Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue
Valeria Caldarelli,
Federica Porcaro,
Paola Di Filippo,
Marina Attanasi,
Valentina Fainardi,
Marcella Gallucci,
Angelo Mazza,
Nicola Ullmann,
Stefania La Grutta
Affiliations
Valeria Caldarelli
Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
Federica Porcaro
Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
Paola Di Filippo
Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
Marina Attanasi
Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy
Valentina Fainardi
Cystic Fibrosis Unit, Department of Paediatrics, Parma University Hospital, 43126 Parma, Italy
Marcella Gallucci
Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy
Angelo Mazza
Department of Pediatrics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
Nicola Ullmann
Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
Stefania La Grutta
Institute of Traslational Pharmacology IFT, National Research Council, 90146 Palermo, Italy
Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents.
