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Özcan G, Çobanoğlu N. Identifying and managing psychosocial problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2149-2152. [PMID: 37988236 DOI: 10.1002/ppul.26763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/09/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
Home invasive mechanical ventilation (HIMV) has allowed children with chronic respiratory failure to be discharged from the hospital, giving them a chance to return to their home life which is more natural for children to grow up. Many technological tools necessary for their survival have also caused restrictions in the social lives of these children. Psychosocial problems will be inevitable in this group of patients, who often have to cope with more than one medical problem. Identifying the impact of HIMV on these problems will enable these children to have a better quality of life. While the most objective method used to determine the psychosocial status of these children is quality of life measurement, more studies are needed to determine the ideal questionnaire. This review deals with psychosocial problems on HIMV.
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Affiliation(s)
- Gizem Özcan
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
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2
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Bayav S, Çobanoğlu N. Indications and practice of home invasive mechanical ventilation in children. Pediatr Pulmonol 2024; 59:2210-2215. [PMID: 38251866 DOI: 10.1002/ppul.26873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Developments and technological advances in neonatal and pediatric intensive care units have led to a prolonged life expectancy of pediatric patients with chronic respiratory failure. Therefore, the number of hemodynamically stable pediatric patients with chronic respiratory failure who need mechanical ventilator assistance throughout the day has significantly increased. AIMS Numerous conditions, including parenchymal lung diseases, airway disorders, neuromotor disorders, or respiratory defects, can lead to chronic respiratory failure. For individuals who cannot tolerate non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV) is the only suitable choice. Due to increasing need, mechanical ventilator technology is continuously evolving. RESULTS As a result of this process, home-type mechanical ventilators have been produced for patients requiring long-term IMV. Patients with chronic respiratory failure can be safely monitored at home with these ventilators. DISCUSSION Home follow-up of these patients has many benefits such as an increase in general quality of life and a positive contribution to their emotional and cognitive development. CONCLUSION In this compilation, indications for home-based IMV, features of home invasive mechanical ventilators (HMVs), patient monitoring, and the detailed advantages of using IMV at home will be elucidated.
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Affiliation(s)
- Secahattin Bayav
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
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3
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Ozalp Akin E, Bingoler Pekcici B. Monitoring and supporting development in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2224-2227. [PMID: 38270231 DOI: 10.1002/ppul.26876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Each child on home invasive mechanical ventilation is unique with different diagnoses, co-morbidities, families, environment, needs, and developmental conditions. While studies mostly focused on survival and morbidities of these children, every child on home invasive mechanical ventilation has the right to reach his/her optimal developmental potential. OBJECTIVES This can be achieved by monitoring and supporting child development holistically, especially in the early childhood period when brain development is happening rapidly and plasticity is highest. MATERIALS AND METHODS Key theory-based frameworks should be used as universal principles to address child development. These are bioecological theory, family-centered care, World Health Organisation International Classification of Functioning Disability and Health framework, monitoring approach, child-friendly healthcare approach, and transdisciplinary care. RESULTS Monitoring and supporting the development of children on home invasive mechanical ventilation aims to support children in reaching their own full developmental potential, to keep track of children's development, know and support the child's and family's strengths and vulnerabilities over time, address risk factors, support the child's development with the family, use specialized services when needed. CONCLUSIONS When all these principles are put together for children on home invasive mechanical ventilation, monitoring and supporting child development should be a standard approach urgently and holistically in cognitive, receptive, and expressive language, fine and gross motor, relating, play and self help domains, while committing to strengths-based family-centered care, functionality, participation in life, avoidance of stigma, and providing transdisciplinary follow-up.
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Affiliation(s)
- Ezgi Ozalp Akin
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Bahar Bingoler Pekcici
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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4
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Kamalaporn H, Preutthipan A, Coates AL. Weaning strategies for children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2131-2140. [PMID: 38593235 DOI: 10.1002/ppul.27008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
Children who require home mechanical ventilation (HMV) with an artificial airway or invasive mechanical ventilation (HMV) have a possibility of successful weaning due to the potential of compensatory lung growth. Internationally accepted guidelines on how to wean from HMV in children is not available, we summarize the weaning strategies from the literature reviews combined with our 27-year experience in the Pediatric Home Respiratory Care program at the tertiary care center in Thailand. The readiness to wean is considered in patients with hemodynamic stability, having effective cough measured by maximal inspiratory pressure, requiring a fraction of inspired oxygen (FiO2) < 40%, positive end expiratory pressure <5 cmH2O, and acceptable arterial blood gases. The strategies of weaning is start weaning during the daytime while the child is awake and close monitoring is feasible. Disconnect time is gradually increased through naps and sleeping hours. Weaning from the conventional mechanical ventilator to Bilevel PAP or CPAP are optional. Factors affected the successful weaning are mainly the underlying diseases, complications, growth and development, caregivers, and resources. Weaning should be stopped during acute illness or increased work of breathing. The readiness for decannulation could be determined by using the speaking devices, tracheostomy capping, and measurement of end-expiratory pressure. Polysomnography and airway evaluation by bronchoscopy are recommended before decannulation. Weaning when the child is ready is crucial because living with HMV can be challenging and stressful. Failure to remove a tracheostomy when indicated can result in delayed speech, social problems as well as risk for infection.
