Home ventilation in children with chronic respiratory failure: a clinical trial

Abstract

Recently home assisted ventilation care (HAV) in children with chronic respiratory insufficiency has been developed. To report our experience about children discharged with HAV and their follow-up. Patients and methods: We reviewed the clinical notes of 15 children (9 girls) who were discharged from the Paedriatric Service of the Chilean Catholic University between january 1993 and december 2000. Patients: were aged between 5 months and 15 years, 6 had neuromuscular disease, 4 chronic lung disease, 1 thoracic deformity and 4 had severe tracheobronchomalacia. 12 required tracheostomy, mechanical ventilation was used in 4 cases (PLV-102, Lifecare), in 8 CPAP and Downs flow generator with PEEP valve, and in 3 BiPAP. The decision to use HAV was decided 2-4 months after admission, depending on the child's condition, and was accomplished 1-4 months later, taking into account the family situation and health insurance status. Follow-up ranged from 3 months to 8 years. The hospitalization rate was 2.5 and 0.4 admissions/patient/year for morbidity and system failure respectively, with a hospitalization period of 16.5 + 9 days/year. Weaning of the ventilatory system was achieved in 5 patients and 1 died due to a progressive neurological disorder. In summary our experience of home care for the ventilator dependent child supports the use of HAV as a therapeutic alternative. It has few complications and can save significant medical costs.