Prolonged mechanical ventilation and tracheostomised Paediatric

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Medicine
• Medical Technology

Background:

• Prolonged mechanical ventilation (PMV) in paediatric intensive care units (PICU) is increasing due to advances in care for chronically ill children.
• Common causes include chronic respiratory and neuromuscular diseases, prematurity, bronchopulmonary dysplasia, heart disease, and increasingly, oncological conditions.
• PMV in PICU primarily involves invasive mechanical ventilation (MV) via endotracheal tube or tracheostomy (TC), with non-invasive ventilation (NIV) being less common.

Purpose of the Study:

• To review strategies for successful weaning from mechanical ventilation in children.
• To discuss the role of tracheostomy (TC) and non-invasive ventilation (NIV) in facilitating ventilatory weaning and long-term support.
• To highlight considerations for tracheostomy timing, cannula selection, and the transition to home ventilation.

Main Methods:

• Review of current practices and literature regarding prolonged mechanical ventilation in pediatric intensive care.
• Analysis of factors influencing successful weaning from mechanical ventilation.
• Discussion of tracheostomy (TC) and non-invasive ventilation (NIV) as management strategies.

Main Results:

• Successful weaning requires addressing imbalances between respiratory system load and work capacity.
• Tracheostomy (TC) and NIV can aid in weaning or serve as long-term ventilation solutions.
• Tracheostomy timing in children is individualized and often delayed compared to adults; uncuffed cannulae are preferred when clinically stable for home use.

Conclusions:

• Home ventilation can improve quality of life and neurodevelopment but places significant burdens on families.
• Institutional support is crucial for families managing children on home ventilation.
• Individualized risk-benefit assessment is essential for tracheostomy decisions in pediatric patients.