Children Dependent on Respiratory Technology

Abstract The number of children who require chronic mechanical ventilation has grown with improvements in care, assistive technologies, and philosophical approaches to some progressive diseases. The causes of chronic respiratory failure include respiratory pump dysfunction, abnormal respiratory drive, and airway, parenchymal, or pulmonary vascular disorders. The goals of chronic mechanical ventilatory support, however, are independent of the etiology of respiratory failure. Children considered for chronic mechanical ventilation at home must be medically stable, have a family committed to learning all aspects of the child's care, and adequate funding to support the cost of equipment, supplies, and skilled care. Technological improvements in equipment have broadened options to improve patient-ventilator synchrony and comfort. Outcomes of ventilator-assisted children depend in part on the etiology of their underlying illness, with those diseases likely to improve over time also being the most likely to permit liberation from chronic ventilatory support. Underlying disease impacts survival as well, although some children with chronic respiratory failure die of complications from other comorbidities or from tracheostomy-related accidents. Ventilator-assisted childrens' quality of life is generally good, but their care is stressful for their families. Challenges in developing better equipment for very young patients, and in supporting patients and their families to gain better access to public resources like school, transportation, and housing as well as services to avoid caregiver fatigue, take on increased importance as this population continues to grow. Health care systems must also develop transition programs for older ventilator-dependent children as they reach adulthood.