An Economic Approach for Children with Chronic Ventilation Support

Preutthipan, Aroonwan; Nugboon, Malinee; Chaisupamongkollarp, Thitida; Kuptanon, Teeradej; Kamalaporn, Harutai; Leejakpai, Anchalee

doi:10.1007/s40124-013-0038-0

Cited by 12 publications

(27 citation statements)

References 45 publications

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“…As compared to adults with chronic obstructive pulmonary disease (COPD), better outcomes have been reported in children especially those with reversible underlying diseases such as bronchopulmonary dysplasia and tracheobronchomalacia [2,13]. More than half of the children suffering from severe bronchopulmonary dysplasia were liberated from positive pressure ventilation and decannulated before their sixth birthday [13].…”

Section: Special Considerations In Childrenmentioning

confidence: 99%

“…Neuromuscular disorders have been listed in the majority of reports as the first or second most common diagnostic categories in pediatric population [2,[19][20][21][22]. It should be noted that a number of children have had multiple problems and disabilities such as cardiac diseases, seizure disorders, endocrine disorders and so on.…”

Section: Candidates For Home Mechanical Ventilationmentioning

confidence: 99%

“…The parental responsibility was found to be highly stressful and sometimes overwhelming [41]. However, the success in training the parents and family members as caregivers has been reported in many studies [2,[42][43][44].…”

Section: Discharge Planningmentioning

confidence: 99%

“…Among 53 children sent home with invasive home mechanical ventilation, 35 (66 %) of primary caregivers were parents, 9 (17 %) were relatives, 9 (17 %) were nursery maids. All of them were non-medical professionals [2]. One advantage in Thai society is the extended family setting in which two or three generations live together in the same house.…”

Section: Discharge Planningmentioning

confidence: 99%

“…The number of children dependent on home mechanical ventilation has been reported to be increasing in many countries around the world [1][2][3][4][5][6]. This growing trend could be explained by a variety of reasons.…”

Section: Introductionmentioning

confidence: 99%

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Home Mechanical Ventilation in Children

Preutthipan

2015

Indian J Pediatr

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The number of children dependent on home mechanical ventilation has been reported to be increasing in many countries around the world. Home mechanical ventilation has been well accepted as a standard treatment of children with chronic respiratory failure. Some children may need mechanical ventilation as a lifelong therapy. To send mechanically ventilated children back home may be more difficult than adults. However, relatively better outcomes have been demonstrated in children. Children could be safely ventilated at home if they are selected and managed properly. Conditions requiring home ventilation include increased respiratory load from airway or lung pathologies, ventilatory muscle weakness and failure of neurologic control of ventilation. Home mechanical ventilation should be considered when the patient develops progressive respiratory failure or intractable failure to wean mechanical ventilation. Polysomnography or overnight pulse oximetry plus capnometry are used to detect nocturnal hypoventilation in early stage of respiratory failure. Ventilator strategy including non-invasive and invasive approach should be individualized for each patient. The author strongly believes that parents and family members are able to take care of their child at home if they are trained and educated effectively. A good team work with dedicated members is the key factor of success.

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Section: Special Considerations In Childrenmentioning

confidence: 99%

Section: Candidates For Home Mechanical Ventilationmentioning

confidence: 99%

Section: Discharge Planningmentioning

confidence: 99%

Section: Discharge Planningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Home Mechanical Ventilation in Children

Preutthipan

2015

Indian J Pediatr

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Utility of polysomnography for management of chronic invasive mechanical ventilation in children

Gurbani

Benscoter

Silva

et al. 2021

Pediatric Pulmonology

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Objective With advances in technology, pediatric patients are sent home with chronic invasive mechanical ventilation (CIMV). Ventilation optimization and preparation for weaning are essential processes, however, there is no standard approach to weaning and titrating ventilator settings in children. There is little information in the literature on the utility of polysomnography (PSG) in weaning and titration of CIMV. Our objective is to review the role of PSG on titration and weaning of CIMV in children. Methods A retrospective review of medical records and polysomnograms was performed on CIMV dependent patients at Cincinnati Children's Hospital Medical Center from January 2011 to October 2017. Patients underwent overnight ventilator weaning or titration PSG. Subjects with less than 3 h of total sleep time were excluded. Results About 163 PSGs were divided into 97 PSGs for ventilator titration and 66 PSGs for ventilator weaning. Of the 97 ventilator titration PSGs, 59 (60.8%) had inadequate ventilation, 10 (10.3%) had inadequate oxygenation, 22 (22.7%) had significant tracheostomy leak, 13 (13.4%) had autocycling, 3 (3.1%) had failure to trigger, 4 (4.1%) had central sleep apnea, and 24 (25.8%) had adequate ventilation on current ventilator settings. Of the 66 ventilator weaning PSGs, 48 (72.7%) weaned to lower ventilator settings or off ventilator support and 18 (27.3%) did not wean. Discussion Our results indicate that PSG is useful in titration and weaning of ventilator settings in children with CIMV. Larger studies are needed to evaluate the subgroup of this population who would benefit most from PSG for assessment of adequate ventilator support.

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Monitoring of physiologic features and treatment aspects of children on home invasive mechanical ventilation

Chawla,

Tan

2024

Pediatric Pulmonology

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Pediatric home invasive mechanical ventilation patients are a small but resource‐intensive cohort, requiring close monitoring and multidisciplinary care. Patients are often dependent on their ventilator for life support, with any significant complications such as equipment failure, tracheostomy blockage, or accidental decannulation becoming potentially life‐threatening if not identified quickly. This review discusses the indications and variations in practice worldwide, in terms of models of care, including home care provision, choice of equipment, and monitoring. With advances in technology, optimal monitoring strategies for home, continue to be debated: In‐built ventilator alarms are often inadequately sensitive for pediatric patients, necessitating additional external monitoring devices to minimize risk. Pulse oximetry has been the preferred monitoring modality at home, though in some special circumstances such as congenital central hypoventilation syndrome, home carbon dioxide monitoring may be important to consider. Children should be under regular follow‐up at specialist respiratory centers where clinical evaluation, nocturnal oximetry, and capnography monitoring and/or poly(somno)graphy and analysis of ventilator download data can be performed regularly to monitor progress. Recent exciting advances in technology, particularly in telemonitoring, which have potential to hugely benefit this complex group of patients are also discussed.

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An Economic Approach for Children with Chronic Ventilation Support

Cited by 12 publications

References 45 publications

Home Mechanical Ventilation in Children

Home Mechanical Ventilation in Children

Utility of polysomnography for management of chronic invasive mechanical ventilation in children

Monitoring of physiologic features and treatment aspects of children on home invasive mechanical ventilation

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