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Affiliation(s)
- Harutai Kamalaporn
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aroonwan Preutthipan
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Allan L Coates
- The Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Tuna Kirsaçlioğlu C. Management of gastrointestinal and nutritional problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2170-2179. [PMID: 38088191 DOI: 10.1002/ppul.26801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/09/2023] [Accepted: 11/10/2023] [Indexed: 07/27/2024]
Abstract
In recent decades, the patient survival is increased due to advances in intensive care units and development of modern mechanic ventilators. Unfortunately, it is not always possible to wean these children from mechanical ventilation. Recently, after placement a tracheostomy tube, these children can be supported at home with noninvasive or invasive mechanical ventilation. Most of the children who need ventilation support at home have neurological impairment. The nutritional issues and gastrointestinal (GI) complications are well defined in critically ill patients, but there are very limited studies on children with tracheostomy. Considering that majority of the patients have neuromuscular disorders, the nutritional and GI problems of the children with tracheostomy are discussed in light of the knowledge of critically ill patients.
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Affiliation(s)
- Ceyda Tuna Kirsaçlioğlu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ankara University School of Medicine, Ankara, Türkiye
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Cobanoglu N, Yalcin E, Zampoli M. Multidisciplinary management of pediatric patients on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2077-2079. [PMID: 38934785 DOI: 10.1002/ppul.27159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Nazan Cobanoglu
- Department of Pediatrics and Child Health, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatrics and Child Health, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Marco Zampoli
- Department of Pediatrics and Child Health, Division of Pediatric Pulmonology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Katz NT, Cooper MS, Kularatne A, Prebble A, McGrath KH, McCallum Z, Antolovich G, Sutherland I, Sacks BH. Intractable Feeding Intolerance in Children With Severe Neurological Impairment: A Retrospective Case Review of Nine Children Known to a Pediatric Palliative Care Service. Am J Hosp Palliat Care 2024; 41:16-25. [PMID: 37029909 DOI: 10.1177/10499091231169497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Intractable feeding intolerance in children with severe neurological impairment (SNI) is poorly defined and understood. OBJECTIVES (1) To describe 9 children with SNI, where intractable feeding intolerance was thought to be a contributor to their deterioration or death. (2) To consider terminology to describe the severe end of the spectrum of feeding difficulties in children with SNI. RESULTS Mean age at death was 10.3 years (range: 5 - 15.6), and median time from palliative care referral to death was 3.1 months. Location of death was home (n = 3), hospice (n = 1), and hospital (n = 5) with 1 death in intensive care. Gastrointestinal "failure" or "dysfunction" were documented for 7 children, (median time between documentation and death was 3.9 months (range: .1 to 13.1)). All children were fed via a gastrostomy tube during their life (median age of insertion 2.5 years (range: 1.2 to 6.8 years)), and 7 via the jejunal route (median age of insertion 9.2 years (range 2.4 to 14.7 years)). Children lived a median of 9 percent of their lives after jejunal tube feeding was commenced. No child had home-based parenteral nutrition. Multiple symptom management medications were required. CONCLUSION 'Intractable feeding intolerance' describes a clinical crossroads in a child's life where there is an opportunity to consider the appropriateness of further interventions. Further work should explore predictors of intractable feeding intolerance and the delicate balance between cause or contributor to death. The importance of clinician-family prognostic conversations and goal-concordant care both during life and in the terminal phase is highlighted.
