Management of gastrointestinal and nutritional problems in
children on home invasive mechanical ventilation
Advances in neonatal/pediatric intensive care units and mechanical
ventilation (MV) over the last three decades have increased the patient
survival in worldwide. Despite increased survival, the patients who
couldn’t be weaned from MV in intensive care units due to chronic
respiratory failure caused by different etiologies, have been emerged
the need of MV support at home. With the development of more modern and
advanced home ventilators, home invasive mechanical ventilation (HIMV)
has been used widely in children with chronic respiratory failure all
over the world1-3.
The children who have progressive respiratory failure or who could not
weaned from MV in intensive care units need long term mechanical
ventilation. When a non-invasive MV support is not an option, invasive
MV support via tracheostomy can be continued at home, after clinical
stability have been established at hospital1,4. To be
a clinically stable child the followings are required; a stable airway,
stable oxygen requirement (< 40%), stable ventilator settings
that haven’ been changed over a period of time, the need for infrequent
laboratory testings, a stable home care plan and an adequate nutrition
to maintain growth1,4. A safe and stable enteral
feeding is as important as a stable airway. While preparing the child to
discharge, not just preparation for MV, but also a detailed nutritional
assessment and adjustment should be done. The caregiver (the parents,
the homecare providers) training should be performed not only for MV,
but also for nutritional issues before discharge. Besides giving
information for the acute life-threatening events related to MV and
underlying disease, the importance of nutrition and negative effects of
inadequate nutrition on growth, development and respiratory functions
should be explained1,5.
In childhood HIMV is generally required for neuromuscular, central
nervous system and cardiopulmonary disorders. The indications for HIMV
support in children are given in Table 1. The majority of these children
have neuromuscular disorders, therefore it is not possible to directly
associate the gastrointestinal and nutritional problems with mechanical
ventilation1-3.