Home Mechanical Ventilation: An Emerging Necessity in the Pediatric Patient with Complex Chronic Conditions

Introduction: Home mechanical ventilation (HMV) is an emerging necessity for children with complex chronic conditions (CCC). The aim of our study was to record all PICU patients that were discharged with HMV.

Methods: Retrospective study of PICU patients discharged with HMV from 5/2011 to 3/2019. Data recorded: Demographics, interfaces, ventilator components, O₂ needs, mode and settings of HMV, and the outcome.

Results: 28 children (11M/17F), median (IQR) age of 18(8.25-72)mo, BW 9(5.6-13)kg, ideal BW 11(8.6-20)kg, were discharged on HMV due to epileptic encephalopathy (11), neuromuscular diseases (13), and congenital syndrome diseases (4). The majority (23) was put on Invasive pressure/volume MV (IMV) through tracheostomy, while 5 were on mask NIV (BIPAP). All IMV patients were connected through a bellow connector and all but one used single circuit with active hydration. Main IMV mode: SIMV-PS (19), assist (2), and PS (2). Main IMV settings: Vt as ml/ideal BW 9.16(7.5-10.43), RR 20(11-22), PEEP 6(5-6), Ti 0.8(0.8-1.2), PS 12(10-14), Trigger 1.25(0.5-1.87)L/min, Flow squared(11)/decelerating(12), aimed at satisfactory lung expansion (9^th rib), and normal/proper ABG. Alarms were set appropriately. All patients were discarded on oxygen and at a follow up time of 31.5(12-47)mo, they remained in a stable condition. All families were supported by a national Home Care system.

Conclusions: Pressure/volume compressors with single circuit and hydration were overwhelmingly used, in accordance to recent guidelines on HMV for children. Pediatric patients with CCC were underweighted, and the use of ideal BW coupling with the increased VD due to connector should be taken into account for the appropriate setting of VT. Proper alarm settings contribute to better patient safety and family satisfaction.