Home ventilation in low resource settings: Learning to do more, with less.
Marco Zampoli1, Jane Booth2, Diane M Gray1
1Department of Pediatrics and Child Health, Division of Pediatric Pulmonology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Pediatric Pulmonology
|December 5, 2023
Summary
Long-term ventilation (LTV) for children at home is challenging in low-resource settings (LRS) due to limited services and high costs. Early caregiver training and simple monitoring tools are crucial for successful LTV implementation in these areas.
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Global health
Background:
- Long-term ventilation (LTV) for children, particularly invasive LTV, is scarce in low-resource settings (LRS).
- Barriers include underdeveloped pediatric critical care, limited expertise, sleep-disordered breathing (SDB) screening challenges, high equipment costs, unreliable electricity, and socioeconomic factors.
- Caregiver reliance is high due to scarce professional home nursing care, posing ethical dilemmas in selecting families.
Purpose of the Study:
- To explore the feasibility and challenges of implementing home-based LTV for children in LRS.
- To identify key strategies for successful LTV provision and management in resource-limited environments.
- To inform policy and practice for improving pediatric LTV access and outcomes in LRS.
Main Methods:
- Review of existing literature and clinical experience regarding LTV in LRS.
- Analysis of barriers and facilitators for home-based pediatric LTV.
- Discussion of essential components for successful implementation, including caregiver training and monitoring.
Main Results:
- Successful LTV implementation in LRS hinges on early, comprehensive caregiver training in tracheostomy and equipment care, regardless of education level.
- Simple tools like overnight oximetry, mobile technology, spirometry, and clinical evaluation aid in recognizing and monitoring children requiring LTV.
- Proactive engagement with adult services is vital for seamless transition pathways as children requiring LTV survive longer.
Conclusions:
- Capacity building in pediatric LTV for LRS necessitates targeted health professional training and advocacy for its life-changing, cost-saving benefits.
- Effective LTV in LRS requires addressing infrastructure, cost, expertise, and caregiver support.
- Strategic planning for long-term care and transition to adult services is essential for children on LTV in resource-limited settings.
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