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[Effectiveness of home ventilation of young children and infants]
K H Wollinsky1, A Mindé, H Schreiber
1Abteilungen Anästhesiologie/Intensivmedizin, Universität Ulm.
Insights
Home ventilation for infants with chronic respiratory insufficiency is challenging. Management of "pentaplegia" was safe, while noninvasive ventilation proved effective for neuromuscular disorders, yielding satisfactory outcomes despite significant stress.
Area of Science:
- Pediatric respiratory care
- Home mechanical ventilation
- Chronic respiratory insufficiency
Context:
- Home care ventilation is crucial for chronic respiratory insufficiency.
- Infants and newborns present unique challenges in ventilation management, indication, and prognosis.
- Cervical spine trauma and neuromuscular disorders necessitate specialized ventilation strategies.
Purpose:
- To evaluate the home care ventilation management in infants with chronic respiratory insufficiency.
- To assess outcomes in newborns with "pentaplegia" secondary to cervical spine trauma.
- To analyze the efficacy of noninvasive ventilation for infants with inherited neuromuscular disorders.
Summary:
- Seven infants with chronic respiratory insufficiency underwent home ventilation.
- Children with "pentaplegia" (spinal cord injury) showed manageable outcomes with tracheostomy, with one successfully transitioning to nocturnal iron lung ventilation.
- Three children with neuromuscular diseases (spinal muscular atrophy, myopathy) were managed with noninvasive nasal mask ventilation.
Impact:
- Demonstrates the feasibility and safety of home ventilation in critically ill infants.
- Highlights successful noninvasive ventilation strategies for pediatric neuromuscular respiratory failure.
- Provides insights into managing complex pediatric respiratory insufficiency, despite psychological burdens.
Background:
The home care ventilation of patients with chronic respiratory insufficiency is a well-established method. In treating infants and newborns a lot of problems arise that deal with indication, prognosis and management.
Patients And Methods:
We investigated 7 newborns and infants with chronic respiratory insufficiency after cervical spine trauma causing "pentaplegia" or due to inherited neuromuscular disorders (spinal muscular atrophy, myopathy) during homecare ventilation.
Results And Discussion:
In contrast to experience with adults the management of the children with "pentaplegia" was relatively harmless. All were tracheostomized primarily, but 1 tracheostomy could be closed, because the patient finally achieved to be ventilated only during night-time in the iron lung. The 3 children with neuromuscular diseases were ventilated noninvasively by specially fitted nasal masks. Despite coming to the frontiers of feasibility, and taking into account the psychological stress for patients, relatives, doctors and nurses, satisfactory results were obtained.