The Chronically Critically Ill Patient: Pediatric Considerations

Abstract

Whether defined as chronically critically ill, long-term mechanical ventilator dependent (or otherwise chronically medically supported), or medically fragile, a population of infants and children with chronic illness clearly exists. Infants and children with chronic healthcare needs are at an increased risk for physical, developmental, behavioral, and/or emotional conditions and generally require healthcare services of a type or amount beyond that of a general pediatric or adult population. This review will focus on the specific management and psychosocial needs associated with the healthcare of this subgroup of infants and children with chronic illness. Attention will be paid to defining the population, describing trends over time, reviewing their special needs, and discussing outcomes. Increased focus and an increasing quantity of resources for this subgroup of infants and children are needed, as the number of such pediatric patients continues to grow.

Long-Term Ventilation at Home and Pediatric Palliative Care: Patients’ Characterization in an Italian Regional Survey

“…Patients on LTMV-H accounted for 19% of all patients taken into care by the VRCPPC during the period considered, consistently with other reports in the literature [29,30]. When only the patients still in the care of the center at the time of our study were considered, those on LTMV-H represented 50% of the sample (given the open nature of the cohort that gives rise to a cumulative prevalence).…”

“…Patients on LTMV-H account for a significant proportion of the population offered pediatric palliative care (PPC), that is estimated in the literature to be in the range of 50-90% [1][2][3]29,30].…”

An Emerging Population: The Chronically Critically Ill

“…The estimated prevalence of these children is six to seven per 100,000. Similar to adults, the majority of chronically critically ill pediatric patients are treated for underlying respiratory issues (Peterson-Carmichael & Cheifetz, 2012). accessed by following the link in the citation at the bottom of the page.…”

Rehabilitation Considerations for Children Dependent on Long-Term Mechanical Ventilation

“…Parent-child interaction, parent education, and growth and development can be promoted along with the achievement of medical stability [13,24,51]. A limited number of rehabilitation facilities however, report admitting children who are ventilator dependent [4,24,[46][47][48].…”

“…Additionally, advances in medical technology are allowing children to live in to adulthood and the increasing use of portable ventilators is allowing children to be managed at home and in their communities [1][2][3][4][5]. While children dependent on long-term MV remain a small percentage of the overall group of children requiring rehabilitation services, studies indicate that this group of children continues to grow around the world [3,[6][7][8][9][10][11].…”