Abstract
BACKGROUND: The transition from an ICU ventilator to a portable home ventilator (PHV) for children requiring long-term mechanical ventilation is a crucial step in preparing for discharge home and may not be successful on the first attempt. A review of this process at our institution revealed that some children required multiple trials before they were able to tolerate a PHV. A protocol was developed to standardize the transition process and reduce the number of failed attempts. Key features of the protocol included a transition readiness assessment and criteria for changing to the PHV.
METHODS: A retrospective chart review was completed to evaluate the process of changing to a PHV before and after the protocol was in place during the time period of 2011–2018. Primary outcome measures included the number of transition attempts and the length of time to achieve successful transition. A successful transition attempt was defined as the ability to tolerate a PHV for 14 d.
RESULTS: The study included 56 children ≤ 3 y old with a tracheostomy who required long-term ventilator support. The majority of subjects were from the neonatal ICU and had a diagnosis of bronchopulmonary dysplasia. There was a significant decrease in the number of attempts (P = .005) and in the length of time (P = .01) to successfully transition to a PHV for those who underwent the protocol.
CONCLUSIONS: The process of changing from an ICU ventilator to a PHV in children requiring long-term mechanical ventilation was improved through the use of a standardized protocol. Both the number of failed attempts and the length of time to achieve successful transition were reduced when the protocol was applied. Further study is needed to evaluate other medical and nonmedical factors that may affect successful transition to a PHV.
- ventilator-dependent children
- long-term mechanical ventilation
- portable home ventilator
- pediatric ventilation
- home mechanical ventilation
- pediatric tracheostomy
- transition to home ventilator
- bronchopulmonary dysplasia
- chronic respiratory failure
- discharge planning
Footnotes
- Correspondence: Amit Agarwal MD. E-mail: AgarwalAmit{at}uams.edu
See the Related Editorial on Page 1933
Ms Willis presented a version of this paper at the AARC Congress 2018, held December 4–7, 2018, in Las Vegas, Nevada.
The authors have disclosed no conflicts of interests.
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