Transition From an Acute Care Ventilator to a Home Ventilator in Children Post-Protocol Initiation

Abstract

Background:

Transitioning to a home ventilator can present many challenges and may not always be accomplished initially. A previous study of changing to a home ventilator for long term ventilation revealed several attempts in some cases before successful transition was achieved.1 As a result, a protocol was developed to standardize the process for trialing the home ventilator in efforts to reduce the number of failed transitions which may impact length of stay (LOS). The protocol includes a readiness assessment, stepwise approach for transition to the home ventilator and criteria for unsuccessful transition and return to the acute care ventilator.

Methods:

This study was approved by the local Institutional Review Board. A retrospective analysis was conducted to evaluate transition from an acute care to a home ventilator following protocol initiation. Medical records were reviewed for children with a tracheostomy requiring ventilation who were changed to a home ventilator after the protocol was implemented. Age, diagnosis, ventilator settings, LOS and number of transition attempts to a home ventilator were reviewed.

Results:

A total of 27 ventilator dependent patients with chronic respiratory failure were included in the study. The mean age at the time of the initial home ventilator trial was 14 months. The majority, 78%, were preterm infants with bronchopulmonary dysplasia. Following initiation of the protocol, 52% were successful on the first attempt to transition to a home care ventilator while 33% required a second attempt. In 15%, a third or fourth trial was necessary before transition was successful. The maximum number of attempts was 4 and the mean was 1.8. Mean LOS was 9.1 months. Prior to the protocol, the mean number of attempts was 3.8, 18% were successful on the first trial with a home ventilator, and the mean LOS was 14.5 months.1

Conclusions:

Children requiring long-term ventilation have complex medical needs. Many factors including disease process and social determinants can impact the transition from an acute care to a home ventilator. A protocol to establish readiness to transition and standardize the approach to transition from an acute care to a home ventilator may assist in decreasing the number of attempts to change devices and reduce LOS.

1. Lowe G, Cockerham J, Willis R, Carroll J, Agarwal, A. Transitioning Chronically Ventilated Pediatric Subjects from the Servo-i to a Home Care Ventilator. Respir Care 2015;60(10):OF40.