Paediatric home ventilatory support: The Auckland experience

Edwards, Elizabeth S.; Hsiao, Kai Hsun; Nixon, GM

doi:10.1111/j.1440-1754.2005.00753.x

Cited by 75 publications

(111 citation statements)

References 42 publications

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“…The percentage distribution of the various diseases and disorders in our sample was only partially consistent with other reports [1][2][3][4][5][6][7][8][10][11][12][13][31][32][33][34][35][36]: while the percentages relating to NMDs and CCHS were similar, there was a much lower rate of lung and airway diseases (bronchial dysplasia, malaria, ciliary dyskinesia, OSAS, and other respiratory diseases with chronic hypoventilation) in our sample, with 3.6% as opposed to 25-35% in the literature [1][2][3][4][5][6]8,9,[11][12][13][31][32][33][34][35][36]. This may relate to patient care and clinical or organizational factors particular to our setting: patients are only referred to the regional reference center if they are under 18 years old and have complex, lifethreatening diseases posing very complicated care issues.…”

Section: Discussionsupporting

confidence: 72%

“…In recent years, technological advances have enabled the use of mechanical ventilation at home, but home care for a child needing mechanical ventilatory support demands the adoption of a highly complex patient care plan [7][8][9][10][11][12][13][14]. This includes drawing up a detailed program for providing medical and nursing care, and organizational support [7,14,[22][23][24], as well as planning adequate training for family caregivers and territorial healthcare operators [25], a patient monitoring schedule, procedures for managing emergencies and, in due course, appropriate arrangements for handing the patient over to the adult services [26][27][28].…”

Section: Introductionmentioning

confidence: 99%

“…In many countries the last two decades have seen a gradual increase in the prevalence of pediatric patients on long-term mechanical ventilation at home (LTMV-H) [1][2][3][4][5][6][7][8][9][10][11][12] as a result of advances in medicine and technology affording these children a longer survival [1][2][3][4][7][8][9]11,12]. This has given rise to a new pediatric population represented by young patients on LTMV-H, be it invasive (IMV) or non-invasive (NIV), that has been growing more rapidly in the last few years, especially the latter subgroup [4,13].…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Ventilation at Home and Pediatric Palliative Care: Patients’ Characterization in an Italian Regional Survey

Rusalen¹,

Agosto²,

Brugnaro³

et al. 2015

J Palliat Care Med

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Background: The prevalence of children receiving long-term mechanical ventilation at home (LTMV-H) is rising in many countries as advances in technology and medicine extend the survival of such patients. In Italy, the prevalence is 4.2 per 100,000 pediatric patients. It becomes essential to thoroughly assess these patients' needs, and of the quality and adequacy of their home care. Pediatric palliative care (PPC) may be an appropriate strategy for the global care and quality of life of children needing LTMV-H and their families.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-Term Ventilation at Home and Pediatric Palliative Care: Patients’ Characterization in an Italian Regional Survey

Rusalen¹,

Agosto²,

Brugnaro³

et al. 2015

J Palliat Care Med

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“…Pacientes que apresentam condições clínicas e socioeconômicas favoráveis podem ser indicados para receber ventilação mecânica domiciliar (VMD) 7,[11][12][13][14][15][16][17][18] .…”

Section: Introductionunclassified

Care alternatives for pediatric chronic mechanical ventilation

et al. 2011

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Objective: To determine the impact of transferring a pediatric population to mechanical ventilator dependency units (MVDUs) or to home mechanical ventilation (HMV) on bed availability in the pediatric intensive care unit (ICU).Methods: This is a longitudinal, retrospective study of hospitalized children who required prolonged mechanical ventilation at the MVDU located at the Hospital Auxiliar de Suzano, a secondary public hospital in São Paulo, Brazil. We calculated the number of days patients spent at MVDU and on HMV, and analyzed their survival rates with KaplanMeier estimator.Results: Forty-one patients were admitted to the MVDU in 7.3 years. Median length of stay in this unit was 239 days (interquartile range = 102-479). Of these patients, 22 came from the ICU, where their transfer made available 8,643 bed-days (a mean of 14 new patients per month). HMV of eight patients made 4,022 bed-days available in the hospital in 4 years (a mean of 12 new patients per month in the ICU). Survival rates of patients at home were not significantly different from those observed in hospitalized patients. Conclusion:A hospital unit for mechanical ventilator-dependent patients and HMV can improve bed availability in ICUs. Survival rates of patients who receive HMV are not significantly different from those of patients who remain hospitalized. J Pediatr (Rio J) IntroduçãoAs crianças dependentes de ventilação mecânica são um grupo de pacientes pediátricos com necessidades complexas de tratamento, devido ao uso contínuo de aparelhos para fornecer ventilação mecânica e às hospitalizações prolongadas. Essa população vem crescendo nos últimos anos 1 , como resultado dos avanços tecnológicos no tratamento de pacientes crônicos graves, e também do aumento do acesso público aos recursos médicos.Mesmo quando os pacientes estão clinicamente estáveis, muitos permanecem hospitalizados em unidades de terapia

