Home Care NetWork
Home Care Literature Review: January– June 2006
Pediatric Respiratory Disease:
Edwards EA, Hsiao K, Nixon GM. Paediatric home ventilatory support: the Auckland experience. J Paediatr Child Health 2005; 41:652-658
This retrospective case series from New Zealand reviewed the diagnoses and outcomes of children treated at home with continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), and ventilation via tracheostomy (invasive ventilatory support, IVS) by the respiratory service of a large children's hospital from November 1991 to February 2004. Home CPAP, NIV, or IVS was initiated in 160 children (89 boys, median age 6 years) with 69 patients (46 boys) remaining on support and actively managed by the service. The majority received treatment by noninvasive mask interface (68% (n = 108) CPAP, 29% (n = 47) NIV), with only 3% (n = 5) supported via tracheostomy. Eleven percent of patients failed institution of support, and support was discontinued in 57% of cases, after a median of 12.5 months (range 3 to52 months); in two thirds, support was no longer required due to an improvement in the medical condition. The most common indication for support in current patients was respiratory parenchymal or airway disease followed by neuromuscular disease. This article provides an overview of a well-organized team's approach to respiratory support in the home in the pediatric population. It’s interesting to note that 46% of these children lived outside of the metropolitan area.
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