Paediatric Invasive Ventilation at Home. Clinical Outcomes, Progression and Survival

Abstract

Introduction: Home invasive mechanical ventilation (HIMV) has demonstrated clinical and economic benefits, reducing morbidity, hospitalisation times and healthcare costs. It is indicated in patients with severe chronic respiratory failure, requiring advanced technological support and teams of specialised professionals. In 2008, Chile established a programme to ensure its safe and sustainable implementation. Our objective was to describe and characterise the clinical and evolutionary aspects of children monitored at the Guillermo Grant Benavente Hospital in Concepción, Chile. 

Materials: Retrospective cohort study. Patients admitted to the HMIV programme over a period of 16 years (2010-2025). Demographic and clinical characteristics, length of stay, reason for discharge and mortality were described. Associations, survival and temporal trend were analysed using non-parametric tests, linear regression, segmented regression and Kaplan-Meier analysis.

Results: Forty-eight children were included. Age at admission was 1.4 (IQR 0.9-2.8) years; 47.9% remained active. Main diagnoses: central nervous system disease (CNS) 39.6% and cardiorespiratory disease 25.0%. Twenty-five patients (52.1%) were discharged: death (52.0%) and improvement (48.0%). Causes of death were: 5 progression of their underlying disease, 3 infectious, 3 cardiac, and 2 accidental. The length of stay in the programme was 2.9 (IQR 0.9-6.8) years. In 2016, a stabilisation in the slope of the growth curve of active patients was observed. The median survival was 9.1 years, with no difference according to cause of death (p=0.470) or diagnostic group (p=0.110). The cumulative survival rates at 1, 3, and 5 years were 93.0% (95% CI, 85. 6%-100%), 79.6% (95% CI, 67.0%-94.7%), 61.9% (95% CI, 45.8%-83.8%) and 45.9% (95% CI, 27.2%-77.3%), respectively. 

Conclusions: The most frequent cause of admission to the HIMV programme was SNC. At 5 years, 46% of patients remain on HIMV. Discharges due to improvement and death correspond to 25% and 27%, respectively, reflecting the complexity and need for prolonged follow-up.