PEDIATRICIAN Spring 2003 - AAP-CA

TWENTY-FIVE YEARS OF HOME MECHANICAL VENTILATION IN CHILDREN CONTINUED FROM PAGE 21
ventilation. We generally keep the end-tidal
Pco 2
at values between 30-35 torr at all times
to provide the children with some respiratory
reserve in the event of an illness. It is imperative
that each child has a general pediatrician
participate in her overall care.
Mechanical ventilation is not always a
life-long therapy. Some of the children may
be weaned from ventilation depending on
the underlying lung disease. The types of
patients that can be weaned include those with
chronic lung disease and some children with
ventilatory muscle weakness. The process of
weaning, also known as “sprinting,” should
be gradual, with brief periods of time breathing
spontaneously off the ventilator. These are
progressively increased as long as the patient
tolerates the changes. The tolerance of the
weaning regimen can be assessed clinically
and objectively by means of oximetry and
carbon dioxide monitoring. These children are
weaned during waking hours first and should
be able to tolerate this regimen before considering
changes in nighttime ventilation.
The goals of home ventilation are: 1) to
ensure medical safety, 2) prevent and minimize
complications, 3) optimize quality of life and
rehabilitation potential, and 4) reintegrate the
child back into the family. The success of a
home ventilator program is dependent on the
dedicated and integrated services provided by
the hospital and the community. Once an infant
or child is deemed to need home mechanical
ventilation, the coordinated effort for transition
from hospital to home is dependent on
multiple factors including: the availability of
ventilators, the education of the parents, and
the availability of home nursing. Criteria for
discharge to home are: medical stability with
stable ventilatory settings, family commitment
to home care, education of parents regarding
technical aspects of care of children with
mechanical ventilation, adequate home care
environment (power, telephone and electricity),
access to emergency services, and vendor
services as well as access to a pediatrician.
Local pulmonary services should be consulted
to help plan the process of implementing ventilatory
support.
In summary, home ventilation has
approached a new era with many changes in
the last 25 years. With the new technology,
children with severe lung disease are able to
live at home and reintegrate into their families
with a reasonably good quality of life. The
transition from hospital to home is possible
with more portable technology and with the
dedication of all those involved in the program,
in the hospital and in the community.
Address Correspondence to:
Thomas G. Keens, M.D.
Division of Pediatric Pulmonology
Childrens Hospital Los Angeles
4650 Sunset Boulevard, Box #83
Los Angeles, California 90027-6062
Phone: 323/669-2101
FAX: 323/664-9758
E-Mail: tkeens@chla.usc.edu
Head to Toe: Orthopaedic Aspects of the Growing Child.
Orthopaedic problems are a common cause of concern for parents and a frequent reason for
visiting the primary care provider. The evaluation and treatment of these problems is rapidly
evolving. This course will focus on orthopaedic problems commonly encountered by primary
care physicians (pediatricians and family practitioners), including congenital abnormalities of the
hip and feet, fractures, sports injuries, and developmental deformities such as lower extremity
bowing and leg length discrepancies. Participants will have the opportunity to actively discuss
these problems with experts in the field.
SATURDAY, October 18, 2003
7:30 am to 4:30 pm
Cedars-Sinai Medical Center
Harvey Morse Auditorium
8701 Gracie Allen Drive
Los Angeles, California
For additional information call the Office of Continuing Medical Education at
(310) 423-5548 or 423-2935; you may also email: stokes@cshs.org
CALIFORNIA PEDIATRICIAN — SPRING 2003/ 27