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Järvelä M, Katila M, Eskola V, Mäkinen R, Mandelin P, Saarenpää-Heikkilä O, Lauhkonen E. Finnish children who needed long-term home respiratory support had severe sleep-disordered breathing and complex medical backgrounds. Acta Paediatr 2024; 113:309-316. [PMID: 37767938 DOI: 10.1111/apa.16981] [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: 05/14/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
AIM No studies have described long-term paediatric home respiratory support in Nordic countries. We examined the clinical characteristics and long-term outcomes of paediatric patients who received continuous positive airway pressure, non-invasive-positive-pressure ventilation and invasive ventilation from a multidisciplinary home respiratory support team. METHODS Retrospective tertiary-level data were collected between 1 January 2010 and 31 December 2020 in Tampere University Hospital. These comprised patient demographics, treatment course and polysomnography-confirmed sleep-disordered breathing (SDB). RESULTS There were 93 patients (63.4% boys). The median age at treatment initiation was 8.4 (range 0.11-16.9) years. The patients had: neuromuscular disease (16.1%), central nervous system disease (14.0%), developmental disabilities and congenital syndrome (29.0%), lung-airway conditions (11.8%), craniofacial syndrome (15.1%) and severe obesity (14.0%). More than two-thirds had severe SDB (66.7%) and the most common one was obstructive sleep apnoea in 66.7%. We found that 92.5% received long-term therapy for more than 3 months and the mean treatment duration was 3.3 ± 2.7 years. A non-invasive mask interface was used in 94.7% of cases and 5.3% needed tracheostomy ventilation. More than a quarter (26.7%) achieved disease resolution during the study period. CONCLUSION Most children who needed long-term home respiratory support had complex conditions and severe, persistent SDB.
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Affiliation(s)
- Mervi Järvelä
- Tampere University, Tampere, Finland
- Department of Paediatrics, Seinäjoki Central Hospital, Seinäjoki, Finland
- Department of Anesthesiology and Intensive Care, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Maija Katila
- Tampere University, Tampere, Finland
- Tampere University Hospital, Tampere, Finland
| | - Vesa Eskola
- Tampere University, Tampere, Finland
- Tampere University Hospital, Tampere, Finland
| | | | | | | | - Eero Lauhkonen
- Tampere University, Tampere, Finland
- Tampere University Hospital, Tampere, Finland
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Alrø AB, Klitnaes C, Dreyer P. Personal care assistants' lived experience of working in the home setting with children and adults on mechanical ventilation. Scand J Caring Sci 2021; 36:536-544. [PMID: 34908178 DOI: 10.1111/scs.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 11/09/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Working as a personal care assistant (PCA) with children and adults on mechanical ventilation in a home setting may be complex and challenging due to the physical and mental working conditions. AIM To explore the lived experience of working as a (PCA) with patients, children and adults on mechanical ventilation in the home setting. DESIGN AND METHODS A qualitative study using a phenomenological-hermeneutic approach. Data collection involved semi-structured individual interviews with 20 PCAs (n = 15 women and n = 5 men) in Denmark in 2020. Their work experience with patients on home mechanical ventilation ranged from 8 months to 25 years (median 8 years). The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline. FINDINGS Four main themes emerged from the structural analysis: Being a fly on the wall or part of the family, Always being in a state of readiness is exhausting, Being a team player and Mutual respect is key in the work relationship. CONCLUSION PCAs had to balance on a knife's edge when working with children and adults on mechanical ventilation in the home setting and try to strike a happy medium. Enduring the job required a proper physical and mental work environment, and thorough preparation, achieved not only through technical training, but also through learning how to be part of a professional relationship characterised by mutual respect and matched expectations. RELEVANCE TO CLINICAL PRACTICE The findings provide clinical practice with important insights into how to inform, prepare and educate PCAs working with patients on mechanical ventilation in the home setting. Further research into home care education and training programmes with a patient- and family-centred care approach is needed.
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Affiliation(s)
| | - Charlotte Klitnaes
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.,Section of Nursing, Institute of Public Health, Aarhus University, Aarhus C, Denmark.,Bergen University, Bergen, Norway
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Alrø AB, Høyer L, Dreyer P. A Child with Home Mechanical Ventilation Affects the Family: A Danish Study shows that well Siblings may become Shadow Children. J Pediatr Nurs 2021; 59:19-24. [PMID: 33412361 DOI: 10.1016/j.pedn.2020.12.013] [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: 08/18/2020] [Revised: 12/20/2020] [Accepted: 12/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Having a child with chronic respiratory illness and home mechanical ventilation (HMV) may not only affect the ill child, but also the family, including well siblings' everyday life and physical and mental well-being. PURPOSE To explore the perspectives of parents to a child with HMV on well siblings' lives. DESIGN AND METHODS A qualitative phenomenological-hermeneutic approach using semistructured interviews with eight families, that included a child on HMV and well siblings. Data were collected from March to June 2019 at a Danish University Hospital. RESULTS Three main themes emerged: Tying emotional bonds with both children, Protection of everyday life for well siblings and A different family life - sharing attentiveness. The findings showed that being a parent to an HMV child and well siblings is complex to manage, and may make parents feel inadequate towards their children. CONCLUSIONS Parents feel inadequate in being parents to both the HMV child and well siblings, often transferring adult responsibilities to the well sibling, and sometimes leaving the well siblings in the shadow. IMPLICATIONS Clinical practice needs to expand interventions to support parents and well siblings by using a more family-centred care approach, not only during admission, but also in a long-term perspective.
