1
|
Stehling F, Wendt A, Berger M, Kerzel S, Vlajnic D, Fuchs H, Gunst L. [Emergency Care Plans for the Management of Emergencies in Children on Home Mechanical Ventilation]. KLINISCHE PADIATRIE 2024; 236:57-63. [PMID: 38286407 PMCID: PMC10883754 DOI: 10.1055/a-2235-7805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
In pediatrics chronic respiratory insufficiency is increasingly treated on an outpatient basis with home mechanical ventilation. Nursing and medical teams with different structures take care of the often complex ill children in the outpatient setting. Structured treatment processes, especially emergency plans for the management of respiratory emergencies of home mechanical ventilated children are lacking. This article is a proposal for emergency management of respiratory infections, emergencies of non-invasively ventilated and invasively ventilated, tracheotomized children. In addition to resuscitation measures according to ERC/AHA, the focus is primarily on secretion management, as well as on the handling of ventilators and devices.
Collapse
Affiliation(s)
- Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center,
University Hospital Essen, Essen, Germany
| | - Anke Wendt
- Department of Pediatric Respiratory Medicine, Immunology and Critical
Care Medicine, Charite University Hospital Berlin, Berlin, Germany
| | - Michael Berger
- Division of Pediatric Surgery, Department of General, Abdominal and
Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Hospital
Regensburg, Regensburg, Germany
| | - Dejan Vlajnic
- Department of Pediatrics, Vest Children's Hospital Datteln,
Datteln, Germany
| | - Hans Fuchs
- Center for Pediatrics, Department of Neonatology, Medical Center,
University of Freiburg, Freiburg im Breisgau, Germany
| | - Lennart Gunst
- Center for Pediatrics, Department of Neonatology, Medical Center,
University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
2
|
Hysinger EB, Ahlfeld SK. Respiratory support strategies in the prevention and treatment of bronchopulmonary dysplasia. Front Pediatr 2023; 11:1087857. [PMID: 36937965 PMCID: PMC10018229 DOI: 10.3389/fped.2023.1087857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Neonates who are born preterm frequently have inadequate lung development to support independent breathing and will need respiratory support. The underdeveloped lung is also particularly susceptible to lung injury, especially during the first weeks of life. Consequently, respiratory support strategies in the early stages of premature lung disease focus on minimizing alveolar damage. As infants grow and lung disease progresses, it becomes necessary to shift respiratory support to a strategy targeting the often severe pulmonary heterogeneity and obstructive respiratory physiology. With appropriate management, time, and growth, even those children with the most extreme prematurity and severe lung disease can be expected to wean from respiratory support.
Collapse
Affiliation(s)
- Erik B. Hysinger
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Correspondence: Erik B. Hysinger
| | - Shawn K. Ahlfeld
- Division of Neonatology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| |
Collapse
|
3
|
Abstract
For infants with the most severe forms of chronic lung disease, regardless of etiology, chronic mechanical ventilation can provide stability, reduce acute respiratory events, and alleviate increased work of breathing. This approach prioritizes the baby's growth and development during early life. Once breathing comfortably, these infants can tolerate developmental therapies with the goal of achieving the best neurocognitive outcomes possible.
Collapse
Affiliation(s)
- Christopher D Baker
- Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue Box B-395, Aurora, CO 80045, USA.
| |
Collapse
|
4
|
Baker CD. Chronic respiratory failure in bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:3490-3498. [PMID: 33666365 DOI: 10.1002/ppul.25360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/09/2022]
Abstract
Although survival has improved dramatically for extremely preterm infants, those with the most severe forms of bronchopulmonary dysplasia (BPD) fail to improve in the neonatal period and go on to develop chronic respiratory failure. When careful weaning of respiratory support is not tolerated, the difficult decision of whether or not to pursue chronic ventilation via tracheostomy must be made. This requires shared decision-making with an interdisciplinary medical team and the child's family. Although they suffer from increased morbidity and mortality, the majority of these children will survive to tolerate ventilator liberation and tracheostomy decannulation. Care coordination for the technology-dependent preterm infant is complex, but there is a growing consensus that chronic ventilation can best support neurodevelopmental progress and improve long-term outcomes.
