Acute Care for the Chronically Ventilated Child

Children are discharged home on mechanical ventilation because of pulmonary, cardiac, anatomic, neuromuscular, central nervous system, or metabolic reasons. These children are extremely vulnerable and have complex medical needs. They often present to the emergency department with respiratory symptoms that may be related to their underlying condition, to an intercurrent illness, or due to equipment failure. These children require a thorough evaluation that includes a complete review of underlying medical problems and an assessment of the airway and ventilator equipment. It is important to remember that in addition to cardiopulmonary reasons, central nervous system and metabolic processes may produce respiratory distress. The decision to admit the child to the hospital or to discharge home is equally complex. In addition to the child's severity or complexity of illness, factors to consider include availability and competency of home caregivers, integrity of essential ventilator equipment, reliability and safety of transport, and plan for follow-up care.