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.