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The ventilator-dependent child: issues in diagnosis and management
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
Insights
Ventilator-dependent pediatric patients with chronic respiratory failure are increasing. Careful management, including prognostication and family involvement, leads to good outcomes for selected children.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Respiratory Physiology
Background:
- Increasing survival of pediatric patients with chronic respiratory failure leads to a growing population requiring mechanical ventilatory support.
- Chronic respiratory failure in children stems from central nervous system issues or respiratory pump dysfunction, often marked by hypercapnia and hypoxemia.
Purpose of the Study:
- To outline the complex management of ventilator-dependent pediatric patients.
- To emphasize the importance of accurate prognostication and informed decision-making regarding ventilatory support.
Main Methods:
- Review of pathophysiologic mechanisms of chronic respiratory failure in children.
- Discussion of management strategies including airway, ventilation mode, and care setting decisions.
- Highlighting the necessity of family education and multidisciplinary team involvement.
Main Results:
- Mechanical ventilatory support can enable long-term survival for pediatric patients with chronic respiratory failure.
- Care setting decisions (hospital vs. home) depend on the underlying condition, such as bronchopulmonary dysplasia versus neuromuscular disorders.
- Family education and involvement are crucial for successful long-term care.
Conclusions:
- Optimal care for ventilator-dependent pediatric patients requires accurate prognostication and careful selection.
- A multidisciplinary approach involving physicians, therapists, nurses, and family is essential for good outcomes.
- Selected pediatric patients with chronic respiratory failure managed with ventilatory support can achieve favorable outcomes.
Abstract:
Infants, children, and adolescents with chronic respiratory failure are surviving in increasing numbers and, thereby, producing a significant population of ventilator-dependent pediatric patients. Chronic respiratory failure can occur as a complication of a wide variety of disease states; in pathophysiologic terms, it generally results from either decreased central nervous system output or inadequate force generated by the respiratory pump. Its laboratory hallmark is hypercapnia with or without hypoxemia. Stabilization of the patient with mechanical ventilatory support may permit long-term survival. Management of the ventilator-dependent pediatric patient is a complex task that must begin with an accurate prognostication of each patient's survival and quality of life. Once a decision is made concerning the practicality and appropriateness of long-term ventilatory support, informed choices must be made with respect to need for an artificial airway, mode of ventilation, and location of care. Many younger patients, especially those with intrinsic lung disease (like bronchopulmonary dysplasia), may require a hospital setting for long-term care, whereas others with neuromuscular or central disorders may benefit from being discharged to home. The patient's family must be thoroughly educated in the child's care, and they must be involved in decision-making. A multidisciplinary team of physicians, therapists, nurses, and other professionals is required to deliver optimal care. Outcome is good for most patients who are carefully selected.