Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Practice Guideline

An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation

Laura M Sterni et al. Am J Respir Crit Care Med. .

Abstract

Background: Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children.

Purpose: To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation.

Methods: The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questions of clinical importance and used an evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations.

Results: Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed.

Conclusions: Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child's care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available.

Keywords: children; discharge planning; mechanical ventilators; medical home; respiratory insufficiency.

PubMed Disclaimer

Comment in

  • Pediatric Chronic Home Invasive Ventilation.
    Moore PE, Boyer D, O'Connor MG, Baker CD, Rettig JS, Sterni L, Halbower A, Wilson KC, Thomson CC. Moore PE, et al. Ann Am Thorac Soc. 2016 Jul;13(7):1170-2. doi: 10.1513/AnnalsATS.201603-196CME. Ann Am Thorac Soc. 2016. PMID: 27388405 Free PMC article. No abstract available.

References

    1. U.S. Department of Health and Human Services. The national survey of children with special health care needs: chartbook 2001. 2004 [accessed 2016 Mar 4] Available from: http://mchb.hrsa.gov/chscn/pages/prevalence.htm.
    1. U.S. Department of Health and Human Services. Report of the Surgeon General’s workshop on children with handicaps and their families. Case example: the ventilator-dependent child. 1983 [accessed 2016 Mar 4]. Available from: http://profiles.nlm.nih.gov/NN/B/C/G/M/
    1. U.S. Department of Health and Human Services. Surgeon General’s Report. Campaign ’87: commitment to family-centered, coordinated care for children with special health care needs. 1987 [accessed 2016 Mar 4] Available from: http://profiles.nlm.nih.gov/ps/access/NNBCFP.pdf.
    1. Adams K, Corrigan JM, editors; Institute of Medicine. Priority areas for national action: transforming health care quality. 2003 [accessed 2016 Mar 4] Available from: http://www.nap.edu/read/10593/chapter/1. - PubMed
    1. Schünemann HJ, Jaeschke R, Cook DJ, Bria WF, El-Solh AA, Ernst A, Fahy BF, Gould MK, Horan KL, Krishnan JA, et al. ATS Documents Development and Implementation Committee. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med. 2006;174:605–614. - PubMed

Publication types