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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
PubMed

Insights

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 breathing

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