Outcomes and Causes of Death in Children on Home Mechanical Ventilation via Tracheostomy: An Institutional and Literature Review

被引:119
作者
Edwards, Jeffrey D. [1 ]
Kun, Sheila S. [2 ]
Keens, Thomas G. [2 ]
机构
[1] Univ Calif San Francisco, Div Pediat Crit Care, Dept Pediat, San Francisco, CA 94143 USA
[2] Childrens Hosp Los Angeles, Div Pediat Pulmonol, Dept Pediat, Los Angeles, CA 90027 USA
关键词
CHRONIC RESPIRATORY-FAILURE; TERM-FOLLOW-UP; DEPENDENT CHILDREN; CARE; INFANTS; CHILDHOOD; COMMUNITY; OXYGEN;
D O I
10.1016/j.jpeds.2010.06.012
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective To describe outcomes and causes of death in children on chronic positive-pressure ventilation via tracheostomy. Study design We conducted a retrospective observational cohort analysis of 228 children enrolled in an university-affiliated home mechanical ventilation (HMV) program over 22 years (990 person-years). Cumulative incidences of survival and liberation from HMV are presented. Time-to-events were compared by reason for chronic respiratory failure (CRF) and age and date of HMV initiation with Kaplan-Meier and Cox regression analyses. Circumstances of death are described. Results Of our cohort, 47 of 228 children died, and 41 children were liberated from HMV. The 5-year cumulative incidences of survival and liberation were 80% and 24%, respectively. Being placed on HMV for chronic pulmonary disease was independently associated with liberation from HMV (hazard ratio, 7.38; 95% CI, 3.0-18.2; P < .001). Neither age nor reasons for CRF were associated with shortened survival. Progression of underlying condition accounted for only 34% of deaths; 49% of deaths were unexpected. Conclusion Most children on HMV survive or were weaned off. However, a sizable number of children in our cohort died, and many deaths were unexpected and from causes not directly related to their primary reason for CRF. (J Pediatr 2010;157:955-9).
引用
收藏
页码:955 / U140
页数:7
相关论文
共 28 条
[11]   The population prevalence of children receiving invasive home ventilation in Utah [J].
Gowans, Melissa ;
Keenan, Heather T. ;
Bratton, Susan L. .
PEDIATRIC PULMONOLOGY, 2007, 42 (03) :231-236
[12]   Chronic ventilator need in the community: A 2005 pediatric census of Massachusetts [J].
Graham, Robert J. ;
Fleegler, Eric W. ;
Robinson, Walter M. .
PEDIATRICS, 2007, 119 (06) :E1280-E1287
[13]   LONG-TERM MECHANICAL VENTILATION IN INFANTS WITH NEUROMUSCULAR DISEASE [J].
IANNACCONE, ST ;
GUILFOILE, T .
JOURNAL OF CHILD NEUROLOGY, 1988, 3 (01) :30-32
[14]   Oxygen and ventilator weaning during inpatient pediatric pulmonary rehabilitation [J].
Kharasch, VS ;
Haley, SM ;
Dumas, HM ;
Ludlow, LH ;
O'Brien, JE .
PEDIATRIC PULMONOLOGY, 2003, 35 (04) :280-287
[15]   Report of a Consensus Conference of the American College of Chest Physicians [J].
Make, BJ ;
Hill, NS ;
Goldberg, AI ;
Bach, JR ;
Criner, GJ ;
Dunne, PE ;
Gilmartin, ME ;
Heffner, JE ;
Kacmarek, R ;
Keens, TG ;
McInturff, S ;
O'Donohue, WJ ;
Oppenheimer, EA ;
Robert, D .
CHEST, 1998, 113 (05) :289S-344S
[16]  
MALLORY GB, 1991, ARCH PHYS MED REHAB, V72, P43
[17]   MEDICAL AND PSYCHOSOCIAL OUTCOME OF CHILDREN WITH CONGENITAL CENTRAL HYPOVENTILATION SYNDROME [J].
MARCUS, CL ;
JANSEN, MT ;
POULSEN, MK ;
KEENS, SE ;
NIELD, TA ;
LIPSKER, LE ;
KEENS, TG .
JOURNAL OF PEDIATRICS, 1991, 119 (06) :888-895
[18]  
Nelson VS, 2004, J SPINAL CORD MED, V27, pS93
[19]   Ventilator weaning outcomes in chronic respiratory failure in children [J].
O'Brien, Jane E. ;
Dumas, Helene M. ;
Haley, Stephen M. ;
Ladenheim, Barbara ;
Mast, Joelle ;
Burke, Sharon A. ;
Birnkrant, David J. ;
Whitford, Kathleen ;
Palazzo, Regina ;
Neufeld, Jacob A. ;
Kharasch, Virginia S. .
INTERNATIONAL JOURNAL OF REHABILITATION RESEARCH, 2007, 30 (02) :171-174
[20]   Clinical findings and resource use of infants and toddlers dependent on oxygen and ventilators [J].
O'Brien, JE ;
Dumas, HM ;
Haley, SM ;
O'Neil, ME ;
Renn, M ;
Bartolacci, TE ;
Kharasch, V .
CLINICAL PEDIATRICS, 2002, 41 (03) :155-162