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Baumann T, Das S, Jarrell JA, Nakashima-Paniagua Y, Benitez EA, Gazzaneo MC, Villafranco N. Palliative Care in Pediatric Pulmonology. CHILDREN 2021; 8:children8090802. [PMID: 34572234 PMCID: PMC8466481 DOI: 10.3390/children8090802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
Children with End Stage Lung Disease (ESLD) are part of the growing population of individuals with life-limiting conditions of childhood. These patients present with a diverse set of pulmonary, cardiovascular, neuromuscular, and developmental conditions. This paper first examines five cases of children with cystic fibrosis, bronchopulmonary dysplasia, neuromuscular disease, pulmonary hypertension, and lung transplantation from Texas Children’s Hospital. We discuss the expected clinical course of each condition, then review the integration of primary and specialized palliative care into the management of each diagnosis. This paper then reviews the management of two children with end staged lung disease at Hospital Civil de Guadalajara, providing an additional perspective for approaching palliative care in low-income countries.
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Affiliation(s)
- Taylor Baumann
- Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Shailendra Das
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (S.D.); (M.C.G.)
| | - Jill Ann Jarrell
- Section of Palliative Care, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Yuriko Nakashima-Paniagua
- Section of Palliative Care, Department of Pediatrics, Hospital Civil de Guadalajara, Guadalajara 44280, Mexico; (Y.N.-P.); (E.A.B.)
| | - Edith Adriana Benitez
- Section of Palliative Care, Department of Pediatrics, Hospital Civil de Guadalajara, Guadalajara 44280, Mexico; (Y.N.-P.); (E.A.B.)
| | - Maria Carolina Gazzaneo
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (S.D.); (M.C.G.)
| | - Natalie Villafranco
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (S.D.); (M.C.G.)
- Correspondence:
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Chen TH, Hsu JH. Noninvasive Ventilation and Mechanical Insufflator-Exsufflator for Acute Respiratory Failure in Children With Neuromuscular Disorders. Front Pediatr 2020; 8:593282. [PMID: 33194926 PMCID: PMC7661489 DOI: 10.3389/fped.2020.593282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/12/2020] [Indexed: 02/04/2023] Open
Abstract
Children with neuromuscular disorder (NMD) usually have pulmonary involvement characterized by weakened respiratory muscles, insufficient coughing, and inability to clear airway secretions. When suffering from community-acquired pneumonia, these patients are more likely to develop acute respiratory failure (ARF). Therefore, recurrent pneumonias leading to acute on chronic respiratory failure accounts for a common cause of mortality in children with NMD. For many years, noninvasive ventilation (NIV) has been regarded as a life-prolonging tool and has been used as the preferred intervention for treating chronic hypoventilation in patients with advanced NMD. However, an increasing number of studies have proposed the utility of NIV as first-line management for acute on chronic respiratory failure in NMD patients. The benefits of NIV support in acute settings include avoiding invasive mechanical ventilation, shorter intensive care unit or hospital stays, facilitation of extubation, and improved overall survival. As the difficulty in clearing respiratory secretions is considered a significant risk factor attributing to NIV failure, combined coughing assistance of mechanical insufflator-exsufflator (MI-E) with NIV has been recommended the treatment of acute neuromuscular respiratory failure. Several recent studies have demonstrated the feasibility and effectiveness of combined NIV and MI-E in treating ARF of children with NMD in acute care settings. However, to date, only one randomized controlled study has investigated the efficacy of NIV in childhood ARF, but subjects with underlying NMD were excluded. It reflects the need for more studies to elaborate evidence-based practice, especially the combined NIV and MI-E use in children with acute neuromuscular respiratory failure. In this article, we will review the feasibility, effectiveness, predictors of outcome, and perspectives of novel applications of combined NIV and MI-E in the treatment of ARF in NMD children.
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Affiliation(s)
- Tai-Heng Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Emergency, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Sciences, University of Southern California, Los Angeles, CA, United States
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kao WT, Tseng YH, Jong YJ, Chen TH. Emergency room visits and admission rates of children with neuromuscular disorders: A 10-year experience in a medical center in Taiwan. Pediatr Neonatol 2019; 60:405-410. [PMID: 30482624 DOI: 10.1016/j.pedneo.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/23/2018] [Accepted: 09/28/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND No previous studies have explored emergency medical care for children with chronic neuromuscular disorders (NMDs). We aimed to determine the major reasons for the emergency room (ER) readmission of pediatric patients with NMDs and suggest changes to the care plan to decrease readmissions. METHODS Children with chronic NMDs (aged <18 years) who visited a medical center-based ER between January 2005 and January 2015 were included. The following data were extracted from the patient's ER records: presentations; demographic data, including sex and age; NMD diagnosis; triage classification; emergency examination; initial management and outcomes. The outcomes were death inside or outside the ER, admission to the ward or pediatric intensive care unit (PICU), uneventful discharge, and repeated ER visits. RESULTS In 10 years, 44 children with heterogeneous NMDs (boys/girls: 30/14, mean age: 9.9 years) visited the ER for a total of 204 times. Repeated ER visits and readmissions occurred in 56.8% and 55.6% of the patients, respectively. Most NMD children belonged to triage class 3 (35.3%), with underlying congenital hereditary muscular dystrophy (44.1%). The major symptoms were usually multiple and concurrent, and primarily respiratory (62.3%) or gastrointestinal (28.9%). The most common causes of hospitalization were pneumonia (48.5%) or acute gastritis (20.4%), and approximately half of the ER visits required further hospitalization, of which 28.2% involved PICU admission. Twenty of the 36 children admitted to the ER required readmission. The most commonly prescribed examinations were complete blood count (38%) and C-reactive protein (38%), and the most common therapy was intravenous fluid administration (34%). Although respiratory compromise caused most ER visits and admissions, pulmonary assessments, including chest films (28%), pulse oximetry (15%), and blood gas analysis (11%), were performed in a relatively small proportion. CONCLUSION The ER staff must recognize patients' unmet needs for respiratory and gastrointestinal care related to underlying NMDs.
