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.