Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue

Caldarelli, Valeria; Porcaro, Federica; Filippo, Paola Di; Attanasi, Marina; Fainardi, Valentina; Gallucci, Marcella; Mazza, Angelo; Ullmann, Nicola; Grutta, Stefania La

doi:10.3390/children9111700

Cited by 5 publications

(9 citation statements)

References 38 publications

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“…NIPPV should be initiated when spirometry or respiratory pressures indicate respiratory weakness or when there are symptoms of nocturnal hypoventilation (Table 4). There is a lack of consensus on a specific threshold for initiation of NIPPV based upon respiratory function testing, although there is evidence of improved outcomes with early initiation 114–119 . Use of NIPPV is associated with slowing the rate of decline of respiratory function and improved quality of life and survival 18,19,113,114,118,120,121 .…”

Section: Assisted Ventilationmentioning

confidence: 99%

“…There is a lack of consensus on a specific threshold for initiation of NIPPV based upon respiratory function testing, although there is evidence of improved outcomes with early initiation. [114][115][116][117][118][119] Use of NIPPV is associated with slowing the rate of decline of respiratory function and improved quality of life and survival. 18,19,113,114,118,120,121 NIPPV can be used around the clock for patients with advanced respiratory impairment, even with unmeasurable VCs provided bulbar function is intact.…”

Section: Noninvasive Positive Pressure Ventilationmentioning

confidence: 99%

“…[114][115][116][117][118][119] Use of NIPPV is associated with slowing the rate of decline of respiratory function and improved quality of life and survival. 18,19,113,114,118,120,121 NIPPV can be used around the clock for patients with advanced respiratory impairment, even with unmeasurable VCs provided bulbar function is intact. 90 In patients with ALS without bulbar involvement, NIPPV increases survival on average of 205 days.…”

Section: Noninvasive Positive Pressure Ventilationmentioning

confidence: 99%

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Respiratory considerations in patients with neuromuscular disorders

2023

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Patients with neuromuscular disorders (NMDs) develop respiratory impairment as muscles weaken. Ensuing complications include reductions in lung volume, compliance, and cough ability and increased risk for lung infections. Sleep disordered breathing results from weakened upper airway muscles and/or impaired central ventilatory control systems. Evaluation includes measurement of seated and supine vital capacity (VC) and respiratory muscle strength. Assisted cough techniques facilitate airway clearance. The decision to initiate assisted ventilation is multifactorial, and may include consideration of patient symptoms, spirometry, pulmonary pressures, sleep studies or blood gas values. Most patients prefer noninvasive ventilation to enhance mobility and independence. Tracheostomy is indicated when bulbar function is impaired and cough assist measures fail to clear the airway. Technological advances in respiratory support have improved quality of life and longevity. Home care is the best option for most patients but remains a challenge, especially for caregivers with regard to physical, emotional, and financial implications, as well as social, administrative, and insurance concerns.

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Section: Assisted Ventilationmentioning

confidence: 99%

Section: Noninvasive Positive Pressure Ventilationmentioning

confidence: 99%

Section: Noninvasive Positive Pressure Ventilationmentioning

confidence: 99%

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Respiratory considerations in patients with neuromuscular disorders

2023

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“…Las indicaciones neonatales más frecuentes son: malformación de la vía aérea alta, enfermedades neuromusculares graves, DBP, y condiciones médicas complejas en las que participan el compromiso neurológico, neuromuscular y respiratorio conjuntamente. Muchos de estos RN son ingresados en programas de asistencia respiratoria crónica, que permiten en una proporción significativa de ellos el alta a domicilio con apoyo multidisciplinario (19)(20).…”

Section: Introductionunclassified

Traqueostomía en Prematuros Con Displasia Broncopulmonar Grave

Recondo¹

2023

Neumol Pediatr

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Los recién nacidos con displasia broncopulmonar dependientes de ventilación mecánica a las 36 semanas, corresponden en general a prematuros menores de 27 semanas con morbilidad grave: enterocolitis, infecciones, retinopatía, retraso en el crecimiento y secuelas del neurodesarrollo. Si la extubación no es posible entre las 40 y 50 semanas, se indica una traqueostomía, normalmente acompañada de una gastrostomía. La decisión depende del apoyo ventilatorio, de la morbilidad asociada (neurológica, hipertensión pulmonar, lesiones de la vía aérea) y del grado de desnutrición. La traqueostomía optimiza el manejo ventilatorio, disminuye la necesidad de sedación, facilita la movilidad, la neurorrehabilitación y el alta al hogar en ventilación domiciliaria. La edad óptima de ejecución no está estandarizada, pero hay evidencia que muestra beneficios en el neurodesarrollo si se realiza antes de los 120 días de vida. La mayoría de los prematuros traqueostomizados son manejados en domicilio y a los 5 años ya se encuentran decanulados.

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“…Children with medical complexity represent a growing population who require significant healthcare resources and multidisciplinary care. Long-term ventilation indications and management guidelines are crucial in following patients and their families [ 14 ]. Our medical era offers new therapies for various respiratory diseases, including the so-called “orphan disease”.…”

mentioning

confidence: 99%