 patients with NMD an average increase of 27 cmH 2 O on muscular inspiratory pressure (p < 0.05) after respiratory training was observed. Conclusions: The NIVA program reduced hospitalizations and improved HRQOL. In a group of patients the muscle strength increased with stable respiratory function.

Experience in a Pediatric Prolonged Mechanical Ventilation Unit from a public hospital in Chile

“…3,4,11,21,22 In our group of children, those who met the required socioeconomic conditions at home were admitted to government programs implemented in Chile since 2006 for NIV and since 2008 for IV, which included 658 active pediatric patients and 1212 admitted patients at the beginning of 2019. [8][9][10]23 For the group of patients who did not meet the required socioeconomic conditions for this programs in order to go back home with ventilatory support, a technical and professional team was introduced in an institution external to the hospital. [8][9][10]24 Of all children included in our study, 54 % required an unscheduled readmission to the PMVU, most of them with IV, which may be explained by their highly complex underlying conditions, associated complications, and the need for regular assessments in order to determine behaviors that may suggest an advancement or regression of their underlying condition.…”

Experiencia de una Unidad de Ventilación Mecánica Pediátrica Prolongada en un hospital público de Chile

“…3,4,11,21,22 En nuestro grupo de niños, quienes cumplieron con el respaldo socioeconómico domiciliario ingresaron a programas ministeriales implementados en Chile desde 2006 para AVNI y desde 2008 para AVI, los cuales contaban con 658 pacientes pediátricos activos y 1212 ingresados, hasta inicios del 2019. [8][9][10]23 Para el grupo de pacientes sin condiciones socioeconómicas requeridas por estos programas para regresar con asistencia ventilatoria a domicilio, se implementó un equipo técnico y profesional en una institución externa al recinto hospitalario. [8][9][10]24 El 54 % del universo de nuestros niños requirió el reingreso no programado a la UVMP, la mayor parte con AVI, lo cual puede explicarse por la mayor complejidad de sus patologías de base, sus complicaciones asociadas y la necesidad de evaluaciones periódicas para determinar conductas que puedan implicar un avance o regresión de su patología de base.…”

Feasibility of a pediatric long‐term Home Ventilation Program in Argentina: 11 years' experience

“…In fact, in our cohort, one‐third of the pts lived more than 500 km away from the hospital; hence, it is a representative sample of children with complex diseases from all regions of our country attended in the public sector. Only, Chilean 5–7 and Brazilian authors 8,9 have published reports on other pediatric Latin American experiences on HV. Few pediatric reports have been published from other emerging countries 10–14 …”