Incidence and Mortality of Children Receiving Home Mechanical Ventilation

OBJECTIVES The incidence, as well as the predictors of mortality, for children receiving home mechanical ventilation (HMV) using population-based data in Canada is a current knowledge gap. Our objectives were to describe HMV incidence and mortality rates, and associations of demographic and clinical variables on mortality. METHODS Using Ontario health and demographic administrative databases, we conducted a retrospective cohort study (April 1, 2003–March 31, 2017) of children aged 0 to 17 years receiving HMV via invasive mechanical ventilation and noninvasive ventilation. We identified children with complex chronic conditions. We used data from Census Canada to calculate incidence rates and Cox proportional hazards modeling to assess for predictors of mortality. RESULTS We identified 906 children with a mean (SD) crude incidence rate of 2.4 (0.6) per 100 000 for pediatric HMV approvals that increased by 37% over the 14-year study period. Compared with children who were invasively ventilated, we found mortality was associated with noninvasive ventilation (adjusted hazard ratio aHR, 1.9; 95% confidence interval CI, 1.3–2.8). Mortality was highest in children from families in the lowest income quintile (aHR, 2.5; 95% CI, 1.5–4.0), those with neurologic impairment complex chronic conditions (aHR, 2.9; 95% CI, 1.4–6.4), those aged 11 to 17 years at HMV initiation (aHR, 1.5; 95% CI, 1.1–2.0), and those with higher health care costs in the 1 year before HMV initiation (aHR, 1.5; 95% CI, 1.3–1.7). CONCLUSIONS The incidence of children receiving HMV increased substantially over the 14-year period. Demographic variables associated with increased mortality were identified, suggesting areas requiring greater attention for care providers.