Outcomes and causes of death in children on home mechanical ventilation via tracheostomy: an institutional and literature review

J Pediatr. 2010 Dec;157(6):955-959.e2. doi: 10.1016/j.jpeds.2010.06.012. Epub 2010 Aug 14.


Objective: To describe outcomes and causes of death in children on chronic positive-pressure ventilation via tracheostomy.

Study design: We conducted a retrospective observational cohort analysis of 228 children enrolled in an university-affiliated home mechanical ventilation (HMV) program over 22 years (990 person-years). Cumulative incidences of survival and liberation from HMV are presented. Time-to-events were compared by reason for chronic respiratory failure (CRF) and age and date of HMV initiation with Kaplan-Meier and Cox regression analyses. Circumstances of death are described.

Results: Of our cohort, 47 of 228 children died, and 41 children were liberated from HMV. The 5-year cumulative incidences of survival and liberation were 80% and 24%, respectively. Being placed on HMV for chronic pulmonary disease was independently associated with liberation from HMV (hazard ratio, 7.38; 95% CI, 3.0-18.2; P < .001). Neither age nor reasons for CRF were associated with shortened survival. Progression of underlying condition accounted for only 34% of deaths; 49% of deaths were unexpected.

Conclusion: Most children on HMV survive or were weaned off. However, a sizable number of children in our cohort died, and many deaths were unexpected and from causes not directly related to their primary reason for CRF.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cause of Death
  • Child
  • Child, Preschool
  • Cohort Studies
  • Home Care Services, Hospital-Based*
  • Humans
  • Infant
  • Positive-Pressure Respiration*
  • Retrospective Studies
  • Tracheostomy*
  • Treatment Outcome