Monitoring of Physiologic Features and Treatment Aspects
of Children on Home Invasive Mechanical Ventilation
Jasneek Chawla MBBS BSc (Hons) MRCPCH FRACP PhD1,2,
Hui-leng Tan MBBChir, MD(res)3
1Paediatric Respiratory and Sleep Specialist,
Respiratory and Sleep Medicine
Queensland Children’s Hospital, Brisbane, Australia
2Kids Sleep Research Team, Child Health Research
Centre, The University of Queensland
3Dept of Paediatric Respiratory Medicine, Royal
Brompton Hospital, London, UK
Keywords
Tracheostomy ventilation, Monitoring, Paediatric long term ventilation
Abstract
Paediatric home invasive mechanical ventilation patients are a small but
resource intensive cohort, requiring close monitoring and
multidisciplinary care. Patients are often dependent on their ventilator
for life support, with any significant complications such as equipment
failure, tracheostomy blockage, or accidental decannulation becoming
potentially life threatening, if not identified quickly. This review
discusses the indications and variations in practice worldwide, in terms
of models of care, including home care provision, choice of equipment
and monitoring. With advances in technology, optimal monitoring
strategies for home, continue to be debated: In-built ventilator alarms
are often inadequately sensitive for paediatric patients, necessitating
additional external monitoring devices to minimise risk. Pulse oximetry
has been the preferred monitoring modality at home, though in some
special circumstances such as congenital central hypoventilation
syndrome, home carbon dioxide monitoring may be important to consider.
Children should be under regular follow up at specialist respiratory
centres where clinical evaluation, nocturnal oximetry and capnography
monitoring and/or poly(somno)graphy and analysis of ventilator download
data can be performed regularly to monitor progress. Recent exciting
advances in technology, particularly in telemonitoring, which have
potential to hugely benefit this complex group of patients are also
discussed.
Introduction
The population of children managed at home with ventilatory support has
continued to grow worldwide.(1) This is a direct result of advances in
medical care and technology, which have increased survival rates amongst
children with complex medical disorders who may have co-existing chronic
respiratory failure.(2, 3) Home mechanical ventilation (HMV) is now well
established as a method of facilitating discharge home for this group of
children, enabling them to participate in daily family activities,
attend school and receive an overall improved quality of life.(4) HMV
can be either invasive (IV), via a surgically inserted tracheostomy tube
or non-invasive (NIV), delivered via a nasal or full-face mask
interface. Whilst in children the preference is always to avoid invasive
ventilation, in some instances the severity of the condition or
underlying disease necessitate this method of ventilation.(5) Monitoring
and safety considerations differ in children with invasive HMV compared
to those receiving NIV and are reviewed in this article, in the context
of advances in available technology, existing guidelines and current
practice.