Apparent life threatening events are defined as an acute episode in which the observer fears an infant < 1 year may die. ALTE is characterized by some combination of apnea, color or muscle tone change, chocking and has to be followed by cardiorespiratory reanimation. The present consensus paper reviews international and national evidence concerning diagnosis, etiologies, hospitalization criteria and indications for home monitoring.
Flow generator with double level pressure (BiPAP) through Tracheostomy Background: The Chilean Program of Noninvasive Home Ventilation started using flow generating equipment with differential pressure at 2 levels (BiPAP) through tracheostomies for prolonged mechanical ventilation (PMV). Objective: Describe the experience of this ventilatory support, reporting selection criteria, procedure and technological requirements. Method: Descriptive-transversal study that includes 20 patients treated at Hospital Josefina Martínez, other pediatric hospitals and at home, for 12 months since June 2006. The clinical features, ventilation support, technical characteristics, follow-up and complications were reported. Results: The mean age was 3.5 years-old (range 3 months-17 years). The duration of PMV ranged between 1 month to 5 years. Six patients (30%) are at home and 14 (70%) are hospitalized. In 14 patients (70%), the need of PMV was due to neuromuscular diseases. There was no mortality related to the use of Bipap through tracheostomy; only 4 patients had minor complications. Conclusions: This report suggests that the use of BiPAP through tracheostomy in patients with selection criteria is an applicable PVM method. However, comparative systematic trials are necessary to define costs, benefits and risks of this type of ventilation.
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