Published online May 7, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1280-e1287 (doi:10.1542/peds.2006-2471)
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ARTICLE

Chronic Ventilator Need in the Community: A 2005 Pediatric Census of Massachusetts

Robert J. Graham, MDa, Eric W. Fleegler, MD, MPHb and Walter M. Robinson, MD, MPHc

a Division of Critical Care, Department of Anesthesiology, Perioperative, and Pain Medicine
b Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
c Division of Respiratory Medicine, Department of Pediatrics, IWK Health Centre, Dalhousie Medical School, Halifax, Nova Scotia, Canada

OBJECTIVES. The purpose of this study was to describe the population of children with chronic mechanical ventilation in Massachusetts and their patterns of medical care.

PATIENTS AND METHODS. Investigators surveyed all of the Massachusetts home ventilator clinics, pediatric pulmonary services, hospital-based pediatric services for special health care needs, insurers, home care vendors, nursing agencies, the Massachusetts Department of Public Health, selected individual providers, and rehabilitation and long-term care facilities providing services to children with chronic respiratory support needs. Support was defined as daily use of noninvasive, negative-pressure, or invasive/transtracheal ventilators. Subsequent matching of demographic data, including date of birth, zip code, and gender supported maximal census yield without duplications. Geographic information systems were used to create distribution maps and estimate distances between children with chronic mechanical ventilator needs and key resources.

RESULTS. A total of 197 children were identified as requiring chronic mechanical respiratory support in Massachusetts in 2005, which was a nearly threefold increase in this population in the 15-year interval since the last census. Congenital or perinatal-acquired neurologic or neuromuscular disorders constituted the majority of primary diagnoses (n = 107 [54%]). Chronic lung disease attributed to prematurity represented only 7% of the sample.

CONCLUSIONS. Children receiving chronic mechanical respiratory support are a growing population. The shift in underlying diagnoses from pulmonary disease to neurogenic respiratory insufficiency has implications for hospital and community-based providers from all disciplines in extending services to the home setting. Barriers encountered when performing this study, however, reflect an overall lack of coordination among the many individuals and agencies involved in their care. Coordinated and centralized care efforts require a clear and managed flow of information; census reports such as this one are only the beginning. Direct needs assessments and quality-of-life surveys from families are needed to design and implement programmatic changes and advocacy efforts.

Key Words: epidemiology • respiratory diseases • medical home • chronic disease management • disabilities

Abbreviations: CSHCN—children with special health care needs • CPAP—continuous positive airway pressure • BiPAP—biphasic positive airway pressure

Accepted Nov 17, 2006.


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