Chest
Special ReportsObstacles to Discharge of Ventilator-Assisted Children From the Hospital to Home
Section snippets
METHODS
We reviewed the charts of 54 infants and children who were discharged to the home from Childrens Hospital Los Angeles still requiring mechanical assisted ventilation full time or part time. For all children, only the initial hospital discharge on a regimen of home mechanical ventilation was evaluated. This initial hospitalization was defined as the time interval when the diagnosis of chronic respiratory failure was made and the decision to use home mechanical ventilation was made, ventilator
RESULTS
Medical records were available for review on 54 infants and children who were initially discharged on a regimen of home mechanical ventilation between November 1977 and July 1991. Thirty-four were male and 20 were female. The mean age at the time of hospital discharge was 4.6 ± 5.9 years (range, 5 months to 21 years). Eighteen children (33 percent) required assisted ventilation 16 to 24 h/d. Twenty-three children (43 percent) required 8 to 16 h/d, and 13 (24 percent) required assisted
DISCUSSION
This study shows that ventilator-assisted children often remain hospitalized for prolonged periods of time after they were medically stable, and otherwise ready for discharge, for nonmedical reasons. The mean length of this initial hospitalization was nearly 6 months and lasted over 2 years in at least 1 patient. It took only 1 to 2 months to achieve medical stability. Thus, nearly three quarters of the length of this initial hospitalization occurred after the children were medically stable and
ACKNOWLEDGMENTS
The authors wish to thank Marie Anne Legaspi for invaluable assistance with data collection; Mukul Gupta for expert assistance with analysis; and Cheryl D. Lew, M.D., C. Michael Bowman, Ph.D., M.D., and Arnold C. G. Platzker, M.D., for graciously allowing us to study their patients.
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This research was supported, in part, by grants from the Ventilatory Control Disorders Research Fund of the Division of Neonatology and Pediatric Pulmonology, Childrens Hospital Los Angeles, e Ruth and Vernon Taylor Foundation.