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

Abstract

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.

Tracheostomy in infants with severe bronchopulmonary dysplasia: A review

“…Once these children are weaned off the ventilator and continue to improve and thrive, the introduction and demonstration of tolerance for using a speaking valve (Passy Muir) to facilitate swallowing, vocalization, and improved secretion clearance ( 46 , 47 ), followed by tracheostomy tube capping during awake periods, may be prescribed. In our institution, as in many other institutions, to prepare for decannulation, we perform a routine surveillance airway bronchoscopy to look for possible airway obstructive lesions or dynamic airway collapse and a capped overnight sleep study in the sleep lab ( 39 , 43 , 45 , 48 – 51 ), to ensure successful and safe decannulation. Post decannulation, otolaryngologists and pediatric pulmonologists follow these patients for the management of tracheostomy stoma, other airway complications, and long-term respiratory morbidities related to severe BPD ( 19 ).…”

Pediatric pulmonary year in review 2021: Sleep medicine

“…These findings showed that contrary to adults where heart failure contributes to central apnea, pediatric patients who have additional underlying conditions such as prematurity or underlying neurologic disorders are at increased risk for central sleep apnea. [37][38][39] Naime et al 40 42 Given the heterogeneous nature of their cohort, more extensive studies are needed to identify which subgroups would benefit most from PSG to assess specific ventilatory needs.…”

“…The PSG findings helped with monitoring of clinical status and troubleshooting the ventilator. For the ventilator weaning PSGs, the results obtained informed the decision to wean to lower ventilator settings or off support and keep the patients on the current settings if needed 42 . Given the heterogeneous nature of their cohort, more extensive studies are needed to identify which subgroups would benefit most from PSG to assess specific ventilatory needs.…”

Management of endocrinological problems in children on home invasive mechanical ventilation

“…Invasive mechanical ventilation (HMV) at home is a revolutionary practice in the care of children with chronic respiratory failure such as neuromuscular diseases, congenital anomalies, or chronic lung diseases. The use of HMV in childhood period has become widespread all over the World 1,2 .…”