Risk factors for first nonscheduled hospital admissions of pediatric patients on home mechanical ventilation

Abstract

Objectives The number of children on home mechanical ventilation (HMV) has increased. Understanding the reasons for nonscheduled hospital admissions during HMV is critical. This study aims to investigate the risk factors of first nonscheduled hospital admissions of pediatric patients on HMV. Methods A retrospective analysis of patients on HMV between May 1, 2014 and October 1, 2020 was performed. Patients' demographic characteristics, duration of the education of the primary caregiver; time of first nonscheduled visit; and type of HMV (noninvasive mechanical ventilation [NIV] or invasive mechanical ventilation [IMV]) were analyzed. The reasons for first nonscheduled hospital visits were categorized as respiratory problems and other reasons. Results Of 97 patients, 41 were female (42.3%), and 70 (72%) were on IMV. The median age was 23 months (IQR, 10–91). Twenty‐nine patients (30%), were admitted to hospital before scheduled visit with a mean duration of 18.1 ± 11.6 days; of them, 14 (48.2%) admitted because of respiratory problems. IMV increases the risk of first nonscheduled visit compared to NIV (OR, 16.3; 95% CI, 2.1–127.4; p = .008). If a caregiver spends less than 14 days in hospital for education, risk of nonscheduled visits increases (OR, 4.0; 95% CI, 1.5–11.2; p = .007). Conclusion A minimum 14 days seems to be necessary for education of the caregivers of the patients with HMV to reduce the number of nonscheduled visits, which is a burden for both patients and healthcare system.

Home mechanical ventilation in children with chronic respiratory failure: a narrative review

“…The potential risks in children on HMV include ventilator failure, airway obstruction by secretion, tracheostomy-related complications (accidental decannulation, bleeding, infection, etc. ), acute lower respiratory tract infection, feeding problems, seizures, dehydration, and electrolyte imbalance [ 78 , 79 ]. A retrospective study reported that children with invasive mechanical ventilation were 16 times more likely to visit hospitals before scheduled visits than children with NIV (odds ratio, 16.3; 95% confidence interval, 2.1–127.4, p =0.008) [ 78 ].…”

“…), acute lower respiratory tract infection, feeding problems, seizures, dehydration, and electrolyte imbalance [ 78 , 79 ]. A retrospective study reported that children with invasive mechanical ventilation were 16 times more likely to visit hospitals before scheduled visits than children with NIV (odds ratio, 16.3; 95% confidence interval, 2.1–127.4, p =0.008) [ 78 ]. Other risk factors for unscheduled hospital admissions were a shorter duration of caregiver education before discharge, a change in the management of the child within 7 days before discharge, and younger age [ 78 - 80 ].…”

“…A retrospective study reported that children with invasive mechanical ventilation were 16 times more likely to visit hospitals before scheduled visits than children with NIV (odds ratio, 16.3; 95% confidence interval, 2.1–127.4, p =0.008) [ 78 ]. Other risk factors for unscheduled hospital admissions were a shorter duration of caregiver education before discharge, a change in the management of the child within 7 days before discharge, and younger age [ 78 - 80 ]. A recent study in Germany evaluating differences in the incidences of complications between children with invasive ventilation at home and children with invasive ventilation at specialized nursing facilities found that children on invasive ventilation at home were more likely to experience tracheostomy-related incidents and infection compared to children with tracheostomy and long-term ventilation support at specialized nursing care facilities, while there was no difference in the incidence of potentially life-threatening severe adverse events with rapid deterioration of vital signs requiring immediate medical intervention, and may require resuscitation and hospital admission [ 81 ].…”

Year in review 2021: Neuromuscular diseases

“…Second, Ozcan et al 2 completed a retrospective analysis analyzing risk factors for nonscheduled hospital admissions of pediatric patients on home mechanical ventilation in Turkey. They included pediatric patients hospitalized and initialized on home mechanical ventilation between May 1, 2014 and October 1, 2020.…”

“…Second, Ozcan et al 2 Monitoring and timely adjustment of support is key in successfully managing patients supported using chronic mechanical ventilation. Telemedicine is a new modality that may help us with this long-term management.…”