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Affiliation(s)
- Naomi T Katz
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Paediatrics Group, Murdoch Children's Research Group, Melbourne, VIC, Australia
| | - Monica S Cooper
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- The Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Clinical Sciences, Neurodevelopment and Rehabilitation, Murdoch Children's Research Group, Melbourne, VIC, Australia
| | - Aeshan Kularatne
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Parkville, VIC, Australia
| | - Anna Prebble
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Department of Paediatric Gastroenterology, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Kathleen H McGrath
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Zoe McCallum
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- The Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Giuliana Antolovich
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- The Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Clinical Sciences, Neurodevelopment and Rehabilitation, Murdoch Children's Research Group, Melbourne, VIC, Australia
| | - Ingrid Sutherland
- The Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Bronwyn H Sacks
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Parkville, VIC, Australia
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Sriboonyong T, Preutthipan A, Nugboon M. Long-term sleep apnea CPAP via tracheostomy in children with tracheomalacia: 20-year experience. Front Pediatr 2023; 11:1169613. [PMID: 37325360 PMCID: PMC10266409 DOI: 10.3389/fped.2023.1169613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Children with severe tracheobronchomalacia may need placements of tracheostomies and long-term mechanical ventilation. Due to financial constraints, continuous positive airway pressure (CPAP) machines commonly used to treat obstructive sleep apnea in adults have been utilized to deliver positive distending pressure to such children at our institution for more than 20 years with favorable outcomes. We, therefore, reported our experience with 15 children using this machine. Methods This is a retrospective study during 2001-2021. Results Fifteen children, 9 boys, aged ranged 3 months-5.6 years, were discharged home with CPAP via tracheostomies. All had co-morbidities including gastroesophageal reflux (n = 9, 60%), neuromuscular disorders (n = 6, 40%), genetic abnormalities (n = 6, 40%), cardiac diseases (n = 4, 27%) and chronic lungs (n = 3, 20%). Eight (53%) children were aged less than 1 year old. The smallest child was aged 3 months old, weighing 4.9 kg. All caregivers were relatives and non-medical health professionals. The 1-month and 1-year readmission rates were 13% and 66% respectively. No factor-associated unfavorable outcomes were statistically identified. No complications related to CPAP malfunction were found. Five (33%) were weaned off CPAP, and 3 died (2 from sepsis and 1 from a sudden unknown cause). Conclusion We first reported the use of sleep apnea CPAP via tracheostomy in children with severe tracheomalacia. In limited-resource countries, this simple device may be another option for long-term invasive ventilatory support. The CPAP use in children with tracheobronchomalacia requires adequately trained caregivers.
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Affiliation(s)
- Tidarat Sriboonyong
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aroonwan Preutthipan
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Malinee Nugboon
- Nursing Affairs, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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9
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Mattson J, Lunnelie J, Löfholm T, Andersson ES, Aune RE, Björling G. Quality Of Life in Children With Home Mechanical Ventilation – A Scoping Review. SAGE Open Nurs 2022; 8:23779608221094522. [PMID: 35493542 PMCID: PMC9047042 DOI: 10.1177/23779608221094522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/20/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Home mechanical ventilation is an established method to support children suffering from chronic respiratory insufficiency, still more research is needed regarding mechanically ventilated children's and adolescents’ quality of life (QoL). Therefore, the aim of this scoping review was to explore research regarding QoL and lived experience of children and adolescents with home mechanical ventilation. Methods A scoping review with systematic searches for research studies published between year 2000–2020 was performed in Cinahl, Medline, and PubMed. Studies that met the inclusion criteria were quality assessed and a thematic analysis was performed. Results In total, ten articles were quality assessed and included in the results. Four themes emerged: Children's self-reported QoL, Parents’ perception and parent-proxy report, Differences between the child's and parent's perception, and challenges in daily life. Children with home mechanical ventilation reported a lower QoL than healthy children and children with other chronic diseases. Generally, parents rate their child's QoL lower than the children themselves. Conclusion This is the first literature review focusing on HMV in the paediatric population. It is clear that HMV does not only affect the treated child or adolescent but also the whole family. It is important to regularly measure and evaluate QoL in children and adolescents with HMV to provide person-centered care. More research is needed to improve these children's and adolescents’ QoL.
