Causes and management of urinary system problems in children on long‐term home invasive mechanical ventilation

Abstract

Many ventilator‐dependent children have comorbid conditions including urinary tract disorders. We aimed to present a focused review of the literature describing the causes and management of urinary system problems in children with long‐term home mechanical ventilation. We performed a literature search in PubMed/MEDLINE, Scopus, and Web of Science with keywords “children,” “home mechanical ventilation,” “urinary system,” “urinary tract,” “neurogenic bladder,” “clean intermittent catheterization,” “urinary tract infection,” “urolithiasis,” and “acute kidney injury.” We included original articles, reviews, guidelines, and case reports published in English. Ventilator‐dependent children may have neurogenic bladder/bowel dysfunction which renders them prone to urinary tract infection, high bladder pressure, vesicoureteral reflux, hydronephrosis, and renal dysfunction. These children require bladder catheterization, medications affecting parasympathetic/sympathetic nervous systems, or surgical procedures to prevent urinary infections, and to maintain continence and renal functions. However, bladder catheterization or surgical procedures like augmentation cystoplasty may also be complicated with urinary infections, urolithiasis, or urethral strictures. Urolithiasis frequency is also increased due to immobilization‐related hypercalciuria, hypocitraturia caused by antiepileptic drugs, urinary stasis, and urinary infections. On the other hand, mechanical ventilation can impair renal function by reduction of cardiac output, redistribution of intrarenal blood flow and stimulation of sympathetic and hormonal pathways. Children requiring long‐term invasive home mechanical ventilation may have other comorbid conditions, including urinary system diseases, which become manifest as these patients are being kept alive due to the advances in ventilation strategies. These children must be carefully observed for urological complications and managed accordingly to prevent kidney injury.

Akibat Hukum Ganti Nama Pemegang Hak Tanggungan Berdasarkan Undang-Undang Tentang Penguatan Sektor Keuangan Bagi Kreditur dan Debitur Bank Perkreditan Rakyat di Kabupaten Sukoharjo

“…Pelunasan kredit termasuk faktor yang menyebabkan penghapusan perjanjian kredit, tidak boleh dipersangkakan, tetapi memerlukan bukti seperti surat dari kreditur bahwasanya kredit tersebut sudah lunas vide Pasal 1438 dan 1439 KUHPer. Maka kreditur harus memberikan surat roya jika kreditur sudah melunasi hutang tersenut lalu melaksanakan pengurusan roya di BPN (Soylu, 2024).…”

Multidisciplinary management of pediatric patients on home invasive mechanical ventilation

“…Many children initiated on HIMV have complex underlying health conditions affecting multiple organ systems that require ongoing medical attention and care. The recognition and awareness of respiratory, 7 gastrointestinal, 8 surgical, 9 neurological, 10 endocrinological, 11 infectious, 12 and urinary system problems 13 and their management are reviewed and discussed in this special issue. In addition, children on HIMV face complications caused by physical inactivity and need ongoing rehabilitation services.…”