Background and objective: The number of children with complex physical
and developmental pathologies, including chronic respiratory
insufficiency, surviving and growing beyond early childhood continues to
rise. No study has examined the clinical pathway of children on invasive
LTMV in an Irish setting. Our data over a 10-year period was reviewed to
see if our demographics and outcomes are in line with global trends.
Methods: Children’s Health Ireland (CHI) at Crumlin, Dublin is Ireland’s
largest tertiary paediatric hospital. A retrospective review analysed
data from children in our centre commenced on LTMV via a tracheostomy
over 10 years (2009 – 2018). This data was subdivided into two epochs
for statistical analysis of longitudinal trends. Results: Forty-six
children were commenced on LTMV from 2009 to 2018. Many had complex
medical diagnoses with associated co-morbidities. Far less children,
30.4% (n=14) commenced on LTMV in the latter half of the 10-year
period, they also fared better in all aspects of their treatment course.
Focusing solely on children who have needed LTMV over this timeframe has
enabled us to isolate trends specific to this cohort. Less patients
commenced LTMV on a year on year basis, and for those that require
tracheostomy and LTMV, their journey to decannulation tends to be
shorter. Conclusion: Over the period reviewed, less patients over time
necessitated long-term invasive therapy and those patients are being
weaned and decannulated with ever more success. This has implications in
terms of predicting numbers transitioning to adult services and
allocation of hospital and community care resources.