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Affiliation(s)
- Janet Mattson
- Department of Health Sciences, Swedish Red Cross University, Sweden
- Department of Learning, Informatics, and Medical Education, Karolinska Institutet, Sweden
| | - Johan Lunnelie
- Department of Health Sciences, Swedish Red Cross University, Sweden
| | - Tim Löfholm
- Department of Health Sciences, Swedish Red Cross University, Sweden
| | | | - Ragnhild E. Aune
- Department of Material Science, Norwegian University of Science and Technology, Norway
| | - Gunilla Björling
- Department of Health Sciences, Swedish Red Cross University, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
- Kilimanjaro Christian Medical University College, Faculty of Nursing, Tanzania
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Gurbani N, Benscoter D, Torres-Silva C, Huang G, Hossain MM, Simakajornboon N. Utility of polysomnography for management of chronic invasive mechanical ventilation in children. Pediatr Pulmonol 2022; 57:560-566. [PMID: 34816625 DOI: 10.1002/ppul.25771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE With advances in technology, pediatric patients are sent home with chronic invasive mechanical ventilation (CIMV). Ventilation optimization and preparation for weaning are essential processes, however, there is no standard approach to weaning and titrating ventilator settings in children. There is little information in the literature on the utility of polysomnography (PSG) in weaning and titration of CIMV. Our objective is to review the role of PSG on titration and weaning of CIMV in children. METHODS A retrospective review of medical records and polysomnograms was performed on CIMV dependent patients at Cincinnati Children's Hospital Medical Center from January 2011 to October 2017. Patients underwent overnight ventilator weaning or titration PSG. Subjects with less than 3 h of total sleep time were excluded. RESULTS About 163 PSGs were divided into 97 PSGs for ventilator titration and 66 PSGs for ventilator weaning. Of the 97 ventilator titration PSGs, 59 (60.8%) had inadequate ventilation, 10 (10.3%) had inadequate oxygenation, 22 (22.7%) had significant tracheostomy leak, 13 (13.4%) had autocycling, 3 (3.1%) had failure to trigger, 4 (4.1%) had central sleep apnea, and 24 (25.8%) had adequate ventilation on current ventilator settings. Of the 66 ventilator weaning PSGs, 48 (72.7%) weaned to lower ventilator settings or off ventilator support and 18 (27.3%) did not wean. DISCUSSION Our results indicate that PSG is useful in titration and weaning of ventilator settings in children with CIMV. Larger studies are needed to evaluate the subgroup of this population who would benefit most from PSG for assessment of adequate ventilator support.
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Affiliation(s)
- Neepa Gurbani
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Dan Benscoter
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cherie Torres-Silva
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Md M Hossain
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Narong Simakajornboon
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
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11
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Luzi D, Pecoraro F, Tamburis O, O’Shea M, Larkin P, Berry J, Brenner M. Modelling collaboration of primary and secondary care for children with complex care needs: long-term ventilation as an example. Eur J Pediatr 2019; 178:891-901. [PMID: 30937604 PMCID: PMC6511355 DOI: 10.1007/s00431-019-03367-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/04/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
Children dependent on long-term ventilation need the planning, provision and monitoring of complex services generally provided at home by professionals belonging to different care settings. The collaboration among professionals improves the efficiency and the continuity of care especially when treating children with complex care needs. In this paper, the Unified Modelling Language (UML) has been adopted to detect the variety of the patterns of collaboration as well as to represent and compare the different processes of care across the 30 EU/EEA countries of the MOCHA project.Conclusion: Half of the analysed countries have a multidisciplinary team with different degrees of team composition, influencing organisational features such as the development of the personalised plan as well as the provision of preventive and curative services. This approach provides indications on the efficiency in performing and organising the delivery of care in terms of family involvement, interactions among professionals and availability of ICT. What is known: • Children with CCNs require a coordination of efforts before and after discharge in a continuum of care delivery dependent on the level of integrated care solutions adopted at country level. What is new: •The adoption of a business process method contributes to perform a cross-country analysis highlighting the variability of team composition and its influence on the delivery of care. • This approach provides indications on the efficiency in performing and organising the delivery of care in terms of family involvement, interactions among professionals and availability of ICT.
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Affiliation(s)
- Daniela Luzi
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32 – 00185, Rome, Italy
| | - Fabrizio Pecoraro
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32 - 00185, Rome, Italy.
| | - Oscar Tamburis
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32 – 00185, Rome, Italy
| | - Miriam O’Shea
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Philip Larkin
- Centre Hospitalier Universitaire Vaudois, Faculté de Biologie et de Médecine, Institut Universitaire de Formation et de Recherche en Soins, University of Lausanne, Lausanne, Switzerland
| | - Jay Berry
- Boston Children’s Hospital, Boston, USA
| | - Maria Brenner
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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12
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Christensen EW, Maynard RC. Do Changing Labor Market Conditions Affect the Length of Stay for Chronic Respiratory Failure Hospitalizations? HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017. [DOI: 10.1177/1084822317710921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The availability of home care nurses is widely seen as a cause for delayed discharge from inpatient care. However, there is a paucity of data to support or refute this hypothesis. If availability is driven by labor market conditions, the relative availability should vary over time with changing labor market conditions. The purpose of this study was to determine whether the length of stay for pediatric patients bound for home care was correlated with the local unemployment rate. We found that a 1-percentage-point (or marginal) increase in the unemployment rate was associated with a 2.3-day decrease in the length of stay for chronic respiratory failure hospitalizations. This suggests that labor market conditions result in delayed discharge for chronic respiratory failure patients.