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“…36 Tracheostomy is sometimes required for neonates with upper airway abnormalities or occasionally for infants who cannot be weaned from assisted ventilation. [37][38][39][40] Good parental teaching and coordinated multidisciplinary follow-up care are essential for these infants. Infants who require home ventilation should also be on a cardiorespiratory monitor in case the airway should become obstructed, but the home ventilator should also have a disconnect alarm to alert caregivers to ventilator disconnection.…”

mentioning

confidence: 99%

Hospital Discharge of the High-Risk Neonate

2008

Pediatrics

457

149

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This policy statement updates the guidelines on discharge of the high-risk neonate first published by the American Academy of Pediatrics in 1998. As with the earlier document, this statement is based, insofar as possible, on published, scientifically derived information. This updated statement incorporates new knowledge about risks and medical care of the high-risk neonate, the timing of discharge, and planning for care after discharge. It also refers to other American Academy of Pediatrics publications that are relevant to these issues. This statement draws on the previous classification of high-risk infants into 4 categories: (1) the preterm infant; (2) the infant with special health care needs or dependence on technology; (3) the infant at risk because of family issues; and (4) the infant with anticipated early death. The issues of deciding when discharge is appropriate, defining the specific needs for follow-up care, and the process of detailed discharge planning are addressed as they apply in general to all 4 categories; in addition, special attention is directed to the particular issues presented by the 4 individual categories. Recommendations are given to aid in deciding when discharge is appropriate and to ensure that all necessary care will be available and well coordinated after discharge. The need for individualized planning and physician judgment is emphasized. Pediatrics 2008;122:1119-1126 INTRODUCTIONThe decision of when to discharge an infant from the hospital after a stay in the NICU is complex. 1 This decision is made primarily on the basis of the infant's medical status but is complicated by several factors. These factors include the readiness of families for discharge, differing opinions about what forms of care can be provided at home, and pressures to contain hospital costs by shortening the length of stay. Insofar as possible, determination of the readiness for discharge should be based on peer-reviewed scientific evidence. Shortening the length of a hospital stay may benefit the infant and family by decreasing the period of separation of infant and parents; moreover, the infant may benefit from shortening its exposure to the risks of hospital-acquired morbidity. However, the overriding concern is that infants may be placed at risk of increased mortality and morbidity by discharge before physiologic stability is established. Infants born preterm with low birth weight who require neonatal intensive care experience a much higher rate of hospital readmission and death during the first year after birth compared with healthy term infants. 2-5 Careful preparation for discharge and good follow-up after discharge may reduce these risks. It takes time for the family of a high-risk infant to prepare to care for their infant in a home setting and to obtain the necessary support services and mobilize community resources. With increased survival of very preterm and very ill infants, many infants are discharged with unresolved medical issues that complicate their subsequent care. Infants are ofte...

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Paediatric home ventilatory support: The Auckland experience

Abstract: This review documents the increasing trend in children receiving respiratory support at home. Future planning and resources are needed to address this growing need.

Cited by 75 publications

References 42 publications

Long-Term Ventilation at Home and Pediatric Palliative Care: Patients’ Characterization in an Italian Regional Survey

Long-Term Ventilation at Home and Pediatric Palliative Care: Patients’ Characterization in an Italian Regional Survey

Care alternatives for pediatric chronic mechanical ventilation

Hospital Discharge of the High-Risk Neonate

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