Risk Factors for Morbidity and Mortality in Pediatric Home Mechanical Ventilation

BACKGROUND: Home mechanical ventilation (HMV) is increasingly used in children with chronic respiratory insufficiency, but data on incidence and type of adverse events are limited. SETTING: Pediatric HMV program at a tertiary university hospital. METHODS: The authors retrospectively analyzed the type and incidence of severe emergencies in a mixed pediatric HMV program. RESULTS: In all, 295 patient-years of HMV in 54 patients could be analyzed. A total of 26 patients had neuromuscular disease. In 16 patients, mechanical ventilation was initiated at <1 year of age. A total of 45 children were ventilated via tracheostomy and 9 by nasal mask. This study identified 68 severe emergencies (0.2 per patient-year) leading to 4 deaths. Respiratory causes were found in 48 cases (including 15 tracheostomy-related and 3 ventilator failures). Only age, but not underlying diagnosis or mode of ventilation, correlated with incidence of emergencies. CONCLUSIONS: Pediatric HMV including all age and diagnostic groups shows a low incidence of emergencies.