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Affiliation(s)
- Anette Bjerregaard Alrø
- Aarhus University Hospital, Department of Intensive Care / Respiratory Center West, Aarhus, N, Denmark.
| | - Linea Høyer
- Regional Hospital West Jutland, Department of Psychiatry, Herning, Denmark..
| | - Pia Dreyer
- Aarhus University, Institute of Public Health, Aarhus C, Denmark and Bergen University, Norway, and Aarhus University Hospital, Department of Intensive Care, Aarhus, N, Denmark..
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Bjerregaard Alrø A, Klitnaes C, Dahl Rossau C, Dreyer P. Living as a family with a child on home mechanical ventilation and personal care assistants-A burdensome impact on family life. Nurs Open 2021; 8:3340-3348. [PMID: 33949156 PMCID: PMC8510762 DOI: 10.1002/nop2.879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Anette Bjerregaard Alrø
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.,Institute of Public Health, Section of Nursing, Aarhus University, Aarhus C, Denmark
| | - Charlotte Klitnaes
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.,Institute of Public Health, Section of Nursing, Aarhus University, Aarhus C, Denmark.,Bergen University, Bergen, Norway
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Brenner M, Alexander D, Quirke MB, Eustace-Cook J, Leroy P, Berry J, Healy M, Doyle C, Masterson K. A systematic concept analysis of 'technology dependent': challenging the terminology. Eur J Pediatr 2021; 180:1-12. [PMID: 32710305 PMCID: PMC7380164 DOI: 10.1007/s00431-020-03737-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023]
Abstract
There are an increasing number of children who are dependent on medical technology to sustain their lives. Although significant research on this issue is taking place, the terminology used is variable and the concept of technology dependence is ill-defined. A systematic concept analysis was conducted examining the attributes, antecedents, and consequences of the concept of technology dependent, as portrayed in the literature. We found that this concept refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide ranging sequelae for the child and family, and health and social care delivery.Conclusion: The term technology dependent is increasingly redundant. It objectifies a heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. What is Known: • There are an increasing number of children who require medical technology to sustain their life, commonly referred to as technology dependent. This concept analysis critically analyses the relevance of the term technology dependent which is in use for over 30 years. What is New: • Technology dependency refers to a wide range of clinical technology to support biological functioning across a dependency continuum, for a range of clinical conditions. It is commonly initiated within a complex biopsychosocial context and has wide-ranging sequelae for the child and family, and health and social care delivery. • The paper shows that the term technology dependent is generally portrayed in the literature in a problem-focused manner. • This term is increasingly redundant and does not serve the heterogenous group of children who are assisted by a myriad of technology and who adapt to, and function with, this assistance in numerous ways. More appropriate child-centred terminology will be determined within the TechChild project.
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Affiliation(s)
- Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Denise Alexander
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Mary Brigid Quirke
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Jessica Eustace-Cook
- grid.8217.c0000 0004 1936 9705Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Piet Leroy
- grid.5012.60000 0001 0481 6099Pediatric Intensive Care Unit & Pediatric Procedural Sedation Unit, Maastricht UMC and Faculty of Health, Life Sciences & Medicine, Maastricht University, Maastricht, Netherlands
| | - Jay Berry
- grid.2515.30000 0004 0378 8438Department of Medicine and Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - Martina Healy
- Department of Paediatric Anaesthesia, Paediatric Critical Care Medicine and Paediatric Pain Medicine, Children’s Health Ireland Crumlin, Dublin, Ireland ,grid.8217.c0000 0004 1936 9705School of Medicine, Faculty of Health Sciences, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Carmel Doyle
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Kate Masterson
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D’Olier Street, Dublin 2, Ireland ,grid.416107.50000 0004 0614 0346Paediatric Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia
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Praud JP. Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications. Front Pediatr 2020; 8:584334. [PMID: 33224908 PMCID: PMC7674588 DOI: 10.3389/fped.2020.584334] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/22/2020] [Indexed: 01/15/2023] Open
Abstract
This review focuses on the delivery of non-invasive ventilation-i.e., intermittent positive-pressure ventilation-in children lasting more than 3 months. Several recent reviews have brought to light a dramatic escalation in the use of long-term non-invasive ventilation in children over the last 30 years. This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT-NIV equipment that can be used at home. While significant gaps in availability persist for smaller children and especially infants, home LT-NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care. While long-term NIV is usually delivered during sleep, it can also be delivered 24 h a day in selected patients. Close collaboration between the hospital complex-care team, the home LT-NIV program, and family caregivers is of the utmost importance for successful home LT-NIV. Long-term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation, with the aim to increase life expectancy and maximize quality of life. LT-NIV is considered for conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall anomalies). Relative contraindications for LT-NIV include the inability of the local medical infrastructure to support home LT-NIV and poor motivation or inability of the patient/caregivers to cooperate or understand recommendations. Anatomic abnormalities that interfere with interface fitting, inability to protect the lower airways due to excessive airway secretions and/or severely impaired swallowing, or failure of LT-NIV to support respiration can lead to considering invasive ventilation via tracheostomy. Of note, providing home LT-NIV during the COVID 19 pandemic has become more challenging. This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS-CoV-2 during NIV. Delay in initiating LT-NIV, decreased frequency of home visits by the home ventilation program, and decreased availability of polysomnography and oximetry/transcutaneous PCO2 monitoring are observed. Teleconsultations and telemonitoring are being developed to mitigate these challenges.
