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Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue
Valeria Caldarelli1, Federica Porcaro2, Paola Di Filippo3
1Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy.
Children (Basel, Switzerland)
|November 11, 2022
Summary
This review examines clinical and ethical factors for long-term mechanical ventilation (LTMV) in children with medical complexity (CMCs). Shared decision-making with parents is crucial for initiating, continuing, or withdrawing LTMV.
Area of Science:
- Pediatrics
- Medical Ethics
- Respiratory Medicine
Background:
- Children with medical complexity (CMCs) often have multisystemic diseases and respiratory issues.
- Long-term mechanical ventilation (LTMV) is increasingly used for CMCs, but evidence is limited.
- Challenges exist in gathering data on LTMV indications, titration, and monitoring for CMCs.
Purpose of the Study:
- To review clinical indications for LTMV in CMCs.
- To examine ethical considerations surrounding LTMV initiation, continuation, and withdrawal in CMCs.
- To highlight the need for shared decision-making in LTMV management.
Main Methods:
- Literature review of clinical indications for LTMV in CMCs.
- Analysis of ethical frameworks relevant to LTMV decisions.
- Synthesis of current evidence and expert opinion.
Main Results:
- Clinical indications for LTMV in CMCs are diverse and evolving.
- Ethical considerations are paramount in all stages of LTMV management.
- Lack of validated data complicates evidence-based decision-making.
Conclusions:
- LTMV decisions for CMCs require careful clinical and ethical evaluation.
- Shared decision-making with parents is essential for optimal care.
- Further research is needed to establish evidence-based guidelines for LTMV in CMCs.
Keywords:
children with medical complexitycontinuous positive airway pressureethical issueslong-term invasive mechanical ventilationpalliative caresleep apnea syndromesleep-disordered breathingMore Related Videos
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