Characteristics of Pediatric Patients With Home Mechanical Ventilation in a Japanese Regional Core Hospital.

BACKGROUND: Pediatric home mechanical ventilation (HMV) use has risen globally, driven by advances in pediatric critical care and a shift toward community-based management. However, long-term outcome data from Japanese regional core hospitals remain limited. METHODS: We conducted a single-center retrospective cohort study of all patients between 1995 and 2024 aged ≤ 20 years for whom there was initiation of HMV (n = 37). HMV included invasive mechanical ventilation (tracheostomy positive-pressure ventilation) and/or noninvasive ventilation. Cumulative survival after HMV initiation was estimated using the Kaplan-Meier method and compared using log-rank tests according to age at initiation (≤ 7 vs. > 7 years), ventilation modality (invasive mechanical ventilation vs. noninvasive ventilation), predominant pathophysiological indication (respiratory pump insufficiency [Pump], airway disease [Airway], or restrictive lung mechanics [Restrictive]), and presence of severe motor and intellectual disabilities (SMID). RESULTS: The Kaplan-Meier-estimated cumulative survival was 69.1% (maximum follow-up, 29.1 years). In our cohort, survival did not significantly differ by age at initiation or ventilation modality. In contrast, it was significantly lower in patients with restrictive lung mechanics and lower in those with SMID. Among the eight deaths, cardiac disease was common, and death was seen to be clustered in the winter months; it often followed respiratory infections, and it was associated with notable growth impairment. CONCLUSIONS: Our results suggest that children receiving HMV can achieve long-term survival. Nevertheless, high-risk groups, particularly those with restrictive lung mechanics or SMID, warrant risk-stratified care, proactive prevention of winter infection, and timely advance care planning.