Home mechanical ventilation in children: indications and practical aspects.

An increase in the number of paediatric patients dependent on long-term or home mechanical ventilation has led to growing interest in this topic. Primary care physicians are becoming increasingly involved in teamwork with paediatric intensivists and pulmonologists in the care of such children. There are many causes of chronic respiratory failure and different options for provision of ventilatory support at home. Awareness of the possibilities of long-term ventilation is essential in organising discussion of these therapeutic modalities with chronically ill children and their parents prior to any respiratory compromise precluding an elective decision. Home ventilation offers the best option for these children's psychosocial development, social integration and quality of life. Many ventilator-dependent children can attend school. The main problems of paediatric home ventilation are its negative psychosocial impact on family life, limited home care resources, the financial burden, differences in ethical perception by the local community and the fact that the equipment is usually designed for adults. Unfortunately, only scant data are available on the number of home-ventilated children in Switzerland. The creation of a patient organisation dedicated to support of families with ventilator- or technology-dependent children may be helpful in mastering some of these problems.