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)