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Affiliation(s)
- Wei-Tsun Kao
- Division of Pediatric Emergency, Department of Emergency, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Yung-Hao Tseng
- Division of Pediatric Emergency, Department of Emergency, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Yuh-Jyh Jong
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Departments of Pediatrics and Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, Institute of Molecular Medicine and Bioengineering, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
| | - Tai-Heng Chen
- Division of Pediatric Emergency, Department of Emergency, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Ph.D. Program in Translational Medicine, Graduate Institute of Clinical Medicine, 18 Kaohsiung Medical University and Academia Sinica, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Zaman-Haque A, Campbell C, Radhakrishnan D. The Effect of Noninvasive Positive Pressure Ventilation on Pneumonia Hospitalizations in Children With Neurological Disease. Child Neurol Open 2017; 4:2329048X16689021. [PMID: 28503626 PMCID: PMC5417287 DOI: 10.1177/2329048x16689021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/30/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022] Open
Abstract
The aim of this retrospective single-institution observational study was to identify whether the frequency of hospitalizations for pneumonia would change before and after the initiation of noninvasive positive pressure ventilation in children with neurological conditions. Included patients were 1 to 18 years old with an underlying neurological disease and had been prescribed nocturnal noninvasive positive pressure ventilation. The authors excluded patients with a tracheostomy or those who used noninvasive positive pressure ventilation solely for obstructive sleep apnea. A total of 14 patients were included in the study, among whom there was no significant change in the mean number of pneumonias 2 years before versus after the initiation of noninvasive positive pressure ventilation (mean difference = -0.714, standard deviation = 2.4, P = .312). These findings suggest that while noninvasive positive pressure ventilation may not reduce absolute pneumonia frequency, it may have the beneficial value of preventing an increase in the frequency of pneumonias over time, especially in children with progressive respiratory compromise.
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Affiliation(s)
- Abeyat Zaman-Haque
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Craig Campbell
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Dhenuka Radhakrishnan
- Division of Respirology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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Chua K, Lau LL, Hui JHP, Lee EH. Neuromuscular scoliosis: how decision making and treatment are different. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wenninger S, Schoser B. Behandelbare neuromuskuläre Erkrankungen als wichtige Differentialdiagnose der chronisch-progredienten Dyspnoe im höheren Erwachsenenalter. PNEUMOLOGE 2015. [DOI: 10.1007/s10405-015-0922-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mahede T, Davis G, Rutkay A, Baxendale S, Sun W, Dawkins HJS, Molster C, Graham CE. Use of mechanical airway clearance devices in the home by people with neuromuscular disorders: effects on health service use and lifestyle benefits. Orphanet J Rare Dis 2015; 10:54. [PMID: 25943355 PMCID: PMC4432957 DOI: 10.1186/s13023-015-0267-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background People with neuromuscular disorders (NMD) exhibit weak coughs and are susceptible to recurrent chest infections and acute respiratory complications, the most frequent reasons for their unplanned hospital admissions. Mechanical insufflation-exsufflation (MI-E) devices are a non-invasive method of increasing peak cough flow, improving cough efficacy, the clearance of secretion and overcoming atelectasis. There is limited published evidence on the impact of home use MI-E devices on health service utilisation. The aims of the study were: to assess the self-reported health and lifestyle benefits experienced as a result of home use of MI-E devices; and evaluate the effects of in-home use of MI-E devices on Emergency Department (ED) presentations, hospital admissions and inpatient length of stay (LOS). Methods Individuals with NMD who were accessing a home MI-E device provided through Muscular Dystrophy Western Australia were invited to participate in a quantitative survey to obtain information on their experiences and self-assessed changes in respiratory health. An ad-hoc record linkage was performed to extract hospital, ED and mortality data from the Western Australian Department of Health (DOHWA). The main outcome measures were ED presentations, hospital separations and LOS, before and after commencement of home use of an MI-E device. Results Thirty seven individuals with NMD using a MI-E device at home consented to participate in this study. The majority (73%) of participants reported using the MI-E device daily or weekly at home without medical assistance and 32% had used the machine to resolve a choking episode. The survey highlighted benefits to respiratory function maintenance and the ability to manage increased health care needs at home. Not using a home MI-E device was associated with an increased risk of ED presentations (RR = 1.76, 95% CI 1.1-2.84). The number of hospital separations and LOS reduced after the use of MI-E device, but not significantly. No deaths were observed in participants using the MI-E device at home. Conclusions Home use of a MI-E device by people living with NMD may have a potential impact on reducing their health service utilisation and risk of death. Future research with greater subject numbers and longer follow-up periods is recommended to enhance this field of study. Electronic supplementary material The online version of this article (doi:10.1186/s13023-015-0267-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Trinity Mahede
- Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia.
| | - Geoff Davis
- Data Linkage Branch, Department of Health Western Australia, Perth, Australia.
| | - April Rutkay
- Data Linkage Branch, Department of Health Western Australia, Perth, Australia.
| | - Sarah Baxendale
- Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia.
| | - Wenxing Sun
- Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia.
| | - Hugh J S Dawkins
- Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia. .,Centre for Comparative Genomics, Murdoch University, Perth, Australia. .,Centre for Population Health Research, Curtin University of Technology, Perth, Australia. .,School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia.
| | - Caron Molster
- Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia.
| | - Caroline E Graham
- Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia.
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