Henningfeld Jennifer K, Maletta Kristyn, Ren Bixiang, Richards Kathie L, Wegner Carole, D'Andrea Lynn A
Department of Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, 53226, Wisconsin.
National Outcomes Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
Pediatr Pulmonol. 2016 Aug;51(8):838-49. doi: 10.1002/ppul.23396. Epub 2016 Feb 25.
The prevalence of children requiring outpatient invasive long-term mechanical ventilation is increasing. For some children, liberation from home mechanical ventilation (HMV) and decannulation is the desired outcome. This study describes our experience liberating tracheostomy and HMV (T-HMV) dependent children from respiratory technologies.
We reviewed charts of T-HMV dependent children who were cared for at our institution and decannulated between July 1999 and December 2011. Patient characteristics, diagnoses, and important steps leading to decannulation were recorded.
Forty-six children achieved HMV independence and decannulation. The most common indications for T-HMV were lower airway and parenchymal lung disease. The median ages at tracheotomy, initiation of HMV, initiation of tracheostomy collar (TC) trials, HMV independence, and decannulation were 3.5, 6.0, 12.0, 25.5, and 40.5 months, respectively. Twenty-five children (54%) skipped either using a speaking valve, tracheostomy capping, or both without increased likelihood of recannulation. (P = 0.03). Common procedures prior to decannulation were airway surgery, bronchoscopy, and polysomnography (n = 30, 46, and 46 children, respectively). A median of 9.5 clinic visits and 5 hospitalizations occurred from initial hospital discharge to just prior to decannulation. HMV was primarily weaned as an outpatient.
Liberation from respiratory technology is a complex, multi-step process that can be accomplished in medically complex children with varying underlying disease processes at relatively young ages. Five major steps (tracheotomy, initiation of HMV, initiation of TC trials, HMV independence, and decannulation) performed in conjunction with clinic visits, procedures, and home nursing support were integral in the successful decannulation process. Pediatr Pulmonol. 2016;51:838-849. © 2016 Wiley Periodicals, Inc.
需要门诊有创长期机械通气的儿童患病率正在上升。对于一些儿童来说，脱离家庭机械通气（HMV）并拔除气管套管是期望的结果。本研究描述了我们使依赖气管造口术和HMV（T-HMV）的儿童脱离呼吸技术的经验。
我们回顾了1999年7月至2011年12月在我们机构接受治疗并拔除气管套管的依赖T-HMV儿童的病历。记录了患者特征、诊断以及导致拔除气管套管的重要步骤。
46名儿童实现了HMV自主并拔除气管套管。T-HMV最常见的指征是下气道和实质性肺部疾病。气管切开术、开始HMV、开始气管套管颈（TC）试验、HMV自主和拔除气管套管的中位年龄分别为3.5个月、6.0个月、12.0个月、25.5个月和40.5个月。25名儿童（54%）跳过了使用说话瓣膜、气管造口盖帽或两者，且再次插管的可能性未增加（P = 0.03）。拔除气管套管前的常见操作是气道手术、支气管镜检查和多导睡眠图（分别为30名、46名和46名儿童）。从首次出院到即将拔除气管套管期间，平均门诊就诊9.5次，住院5次。HMV主要作为门诊治疗逐渐撤机。
脱离呼吸技术是一个复杂的多步骤过程，在患有不同潜在疾病过程的医学复杂儿童中，相对年轻时即可完成。与门诊就诊、操作和家庭护理支持相结合进行的五个主要步骤（气管切开术、开始HMV、开始TC试验、HMV自主和拔除气管套管）是成功拔除气管套管过程中不可或缺的。《儿科肺科》。2016；51：838 - 849。©2016威利期刊公司。
