Home mechanical ventilation in children with chronic respiratory failure: a narrative review

Abstract

Advances in perinatal and pediatric intensive care and recent advances in mechanical ventilation during the last two decades have resulted in an exponential increase in the number of children undergoing home mechanical ventilation (HMV) treatment. Although its efficacy in chronic respiratory failure is well established, HMV in children is more complex than that in adults, and there are more considerations. This review outlines clinical considerations for HMV in children. The goal of HMV in children is not only to correct alveolar hypoventilation but also to maximize development as much as possible. The modes of ventilation and ventilator settings, including ventilation masks, tubing, circuits, humidification, and ventilator parameters, should be tailored to the patient's individual characteristics. To ensure effective HMV, education for the parent and caregiver is important. HMV continues to change the scope of treatment for chronic respiratory failure in children in that it decreases respiratory morbidity and prolongs life spans. Further studies on this topic with larger scale and systemic approach are required to ensure the better outcomes in this population.

Keywords: Child; Home mechanical ventilation; Long-term mechanical ventilation; Noninvasive ventilation; Respiratory insufficiency.

Fig. 1.

Respiratory balance. (A) Normal respiratory balance, in which the load imposed on the respiratory system, the capacity of the respiratory muscles, and the central drive are in equilibrium. (B) A decrease in central drive (dotted line) causes a decrease in respiratory muscle activity and, subsequently, a reduced alveolar ventilation. (C) A weakness of the respiratory muscles or an increase in respiratory load causes an increased central drive (bold arrow). Alveolar ventilation occurs when the imbalance exceeds a specific threshold. (D) Noninvasive ventilation can correct disequilibrium in the respiratory balance by replacing the central drive, unloading (in case of an increase in respiratory load, as shown), or assisting the respiratory muscles (in case of respiratory muscle weakness). Reprinted from Amaddeo et al. [15] with permission from Elsevier.

Fig. 2.

Application algorithm for noninvasive and invasive ventilation in chronic respiratory failure (CRF) in children.