Introduction:
The inability of the respiratory system to keep blood gas concentrations
within the normal range is called chronic respiratory failure. These
patients need external respiratory support and mechanical ventilators
are appropriate treatment option to improving the ventilatory capacity
of the respiratory system. While in the past, these patients were
followed up with conventional mechanical ventilators in intensive care
units when they needed external respiratory support. In recent years,
with the development of new technologies, airway is provided with
tracheostomy in prolonged intubations to avoid of complications of
intubation. After family education these patients can be discharged, and
their treatment is continued at an earlier time with home invasive
mechanical ventilators (HIMV). Because long-term invasive mechanical
ventilation in a hospital can have negative effects on a child’s
maturation including social, psychological even emotional impacts. Being
in a hospital for an extended period can disrupt a child’s normal
routines and interactions, potentially affecting their social skills and
emotional well-being. Additionally, being in a hospital environment
exposes the child to a higher risk of hospital-acquired infections,
which can further complicate their medical condition. As a result,
patients dependent on HIMV represent a growing population worldwide,
which have specific and variable care needs. The management of HIMV
patients involves addressing their ventilator settings, monitoring their
respiratory status, ensuring airway safety, and providing ongoing
support and education to both the patients and their families or
caregivers 1. Once all processes for home support are
in place, if clinical conditions allow; such as stable cardiopulmonary
status as demonstrated by heart rate, pulse oximetry recording, oxygen
support (possibly <40%), absence of recurrent respiratory
infections and adequate weight gain; the child is a candidate for
discharge from home 2. Even if the patients discharged
with a HIMV are discharged after the completion of home settings and
family education, they experience various respiratory problems in their
home follow-up. In a retrospective observational cohort analysis of 228
children enrolled in a home mechanical ventilation program over a
22-year period in Southern California, found that 21% mortality rate of
34% due to progression of underlying conditions and 49% due to
unexpected events; 19% of these unexpected deaths were associated with
airway problems, such as tracheal hemorrhage, acute airway obstruction
and accidental decannulation 3. They also found that
pneumonia and tracheitis were the most common causes of non-elective
hospital readmissions in 40% of patients receiving HIMV support during
their first year at home after discharge; half of these admissions
occurred in the first 3 months 4. Edwards et al.
examined severe emergencies in a group of ventilator-dependent children,
they found that the majority of admissions were associated with
respiratory problems such as increased secretions, infection,
atelectasis, and complications from tracheostomy 5.
Below, the management of respiratory problems in patients dependent on
home invasive mechanical ventilation will be addressed.