An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation

Factors leading to rehospitalization for tracheostomized and ventilator-dependent infants through 2 years of age

“…The training and education was fairly close to American Thoracic Society clinical practice guidelines. 8 At least two caregivers are specifically trained on pulmonary care and assessment, tracheostomy care, emergency response, ventilator training, infection control practices, oxygen and medication administration, tracheal suctioning, pulmonary toilette and use of monitoring devices. A local durable medical equipment company provides for all the equipment and supplies at home.…”

Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia

“…The home caregiver must be able to recognize signs of respiratory distress and illness in their child and to address emergency health issues in the home environment, such as emergency tracheostomy changes, need for inhalational medications, and/or equipment failure. 98 Poor adherence to respiratory medications was associated with an increased risk of emergency department visits and rescue inhaled beta-agonist use and increased activity limitations in infants with sBPD. 99 The same study reported that medication non-adherence was associated with caregiver concerns regarding medication efficacy and side effects rather than sociodemographic or clinical factors, therefore, the risks and benefits of each therapy should be explained to the caregiver.…”

“…Overall, it is highly advisable to have at least 2 caregivers trained for the appropriate cares, especially for an infant or child with a tracheostomy. 98 …”

“…Continuous monitoring by trained caregivers 24 hours per day, 7 days per week is required, including substantial home nursing presence. 98 Lastly, anticipatory support from social work should also address potential insurance concerns that may arise from medical costs in the outpatient setting, travel, and time commitments required to attend outpatient visits, as well as discussions of the adjustment process for caring for a chronically ill child at home, including issues of social isolation and management of communication issues with multiple health care professionals. 100 …”

Predicting Health Care Utilization for Children With Respiratory Insufficiency Using Parent-Proxy Ratings of Children's Health-Related Quality of Life

“…Recent technological innovations allow many children with these conditions to receive home-based care in their communities (Sterni et al, 2016). Despite this shift to home-based care, including mechanical ventilation, children requiring technology assistance are significantly more likely to develop a severe acute illness resulting in unscheduled and costly hospitalizations with care delivered in the intensive care unit (ICU) (Dosa, Boeing, & Kanter, 2001; Edwards, Rivanis, Kun, Caughey, & Keens, 2011).…”