EXPERIENCES WITH HOME MECHANICAL VENTILAT ION IN CHILDREN

Background: The introduction of portable ventilators independent of co mpressed air as well as non-invasive devices for assessment of blood g ases, helped to facilitate a long-term mechanical ventilation in famil y environment in the last decade. Home care is of particular interest at the infant age, as the disruption of the mother-child relationship may induce severe developmental disorders, known as syndrome of psycho social deprivation. Patients and Methods: We investigated retrospectiv ely the tendency of the ventilator parameters, the support and the dai ly practice of 16 families with children of all ages with long-term ve ntilator assistance. Results: The duration of the ventilation ranged b etween 5 months and 14 years, on the average at 5.5 years. The average portion of the ventilation at home care was 78%. The respiratory patt erns, tidal volume and positive inspiration pressure, exceeded occasio nally the physiologic standard of the age group. The common reason is, that the children prefer small sized tubes, having advantages in comf ort and speech abilities. Therefore results an increased tube-resistan ce and air leackage of the tracheostomy tubes. The long-term tendency of the ventilator parameters is stable or improving, excluding the pat ients with progredient primary diseases. Commonly the motivation of th e family members is high, therefore the psychosocial integration of th e patients satisfying. Two thirds of the families have no personal sup port for the domiciliary care of the ventilator assisted child. Mother s tell about an enormous distress. Conclusions: The long-term mechanic al ventilation of children at home care is an adequate therapy for all ages. It combines technical support of the underlying chronic respira tory failure with the chance of an intact psychosocial development of the child. Specialized centres and a national organisation may provide competent information and support for the increasing number of home-v entilated children in Germany.