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13
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Nathan AM, Loo HY, de Bruyne JA, Eg KP, Kee SY, Thavagnanam S, Bouniu M, Wong JE, Gan CS, Lum LCS. Thirteen years of invasive and noninvasive home ventilation for children in a developing country: A retrospective study. Pediatr Pulmonol 2017; 52:500-507. [PMID: 27712049 DOI: 10.1002/ppul.23569] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/11/2016] [Accepted: 08/19/2016] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Home ventilation (HV) for children is growing rapidly worldwide. The aim was to describe (1) the sociodemographic characteristics of children on HV and (2) the indications for, means and outcome of initiating HV in children from a developing country. METHODOLOGY This retrospective study included patients sent home on noninvasive or invasive ventilation, over 13 years, by the pediatric respiratory unit in a single center. Children who declined treatment were excluded. RESULTS Seventy children were initiated on HV: 85.7% on noninvasive ventilation, 14.3% on invasive ventilation. There was about a threefold increase from 2001-2008 (n = 18) to 2009-2014 (n = 52). Median (range) age of initiating HV was 11 (1-169) months and 73% of children were <2 years old. Common indications for HV were respiratory (57.2%), chest/spine anomalies (11.4%), and neuromuscular (10.0%). Fifty-two percent came off their devices with a median (interquartile range) usage duration of 12 (4.8, 21.6) months. Ten children (14.3%) died with one avoidable death. Children with neuromuscular disease were less likely to come off their ventilator (0.0%) compared to children with respiratory disease (62.1%). Forty-one percent of parents bought their equipment, whereas 58.6% borrowed their equipment from the medical social work department and other sources. CONCLUSION HV in a resource-limited country is possible. Children with respiratory disease made up a significant proportion of those requiring HV and were more likely to be weaned off. The mortality rate was low. The social work department played an important role in facilitating early discharge. Pediatr Pulmonol. 2017;52:500-507. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Anna Marie Nathan
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Pediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Hui Yan Loo
- University of Malaya, Kuala Lumpur, Malaysia
| | - Jessie Anne de Bruyne
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Pediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Kah Peng Eg
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Pediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Sze Ying Kee
- Department of Pediatrics, Universiti Putra Malaysia, Serdang, Malaysia
| | - Surendran Thavagnanam
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Pediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Chin Seng Gan
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Pediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Lucy Chai See Lum
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia.,University Malaya Pediatric and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia
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14
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Sakai T, Murakami Y, Okuda Y, Hamada R, Hamasaki Y, Ishikura K, Hataya H, Honda M. Prolonged respiratory disorder predicts adverse prognosis in infants with end-stage kidney disease. Pediatr Nephrol 2016; 31:2127-36. [PMID: 27271033 DOI: 10.1007/s00467-016-3430-5] [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: 12/25/2015] [Revised: 04/27/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Among comorbidities, pulmonary hypoplasia (PH) is known as a significant risk factor for mortality in infants with end-stage kidney disease (ESKD). However, the final outcomes of infants with both ESKD and PH are still not well defined, as the diagnosis modality, and definition of PH severity remain ambiguous. METHODS Children initiating peritoneal dialysis during infancy from 1990 to 2015 were followed until death, date of last contact, or the end of 2015. We examined the long-term outcome of children with congenital pulmonary disorders by studying infants with prolonged respiratory disorders of greater than 28 days duration after birth and evaluated risk factors for mortality. RESULTS Forty-six children were followed (median follow-up, 9.23 years), and classified as children without (n = 38; Group A) or with (n = 8; Group B) a prolonged respiratory disorder. Overall actuarial 5 year survival rate in this cohort was 79.5 %. The survival curve in Group B showed a significant decline compared with Group A. Prolonged respiratory disorder was significantly associated with mortality by multivariate analysis (hazard ratio, 8.32). CONCLUSIONS Infants who initiate peritoneal dialysis complicated by prolonged respiratory disorders have increased adverse risk factors for mortality; therefore, withholding aggressive treatment should be considered.
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Affiliation(s)
- Tomoyuki Sakai
- Department of Pediatrics, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan.
| | - Yoshitaka Murakami
- Department of Medical Statistics, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yusuke Okuda
- Department of Pediatrics, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan
| | - Riku Hamada
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuko Hamasaki
- Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Hataya
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masataka Honda
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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15
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Kabra SK, Bush A. Editorial: Old Problems and New Solutions in Pediatric Pulmonology. Indian J Pediatr 2015. [PMID: 26204978 DOI: 10.1007/s12098-015-1826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sushil K Kabra
- Division of Pediatric Pulmonology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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