Safety of a 4‐Week Pediatric Home Mechanical Ventilated Pathway—A Single Center's Retrospective Study
Derek Corpus, Laura Lazzarini Wo, Josephine Ellashek, Sarah Heinonen, Andrea Connelly, Sheila Kun, Sasha Singh, Lisa Barrios, Gabriel Costea, Danielle Mountan, Manvi Bansal, Roberta M. KatoABSTRACT
Background/Objective
Pediatric Home Mechanical Ventilator (HMV) Programs have supported children with chronic respiratory failure since the 1970s, yet optimal caregiver training duration remains unclear. This study evaluated the safety and effectiveness of a standardized 4‐week HMV multidisciplinary action plan (HMV MAP) by analyzing hospital length of stay (LOS) and 30‐day revisit rates.
Methods
A retrospective cohort study was conducted at a single center, including 59 children (ages 0–21) with tracheostomy and chronic home ventilator use who completed the HMV MAP training between 2016 and 2021. Data were extracted from electronic medical records. Existing home ventilator‐dependent patients re‐admitted for any reason, HMV MAP patients on palliative, hospice and/or concurrent care for home, as well as patients discharged to long‐term care facilities/subacute care facilities were excluded.
Results
Of 59 eligible patients, the most common indication for long‐term mechanical ventilation was chronic respiratory failure due to respiratory insufficiency. The HMV MAP median LOS was 37 days (IQR: 12–92). There were 30 patients who had extended LOS (eLOS HMV MAP). Of these, 21 were due to non‐respiratory causes, with 14 being medical‐related and 7 being social‐related. Among patients discharged in 4 weeks, 0% had ED visits within 48 h of discharge, 17% were readmitted within 30 days for respiratory complications and 6.9% for non‐respiratory complications; compared to 6.7%, 10% and 10% respectively for eLOS 4 W HMV MAP.
Conclusions
The HMV MAP appears safe and effective, with low early ED visits and readmission rates. Most discharge delays were due to non‐respiratory factors, suggesting the pathway may benefit from flexibility to accommodate medical and social complexities.