Ventilator change in children on home mechanical ventilation affected by the Philips respironics trilogy ventilator recall

Abstract

The Philips Respironics recall notification issued in June 2021 affected many of their positive airway pressure devices and mechanical ventilators including the Trilogy 100 and 200 ventilators that are often utilized in children using home positive pressure ventilation via tracheostomy (PPV-T). Optimal strategies to replace ventilators in children using home PPV-T affected by the Philips recall are unknown. We conducted a retrospective study of children using home PPV-T with recalled Trilogy ventilators who underwent inpatient ventilator change to non-recalled portable home ventilators (PHV) using our collaborative institutional protocol. During the study period, there were 40 children using PPV-T with recalled Trilogy ventilators and 19 patients underwent inpatient ventilator change either during an elective hospitalization (n = 8) or during an unscheduled or postoperative hospitalization (n = 11). The median duration of hospitalization for ventilator change was 2 days (interquartile range: 6 days) and generally 1 day for patients admitted solely for ventilator change. In children using PPV-T with recalled Trilogy ventilators, a systematic protocol collaborating with the patients, physicians, and durable medical equipment companies may optimize transition to nonrecalled PHVs.

Use of average volume‐assured pressure support (AVAPS) in invasive pediatric chronic mechanical ventilation

“…Additionally, the indications for placement of tracheostomy and utilization of mechanical ventilation have expanded. Currently, most pediatric patients requiring invasive chronic mechanical ventilation are managed using synchronized intermittent mandatory ventilation in either volume-or pressurecontrol modalities, [1][2][3][4] although we speculate that the use of other nontraditional modalities via tracheostomy can also be utilized.…”

To trach or not to trach? Ethical considerations for medically complex children during a home nursing crisis

“…Although recommended in the pediatric home ventilation guidelines, state policies vary regarding whether an emergency back‐up ventilator is covered by insurance 3 . In addition to the home nursing shortage, ventilator recalls and supply chain issues (for the manufacturing of both ventilators and tracheostomy tubes) have placed these children at even greater risk of adverse events at home 7,8 …”

“…3 In addition to the home nursing shortage, ventilator recalls and supply chain issues (for the manufacturing of both ventilators and tracheostomy tubes) have placed these children at even greater risk of adverse events at home. 7,8 These ethical considerations are troubling and raise several important questions. In addition to identifying the medical indications for tracheostomy placement, should the home environment be comprehensively assessed to identify social determinants of health that might predispose a child to adverse outcomes?…”