Collapse
Affiliation(s)
- Christopher D Baker
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
5
|
Benscoter D, Borschuk A, Hart C, Voos K. Preparing families to care for ventilated infants at home. Semin Fetal Neonatal Med 2019; 24:101042. [PMID: 31648918 DOI: 10.1016/j.siny.2019.101042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Advances in neonatal care have led to increased survival of infants with complex medical needs and technology dependence. Transition of the ventilator-dependent infant from hospital to home is a complex process that requires extensive coordination between the medical team and family. Home caregivers must be prepared to provide routine care for the ventilator-dependent child and respond to life-threatening emergencies. Families should be counseled on the need for home nursing, medical equipment and an adequate home environment to ensure a safe transition to home. Throughout the process, the family may require financial, social and psychological support. A structured education and transition process that is clearly communicated to parents is necessary to have an effective partnership with families.
Collapse
Affiliation(s)
- Dan Benscoter
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Adrienne Borschuk
- Department of Pediatrics, University of Cincinnati, College of Medicine, 3333 Burnet Ave, Cincinnati, 45229, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, 45229, OH, USA.
| | - Catherine Hart
- Department of Otolaryngology, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, 45267, OH, USA.
| | - Kristin Voos
- Department of Pediatrics, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, 44106, OH, USA; Division of Neonatology, University Hospitals Cleveland Medical Center Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, 44106, OH, USA.
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Modern medical advances have resulted in an increased survival after extremely preterm birth. However, some infants will develop severe bronchopulmonary dysplasia (BPD) and fail to wean from invasive or noninvasive positive pressure support. It remains unclear which infants will benefit from tracheostomy placement for chronic ventilation. Once the decision to pursue chronic ventilation has been made, questions remain with respect to the timing of tracheotomy surgery, optimal strategies for mechanical ventilation, and multidisciplinary care in both the inpatient and outpatient settings. The appropriate time for weaning mechanical ventilation and tracheostomy decannulation has similarly not been determined. RECENT FINDINGS Although there remains a paucity of randomized controlled trials involving infants with severe BPD, a growing body of evidence suggests that chronic ventilation via tracheostomy is beneficial to support the growth and development of severely affected preterm children. However, delivering such care is not without risk. Chronic ventilation via tracheostomy requires complex care coordination and significant resource utilization. SUMMARY When chronic respiratory insufficiency limits a preterm infant's ability to grow and develop, chronic invasive ventilation may facilitate neurodevelopmental progress and may lead to an improved long-term outcome.
Collapse
|
7
|
Rai SK, Holler T, Propst EJ, Wolter NE, Amin R. Tracheostomy care: Clinical practice patterns of pediatric otolaryngologists-head and neck surgeons in a publicly funded (Canadian) health care system. Int J Pediatr Otorhinolaryngol 2018; 115:177-180. [PMID: 30368382 DOI: 10.1016/j.ijporl.2018.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate variability in pediatric tracheostomy tube care practice patterns and access to resources across Canada. METHODS Canadian pediatric otolaryngologists-head & neck surgeons reported their own practice patterns for children with chronic tracheostomy tubes using a web-based, 29-item multiple choice and short answer questionnaire. Domains investigated included tracheostomy team membership, inpatient care practices, caregiver education, homecare resources, speech and communication, and completeness of emergency tracheostomy kits. RESULTS The response rate was 86.4% (38/44). Most respondents care for children with tracheostomy tubes as part of an inter-professional team (25/36; 69.4%) and arrange routine follow-up with a speech and language pathologist (22/36; 61.1%). However, the majority (23/34; 67.6%) of respondents do not formally reassess caregiver competencies (i.e. cardiopulmonary resuscitation, emergency tracheostomy care). Notably, respondents were also unsure 36.1% (13/36) of how frequently Shiley tracheostomy tubes should be washed and reused with the majority (15/36; 41.7%) reporting never. Most (15/36; 41.7%) respondents were also unsure of reuse recommendations for Bivona tracheostomy tubes. One third (12/36; 33.3%) of respondents were unsure about government-funded homecare services being provided in their community to children with tracheostomy tubes. CONCLUSION There is much variability in pediatric tracheostomy tube care practice patterns across Canada. Results suggest that an evidence-based Canadian clinical practice guideline may help to streamline care provided to Canadian children with tracheostomy tubes.
Collapse
Affiliation(s)
- Sunita K Rai
- Department of Otolaryngology, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Theresa Holler
- Department of Otolaryngology, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Evan J Propst
- Department of Otolaryngology, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Nikolaus E Wolter
- Department of Otolaryngology, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Reshma Amin
- Division of Respiratory Medicine, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Canada.
| |
Collapse
|