Risk factors for first nonscheduled hospital admissions of pediatric patients on home mechanical ventilation

Identifying and managing psychosocial problems in children on home invasive mechanical ventilation

Home invasive mechanical ventilation (HIMV) has allowed children with chronic respiratory failure to be discharged from the hospital, giving them a chance to return to their home life which is more natural for children to grow up. Many technological tools necessary for their survival have also caused restrictions in the social lives of these children. Psychosocial problems will be inevitable in this group of patients, who often have to cope with more than one medical problem. Identifying the impact of HIMV on these problems will enable these children to have a better quality of life. While the most objective method used to determine the psychosocial status of these children is quality of life measurement, more studies are needed to determine the ideal questionnaire. This review deals with psychosocial problems on HIMV.

Long-term sleep apnea CPAP via tracheostomy in children with tracheomalacia: 20-year experience

Introduction

Children with severe tracheobronchomalacia may need placements of tracheostomies and long-term mechanical ventilation. Due to financial constraints, continuous positive airway pressure (CPAP) machines commonly used to treat obstructive sleep apnea in adults have been utilized to deliver positive distending pressure to such children at our institution for more than 20 years with favorable outcomes. We, therefore, reported our experience with 15 children using this machine.

Methods

This is a retrospective study during 2001-2021.

Results

Fifteen children, 9 boys, aged ranged 3 months-5.6 years, were discharged home with CPAP via tracheostomies. All had co-morbidities including gastroesophageal reflux (n = 9, 60%), neuromuscular disorders (n = 6, 40%), genetic abnormalities (n = 6, 40%), cardiac diseases (n = 4, 27%) and chronic lungs (n = 3, 20%). Eight (53%) children were aged less than 1 year old. The smallest child was aged 3 months old, weighing 4.9 kg. All caregivers were relatives and non-medical health professionals. The 1-month and 1-year readmission rates were 13% and 66% respectively. No factor-associated unfavorable outcomes were statistically identified. No complications related to CPAP malfunction were found. Five (33%) were weaned off CPAP, and 3 died (2 from sepsis and 1 from a sudden unknown cause).

Conclusion

We first reported the use of sleep apnea CPAP via tracheostomy in children with severe tracheomalacia. In limited-resource countries, this simple device may be another option for long-term invasive ventilatory support. The CPAP use in children with tracheobronchomalacia requires adequately trained caregivers.

Year in review 2021: Neuromuscular diseases

In this years' review of neuromuscular respiratory medicine, there were a series of articles on home mechanical ventilation, real-world studies assessing the impact of nusinersen, and studies describing upper airway dysfunction. Beyond this, we highlight two excellent reviews regarding cardiac dysfunction in neuromuscular diseases.