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Online ISSN 1827-1596
Racca F. 1, Bonati M. 2, Del Sorbo L. 3, Berta G. 3, Sequi M. 2, Capello E. C. 3, Wolfler A. 4, Salvo I. 4, Bignamini E. 5, Ottonello G. 6, Cutrera R. 7, Biban P. 8, Benini F. 9, Ranieri V. M. 3
1 Department of Pediatric Anesthesia and Resuscitation, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy;
2 Laboratory for Mother and Child Health, Mario Negri Pharmacological Research Institute, Milan, Italy;
3 Department of Anesthesia and Resuscitation, University of Turin, S. Giovanni Battista-Molinette University Hospital, Turin, Italy;
4 Department of Anesthesia and Resuscitation, Buzzi Hospital, Milan, Italy;
5 Unit of Pediatric Pneumology, Regina Margherita Child Hospital, Turin, Italy;
6 Department of Anesthesia and Resuscitation, Gaslini Hospital, Genoa, Italy;
7 Unito f Pediatric Pneumology, Bambino Gesù Child Hospital, Rome, Italy;
8 Unit of Neonatal and Pediatric Intensive Care, University of Verona, Ospedale Civile Maggiore, Verona, Italy; 9Pediatric Palliative Care, University of Padua, Padua, Italy
BACKGROUND.To date, few studies have been published regarding the number of children in Italy who require long-term mechanical ventilation (LTV) and their underlying diagnoses, ventilatory needs and hospital discharge rate.
METHODS: A preliminary national postal survey was conducted and identified 535 children from 57 centers. Detailed data were then obtained for 378 children from 30 centers.
RESULTS:The estimated prevalence in Italy of this population was 4.3/100000. The majority of children (72.2%) were followed in pediatric units. The primary physicians who cared for these patients were either pediatric intensivists or pediatric pulmonologists. Neurological patients (78.2% of cases) represented the principal disorder category. 57.2% of the patients were non-invasively ventilated, with a nasal mask being the most common interface (85% of cases). The presence of clinical symptoms that were associated with abnormal findings on diagnostic testing was the primary indication for ventilatory support, whereas weaning failure was the primary indication for tracheotomy. Invasive ventilation was significantly related to younger age, longer daily hours on ventilation and cerebral palsy. Ventilatory modes with guaranteed minimal tidal volume were more often used in patients with tracheotomy. Despite their age, illness severity and need for technological care, 98% of the study population were successfully home discharged.
CONCLUSION:Managing pediatric home LTV requires tremendous effort on the part of the patient’s family and places a significant strain on community financial resources. In particular, neurological patients require more health care than patients in other categories. To further improve the quality of care for these patients, it is essential to establish a dedicated national database.