Outcomes and Causes of Death in Children on Home Mechanical Ventilation via Tracheostomy: An Institutional and Literature Review - 07/03/14
, Sheila S. Kun, RN, MS b, Thomas G. Keens, MD, FCCP, FAAP b
Reprint requests: Jeffrey Edwards, MD, Division of Pediatric Critical Care, University of California, San Francisco, Moffitt Hospital, Box 0106, 505 Parnassus Ave, San Francisco, CA 94143-0106.Abstract |
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.
Le texte complet de cet article est disponible en PDF.Mots-clés : CHS, CHLA, CI, CPD, CRF, HR, HMV, PPV, VMW
Plan
| Supported by the Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles. The authors declare no conflicts of interest. |
Vol 157 - N° 6
P. 955 - décembre 2010 Retour au numéro
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