Ventilação mecânica invasiva domiciliar: a experiência de 10 anos de um serviço de atenção domiciliar pediátrico

Abstract

Background:Demographic, epidemiological, social and cultural changes, in addition to the concern with the increase in public spending and the quality of life of chronic patients dependent on invasive mechanical ventilation (IMV), both in Brazil and worldwide, has driven the demand for a new assistance model. In this scenario, home care presents itself as an alternative for the reorganization of health systems. However, there is still a shortage of protocols and publications related to the subject and therefore it is essential to know the epidemiological profile of this population, to identify the main predictors of outcomes for implementation and continuity of care for patients who require high complexity home care short, medium and long term. Therefore, the objective of this study was to evaluate the de - hospitalization of pediatric patients under IMV in the Home Care Service (SAD) of the Hospital of Clinics of Uberlândia of the Federal University of Uberlândia (HCU-UFU) over a ten year period and to compare the predictors of outcome. Methods:All medical records of pediatric patients in IMV of SAD/HCU-UFU between 2007 and 2016 were evaluated. Patients' records were requested in the filesystem and, later, data were collected regarding age, gender, diagnosis, hospitalization and home care periods, number of readmissions, period of readmissions, number of procedures and outcome. For statistical analysis we used the descriptive analysis, as mean and standard deviation, absolute frequency and percentage. The Odds Ratio was used to understand the chances of death for each diagnosis. For all analyzes, the significance level of 5% was adopted. Results: The medical records of 27 pediatric patients were evaluated. The most prevalent diagnosis was cerebral palsy (37.0%). The home care total mean of stay time (955 ±4.62 days) was higher than the hospital total mean of stay time (341 ±0.49 days). The de-hospitalization of these 27 patients, over 10 years, might have allow for 2,150 new hospitalizations. The main cause of rehospitalization was respiratory tract infections (45.9%), among which tracheitis. Of the total number of deaths (13 patients), 76.9% occurred in a hospital unit and 23.1% at home. We observed that patients who were readmitted for less than 6 months after discharge were 9.9 times more likely to die than those who were readmitted after that period or those who did not require rehospitalization (p = 0.016). Conclusion:Home hospitalization of pediatric patients dependent on IMV is a viable alternative for the release of hospital beds of high complexity. The first rehospitalization with less than six months of home hospitalization proved to be a risk factor for death. These results, added to the frequency of tracheitis, reveal the importance of the caregiver training and the continuity of follow-up at home for maintenance and improvement of the home care service.