Liberation from home mechanical ventilation and decannulation in children

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Critical Care

Background:

• Increasing prevalence of children requiring outpatient invasive long-term mechanical ventilation (HMV).
• Desire for liberation from HMV and decannulation as a treatment goal for some children.
• This study focuses on children dependent on tracheostomy and HMV (T-HMV).

Purpose of the Study:

• To describe the experience of liberating T-HMV dependent children from respiratory technologies.
• To identify key steps and factors contributing to successful decannulation.
• To analyze patient characteristics and outcomes related to HMV liberation.

Main Methods:

• Retrospective chart review of T-HMV dependent children decannulated between July 1999 and December 2011.
• Recording of patient demographics, diagnoses, and critical milestones in the decannulation process.
• Analysis of procedures, clinic visits, and hospitalizations related to HMV weaning.

Main Results:

• Forty-six children achieved HMV independence and decannulation.
• Lower airway and lung disease were common indications for T-HMV.
• Median age at decannulation was 40.5 months; 54% skipped speaking valve or capping trials.
• Airway surgery, bronchoscopy, and polysomnography were common preceding procedures.
• HMV weaning was primarily managed as an outpatient, involving numerous clinic visits and hospitalizations.

Conclusions:

• Liberation from respiratory technology is achievable in medically complex children.
• A five-step process (tracheotomy, HMV initiation, TC trials, HMV independence, decannulation) is integral.
• Success relies on coordinated clinic visits, procedures, and home nursing support.