Respiratory Care Considerations for Children with Medical Complexity

Abstract

Children with medical complexity (CMC) are a growing population of diagnostically heterogeneous children characterized by chronic conditions affecting multiple organ systems, the use of medical technology at home as well as intensive healthcare service utilization. Many of these children will experience either a respiratory-related complication and/or they will become established on respiratory technology at home during their care trajectory. Therefore, healthcare providers need to be familiar with the respiratory related complications commonly experienced by CMC as well as the indications, technical and safety considerations and potential complications that may arise when caring for CMC using respiratory technology at home. This review will outline the most common respiratory disease manifestations experienced by CMC, and discuss various respiratory-related treatment options that can be considered, including tracheostomy, invasive and non-invasive ventilation, as well as airway clearance techniques. The caregiver requirements associated with caring for CMC using respiratory technology at home will also be reviewed.

The utility of paired upper and lower respiratory tract sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing in patients with artificial airways

“…Our experience with universal paired URT and LRT testing may be of value to other pediatric institutions, particularly those that care for medically complex children with tracheostomy tubes, who are disproportionately represented in pediatric hospitalizations. 8,9 Based on the data presented herein and supported by the published literature and revisions to national guidelines Downloaded from https://www.cambridge.org/core. 24 May 2021 at 06:46:07, subject to the Cambridge Core terms of use.…”

Respiratory Diagnostic Tools in Neuromuscular Disease

“…A restrictive pattern is commonly evident in the pulmonary function tests of individuals with NMD [ 4 ]. Specific respiratory muscle testing is usually decreased in comparison to healthy children [ 20 ]. On the basis of the existing literature, certain threshold values have been identified to guide clinicians in deciding when to initiate further treatments, including cough augmentation therapy, or further testing, such as a sleep evaluation (see Table 2 ).…”

“…Lung volume recruitment consists of using a self-inflating resuscitation bag attached to a one-way valve. Compression of the LVR bag is coordinated with the patient’s sequential inhalations with the aim of hyperinflating the lungs, resulting in greater PCFs [ 20 ]. Unfortunately, although standard pediatric values for PCF have been published, thresholds predictive of respiratory complications in young children are not available [ 21 ].…”

Shared decision making for children with chronic respiratory failure—It takes a village and a process

“…The prevalence of this population is small, ranging from 4.2 to 7.3 per 100,000 children 3,6–8 . However, these children have some of the most complex 9 and expensive care needs of all children with special health care needs in terms of inpatient hospitalizations, 10 home nursing, 11 durable medical equipment 12 and caregiving requirements for parents 13,14 . In children with CRF, the decision regarding whether or not to place a nonurgent tracheostomy has a large impact on the life of children and families 15,16 .…”