Predictors for invasive home mechanical ventilation duration in bronchopulmonary dysplasia

Abstract

Background: Children with bronchopulmonary dysplasia (BPD) who require invasive home mechanical ventilation (IHMV) are medically vulnerable and experience high caregiving and healthcare costs. Predictors for duration of IHMV in children with BPD remain unclear, which can make prognostication and decision-making challenging.Methods: A retrospective cohort study of children with BPD requiring IHMV was conducted from independent children's hospital records (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021). The primary outcome was IHMV duration, defined as time from initial discharge home on IHMV until cessation of positive pressure ventilation (day and night). Two new variables were included: discharge age corrected for tracheostomy (DACT) (chronological age at discharge minus age at tracheostomy) and level of ventilator support at discharge (minute ventilation per kg per day). Univariable Cox regression was performed with variables of interest compared to IHMV duration. Significant nonlinear factors (p < 0.05) were included in the multivariable analysis.

Codesign of remote data collection for chronic management of pediatric home mechanical ventilation

“…This is especially important given research showing that children from racial/ethnic minority backgrounds or lower income experienced disproportionately longer time using IHMV and tracheostomies. 39,40 Our results also provided key information on core functionality that would be needed when designing an RPM approach for this population, including: (1) supporting multiple caregivers and nurse logins, (2) reminders to users such as texts or other phone notifications, and (3) individualized data programming based on ventilation settings, schedules, and child activity. This latter finding is consistent with previous literature noting that the care needs of children using IHMV are highly variable between patients and for a…”

“…To prevent any potential for further disparities in care or health outcomes, RPM system designs must consider alternative pathways for those with barriers to digital technologies. This is especially important given research showing that children from racial/ethnic minority backgrounds or lower income experienced disproportionately longer time using IHMV and tracheostomies 39,40 …”

Weaning strategies for children on home invasive mechanical ventilation

“…A retrospective cohort study of children with BPD requiring IHMV in New Zealand during 2005−2021 revealed that half of the patients were weaned off HMV by 36 months and 90% by 52 months once home. This was longer in the patients with higher discharge age corrected for tracheostomy (DACT; chronological age at discharge minus age at tracheostomy) 23 …”