Abstract:BackgroundThe use of long-term non-invasive ventilation (NIV) to treat sleep and breathing disorders in children has increased substantially in the last decade; however, less data exist about its use in infants. Given that infants have distinct sleep and breathing patterns when compared to older children, the outcomes of infants on long-term NIV may differ as well. The aim of this study is to systematically review the use and outcomes of long-term NIV in infants.MethodsOvid Medline, Ovid Embase, CINAHL (via Eb… Show more
“…Nonetheless, procedures aimed to resolve respiratory problems made up for the majority of measures. Oxygen enrichment and mechanical ventilation are crucial when patients present respiratory muscle weakness and still are the preferred treatment in such cases [19,20]. Other repeated procedures are designed to reduce motor impairment, as the fixation or reconstruction of pelvic bones, an expected outcome given the recommendation for intervention in these patients to diminish the consequences of scoliosis, surgery that appears in the highest percentages in the youngest patients to lose ambulation capacity [4,21].…”
Introduction: The interest in patient demographics and disease management has increased in the past years due to their utility in developing measures that allow healthcare providers to reflect disease complexity. Objective: To revise the current status of spinal muscular atrophy in the region of Catalonia, and to validate the utility of the database for this aim. Methods: Five hundred twenty-four patients diagnosed with a spinal muscular atrophy were identified in the region of Catalonia via the novel program of data analysis for research and innovation in health (PADRIS). Patient records included in the analysis corresponded to primary care, hospital, emergency room, extended care and mental health admissions between 2007 and 2017. Results: 58.02% of patients with a SMA diagnosis were males while 40.84% were females. Average age of diagnosis was 38.31 ± 24.49 years ±SD. Significantly lower was the age of diagnosis of spinal muscular atrophy type I, 1.81 ± 3.01 years. An average of 22 patients died per year during the study period, with a mean decease age of 62.96 ± 25.41 years. Patients were generally attended in hospitals, and the use of healthcare resources was focused on resolving respiratory issues and scoliosis. The highest ratio of admissions per patient was registered in those aged 0 to 4 years. Patients presented a higher risk than the general population and a higher frequency of multimorbidites. Conclusions: Patients exhibited similar characteristics to prior European studies. Multiple admissions in younger patients, mostly due to respiratory issues, have a central role in increasing medical costs of SMA. Equally, the higher risk of patients and increased number of multimorbidity groups translate in an elevated number of admissions in health centres and ER, deriving in higher expenses.
“…Nonetheless, procedures aimed to resolve respiratory problems made up for the majority of measures. Oxygen enrichment and mechanical ventilation are crucial when patients present respiratory muscle weakness and still are the preferred treatment in such cases [19,20]. Other repeated procedures are designed to reduce motor impairment, as the fixation or reconstruction of pelvic bones, an expected outcome given the recommendation for intervention in these patients to diminish the consequences of scoliosis, surgery that appears in the highest percentages in the youngest patients to lose ambulation capacity [4,21].…”
Introduction: The interest in patient demographics and disease management has increased in the past years due to their utility in developing measures that allow healthcare providers to reflect disease complexity. Objective: To revise the current status of spinal muscular atrophy in the region of Catalonia, and to validate the utility of the database for this aim. Methods: Five hundred twenty-four patients diagnosed with a spinal muscular atrophy were identified in the region of Catalonia via the novel program of data analysis for research and innovation in health (PADRIS). Patient records included in the analysis corresponded to primary care, hospital, emergency room, extended care and mental health admissions between 2007 and 2017. Results: 58.02% of patients with a SMA diagnosis were males while 40.84% were females. Average age of diagnosis was 38.31 ± 24.49 years ±SD. Significantly lower was the age of diagnosis of spinal muscular atrophy type I, 1.81 ± 3.01 years. An average of 22 patients died per year during the study period, with a mean decease age of 62.96 ± 25.41 years. Patients were generally attended in hospitals, and the use of healthcare resources was focused on resolving respiratory issues and scoliosis. The highest ratio of admissions per patient was registered in those aged 0 to 4 years. Patients presented a higher risk than the general population and a higher frequency of multimorbidites. Conclusions: Patients exhibited similar characteristics to prior European studies. Multiple admissions in younger patients, mostly due to respiratory issues, have a central role in increasing medical costs of SMA. Equally, the higher risk of patients and increased number of multimorbidity groups translate in an elevated number of admissions in health centres and ER, deriving in higher expenses.
