Prolonged mechanical ventilation and tracheostomised Paediatric

Prolonged mechanical ventilation (PMV) in paediatric intensive care (PICU) is increasing due to health advances and ethical criteria favouring the survival of chronically ill children. These patients require resources, generate high family demand and present a high risk of complications and mortality. Among the most frequent underlying pathologies are chronic respiratory diseases, neuromuscular diseases, prematurity, bronchopulmonary dysplasia and heart disease, with oncological pathology emerging in recent years. In PICU, PMV is mainly performed by invasive MV with an endotracheal or tracheostomy tube (TC), with non-invasive ventilation (NIV) being less frequent. Successful weaning from MV requires strategies aimed at identifying and correcting factors that alter the balance between respiratory system load and respiratory work capacity. Both TC and NIV can facilitate ventilatory weaning or be solutions for long-term ventilation. There is no defined optimal time to perform TC in children; this decision should be individualised on a risk-benefit basis. TC tends to be delayed in children much longer than in adults. One-piece cannulae are used in paediatrics; in addition, if there is clinical stability and the possibility of connection to a home ventilator, uncuffed cannulae should be prioritised because of their better tolerance and safety. Home ventilation allows for a return to the home environment, improving quality of life and favouring neurodevelopment. However, institutional support can be insufficient to cope with the high responsibility and burden assumed by families.