Risk factors for first nonscheduled hospital admissions of pediatric patients on home mechanical ventilation.

OBJECTIVES The number of children on home mechanical ventilation (HMV) has increased. Understanding the reasons for nonscheduled hospital admissions during HMV is critical. This study aims to investigate the risk factors of first nonscheduled hospital admissions of pediatric patients on HMV. METHODS A retrospective analysis of patients on HMV between May 1, 2014 and October 1, 2020 was performed. Patients' demographic characteristics, duration of the education of the primary caregiver; time of first nonscheduled visit; and type of HMV (noninvasive mechanical ventilation [NIV] or invasive mechanical ventilation [IMV]) were analyzed. The reasons for first nonscheduled hospital visits were categorized as respiratory problems and other reasons. RESULTS Of 97 patients, 41 were female (42.3%), and 70 (72%) were on IMV. The median age was 23 months (IQR, 10-91). Twenty-nine patients (30%), were admitted to hospital before scheduled visit with a mean duration of 18.1 ± 11.6 days; of them, 14 (48.2%) admitted because of respiratory problems. IMV increases the risk of first nonscheduled visit compared to NIV (OR, 16.3; 95% CI, 2.1-127.4; p = .008). If a caregiver spends less than 14 days in hospital for education, risk of nonscheduled visits increases (OR, 4.0; 95% CI, 1.5-11.2; p = .007). CONCLUSION A minimum 14 days seems to be necessary for education of the caregivers of the patients with HMV to reduce the number of nonscheduled visits, which is a burden for both patients and healthcare system.