“…These results are similar to those described in other infant studies reporting on improvement in PSG parameters with NIV for infants with obstructive sleep apnea and support benefit for NIV in other airway disorders. 38 With limited information on the impact of NIV on sleep and respiratory parameters outside upper airway disorders, additional work is needed to understand the relationship between improvements in sleep and respiratory parameters and subsequent health outcomes in other underlying disease categories for both infants and older children.…”
“…Svabu įvertinti taikytą kvėpavimo nepakankamumo ir gretutinių ligų gydymą bei skiriamo koncentruoto deguonies srauto kiekį ir jo vartojimo trukmę. Pacientą prižiūri pirminės grandies gydytojai, slaugytojai bei suaugusieji, besirūpinantys vaiku, taip pat kiti specialistai pagal poreikį skubių arba planinių konsultacijų metu [8,10].…”
Section: Ilgalaikė Deguonies Terapijaunclassified
“…Tėvai privalo žinoti, kokios priemonės bus reikalingos namuose, kaip jomis naudotis, taip pat kaip vertinti vaiko būklę ir atpažinti pablogėjusios sveikatos požymius. Būtinas nuolatinis jų mokymas bei žinių tikrinimas [7,10].…”
Section: Ilgalaikė Deguonies Terapijaunclassified
“…Ligoninėje gali būti naudojamos ir kitos priemonės: kaukės su rezervuaru, šalmai, gaubtai, kaukės su Venturi tipo vožtuvu ir kt. Tiekiant deguonį per tracheostomą arba didesniu srautu per kaukę, reikalingas įkvepiamo oro drėkinimas [10].…”
Vaikų lėtinis kvėpavimo nepakankamumas (LKN) – tai reta, tačiau vis dažniau pasitaikanti problema. Medicinos pasiekimai ir tobulėjanti sveikatos priežiūra lemia didesnį vaikų išgyvenamumą per anksti gimus ar sergant įvairiomis sunkiomisligomis, kurios sukelia kvėpavimo sutrikimus ir LKN. LKN sutrikimo priežastimis gali būti prasta kvėpavimomechanika, pakitęs kvėpavimo takų praeinamumas, sutrikusi kvėpavimo reguliacija, plaučių parenchimos bei kraujotakos ligos. Tarp kitų įvairių priežasčių, vaikams svarbiausios yra nervų raumenų ir lėtinės pūlinės plaučių ligos. Vaikams skirtingai nei suaugusiems LKN dažnai gali būti ilgainiui praeinanti būklė, o ne progresuojanti liga, todėl labai svarbu laiku pastebėti ir diagnozuoti šią būklę,o nustačius LKN priežastis bei numačius prognozę, adekvačiai gydyti. LKN gydymo sėkmė šiuolaikinėje medicinoje labiausiai priklauso nuo ilgalaikės multidisciplininės paciento priežiūros, darniai ir veiksmingai veikiančios visose sveikatos priežiūrosgrandyse. Tikslas – panaikinti priežastį arba sumažinti pagrindinės priežasties, sukėlusios LKN, padarinius ir pagerinti vaiko bei jį globojančių asmenų gyvenimo kokybę. Svarbiausi gydymo uždaviniai: pagrindinės ligos gydymas ir ilgalaikės deguonies terapijos, ir (arba) dirbtinės plaučių ventiliacijos pritaikymas namuose. Straipsnyje išsamiau aptariamos vaikų LKN priežastys, svarbiausių diagnostikos metodų ypatumai vaikams, taip pat konservatyvaus vaikų gydymo rekomendacijos, atsižvelgiant į teisinį šių paslaugų reguliavimą šalyje.
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