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Affiliation(s)
- Jean-Paul Praud
- Division of Pediatric Pulmonology, University of Sherbrooke, Sherbrooke, QC, Canada
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Leske V, Guerdile MJ, Gonzalez A, Testoni F, Aguerre V. Feasibility of a pediatric long-term Home Ventilation Program in Argentina: 11 years' experience. Pediatr Pulmonol 2020; 55:780-787. [PMID: 31977167 DOI: 10.1002/ppul.24662] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/12/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pediatric home ventilation (HV) has increased worldwide. A Home Ventilation Program (HVP) was started in the Pulmonary Department of the "Hospital de Pediatría Prof. Dr. J. P. Garrahan," Argentina, in 2007. This is the largest Argentine national pediatric tertiary care referral center. Limited studies on pediatric HV from Latin American countries have been published. OBJECTIVE This study describes and analyzes the cohort of children admitted to the HVP during an 11 years period. METHODS Longitudinal study. POPULATION all patients (pts) admitted to the HVP between 2007 and 2018. We analyzed demographic and clinical variables, sleep study results, ventilation setting, and start manner collected in a prospective data base. RESULTS A total of 244 pts were admitted. Median age at ventilation start was 9.41 (3.47-14.08) years, 84% of pts had health insurance. The most frequent underlying diseases were neuromuscular disease (43%) and genetic syndromes (23%). Home-hospital distance was 100-500 km in 16% of cases and greater than 500 km in 34%. Seventy percent of pts had sleep studies before ventilation initiation. Ventilation was started in our general pediatric ward in 83.6%. Noninvasive ventilation was used in 86.1%. The actual number of pts still on follow up is 133 of 244 (54.5%), 16.8% dropped out, 16.4% were transitioned to adult care, 5.32% resolved their sleep-disordered breathing, and 5.32% died. CONCLUSIONS The HVP admitted pts from all the country. Ventilation was started on the basis of clinical and objective sleep measures. This long-term experience underlines the feasibility of a HVP in an emergent country.
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Affiliation(s)
- Vivian Leske
- Sleep Unit, Department of Pulmonology, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - María J Guerdile
- Sleep Unit, Department of Pulmonology, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Adriana Gonzalez
- Department of Physical Therapy, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Fernanda Testoni
- Department of Physical Therapy, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Verónica Aguerre
- Department of Pulmonology, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
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Koncicki ML, Zachariah P, Lucas AR, Edwards JD. A multi-institutional analysis of children on long-term non-invasive respiratory support and their outcomes. Pediatr Pulmonol 2018; 53:498-504. [PMID: 29341504 PMCID: PMC5898633 DOI: 10.1002/ppul.23925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/16/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To characterize a multi-institutional cohort of children with chronic respiratory failure that use long-term, non-invasive respiratory support, perform a time-to-event analysis of transitions to transtracheal ventilation and identify factors associated with earlier transition to transtracheal ventilation. STUDY DESIGN A retrospective cohort study of patients less than 21 years of age with diagnoses associated with chronic respiratory failure and discharged on non-invasive respiratory support was performed using data from the Pediatric Health Information System (PHIS) between 2007 and 2015. Demographic and clinical characteristics, as well as times from index discharge on non-invasive support to transtracheal ventilation were presented. A competing risk regression model was fitted to estimate factors associated with earlier transition to transtracheal ventilation. RESULTS A total of 3802 patients were identified. Their median age at index discharge was 10.4 years (interquartile range [IQR] 4.1-14.9). Of these patients, 337 (8.9%) transitioned to transtracheal ventilation and transitioned at a median of 11.5 months (IQR 4.6-26) post-index discharge, or a median age of 9.3 years (IQR 4.2-14.5). Competing risk modeling demonstrated that patients who were older or whose discharge occurred later in the study period had lower hazards of earlier transition to transtracheal ventilation, whereas patients with anoxia/encephalopathy and quadriplegia had higher hazards of earlier transitioning. CONCLUSIONS Most patients on long-term, non-invasive respiratory support who progress to transtracheal ventilation transition do so within a few years of support initiation. Various characteristics were associated with earlier risk of transitioning to transtracheal ventilation. This information may enhance anticipatory guidance for this population.
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Affiliation(s)
- Monica L Koncicki
- Section of Pediatric Critical Care, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Philip Zachariah
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Adam R Lucas
- Department of Statistics, University of California, Berkeley, California
| | - Jeffrey D Edwards
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, New York
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