Indian Journal of Sleep Medicine

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VOLUME 15 , ISSUE 3 ( July-September, 2020 ) > List of Articles

RESEARCH ARTICLE

Home Mechanical Ventilation in Children: A 7-year Experience

Ilin Kinimi, Supriya S Shinde, Neha M Rao

Keywords : Bilevel positive airway pressure, Continuous positive airway pressure, Chronic respiratory failure, Home mechanical ventilation

Citation Information : Kinimi I, Shinde SS, Rao NM. Home Mechanical Ventilation in Children: A 7-year Experience. Indian Sleep Med 2020; 15 (3):46-50.

DOI: 10.5005/jp-journals-10069-0058

License: CC BY-NC 4.0

Published Online: 22-10-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims and objectives: To review the profile of children requiring home mechanical ventilation (HMV), the diagnoses, modes of presentation, age at initiating HMV, and outcome of these children on follow-up. Materials and methods: This is a retrospective observational study. We included all children up to 18 years of age who were started on HMV between May 2013 to April 2020 at our hospital. Source of data was the hospital records of children receiving HMV. Clinical data were captured on Excel sheet and analyzed. Results: Fifty-seven children were started on HMV with a mean age of 6.43 years (range of 3 months to 17 years 8 months) at start of HMV; 35 (61.4%) were male and 22 (38.6%) were female. Fifteen (17.5%) of 57 presented with acute respiratory failure, and 42 (73.6%) of 57 with chronic respiratory failure. Thirty-nine (68.4%) of 57 had an established diagnosis of a neuromuscular disease (NMD) of 22 (56.41%) of 39 had an underlying diagnosis of spinal muscular atrophy 2 (SMA type II) which was also the most common diagnosis in this study. Average age at initiating ventilation in the neuromuscular group was 7.92 years (range: 4 months–17 years 8 months) and the other non-NMD group was 2.91years (range: 3 months–15 years). Seven children were on invasive tracheostomy and 50 on noninvasive ventilation (NIV). Fifty-six children were started on BiPAP, and one child is on CPAP. Two children have been weaned of HMV and are doing well. There were three episodes of life-threatening complications in three different children, and the annual rate of hospitalization with respiratory morbidity was 0.36 per child. There has been no mortality in this study period. Conclusion: Home mechanical ventilation improves the life expectancy and enhances the quality of care and survival. Under the appropriate clinical scenarios, HMV significantly reduces the economic, psychosocial burden on the family and improves quality of life for the child. Transition to home care is challenging, especially in developing countries with lack of nursing care/home care support, but is feasible with meticulous planning wherein parents or caregivers are the key partners. To the authors knowledge, this is the largest case series of children on HMV from India.


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