Rehabilitation Considerations for Children Dependent on Long-Term Mechanical Ventilation

Abstract

The purposes of this paper are as follows (1) to describe the prevalence, etiology, and care settings for children dependent on longterm mechanical ventilation (MV); (2) to provide a brief introduction to MV and weaning; (3) to explore health care utilization and cost of care; and, primarily, (4) to discuss the rehabilitation needs of children dependent on long-term MV including activities of daily living, mobility, communication, psychosocial needs, and recreation and leisure. Children with ventilator dependence are a growing segment of the population of children with special health care needs and often require rehabilitation services. MV is a form of life-saving technology that substitutes for or assists a child's respiratory efforts. Goals for use of MV vary and there are many combinations of MV elements that can obtain desirable results. No standards of care exist for the rehabilitation examination or interventions utilized for children with long-term MV dependence and it remains unclear what effect MV has on the achievement of developmental milestones, daily activities, and participation in daily life.

Home Mechanical Ventilation in Children

“…Because of the shortage of home health care nurses as well as complexity of children's conditions and technological supports, it is imperative that the children's family and caregivers must be involved and capable of learning all aspects of home care [39]. Caregivers need to be trained in using, cleaning and caring for the ventilators and accessories; basic trouble shooting skills; emergency problem solving; understanding alarms and corrective measures to take; tracheostomy care as well as basic life support [40].…”

Health‐related quality of life and developmental outcome of children on home mechanical ventilation in a developing country: A cross‐sectional study

“…Gonzalez et al 8 also found that in children on HMV, the lowest HRQoL was in physical health. This could be multifactorial due to (a) skeletal muscle weakness as a result of prolonged bed rest during their acute illness; (b) presence of underlying comorbidities; (c) reduced functional status due to ventilator dependence, for example, reduced outdoor and play activities; (d) increased metabolism due to chronic respiratory disease; and (e) reduced prone positioning during infancy 30,31 . Fortunately, this can be overcome with regular physiotherapy and occupational therapy together with parental education on methods to encourage motor movements even while on HMV.…”

“…To perform age‐appropriate self‐care tasks, children need to have adequate gross motor and manipulative skills. Children dependent on mechanical ventilation face unique challenges in gaining and/or maintaining independence with these self‐care activities 30 . Thus, the self‐care domain deficits could reflect impaired motor skills rather than a true reflection of innate self‐care abilities.…”

Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications

“…Chronic respiratory insufficiency can be caused by conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall restriction) (37,38). Table 3 lists the potential indications for long-term non-invasive ventilation (39).…”