Indications for Invasive Home Ventilation Via Tracheostomy
The population of children managed with invasive ventilation at home has
changed over time and particularly with the introduction of non-invasive
respiratory support. Increasingly NIV is preferred to avoid
complications that may result from tracheostomy, including acute airway
blockade by secretions, accidental decannulation, tracheal injury and
respiratory infections.(6) Indications for invasive ventilation in
children include chronic respiratory insufficiency resulting from severe
upper airway obstruction, where anatomy prevents NIV administration
(e.g., facial abnormalities, bilateral vocal cord paralysis, cystic
hygroma), children who have an inability to protect their lower airways
(e.g., bulbar dysfunction) or cannot cooperate with a mask interface
(e.g., severe neurological impairment) and in those who are deemed
ventilator dependent and require ventilatory support for more than 16
hours/day (e.g., high cervical spinal cord injury, infants with
congenital central hypoventilation syndrome).(6)