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- Debbie S. Toder, MD*
- John T. McBride, MD†
- *Assistant Professor of Pediatrics, Wayne State University School of Medicine, Detroit, MI
- †Professor of Pediatrics and Chief of Pediatric Pulmonology, University of Rochester,NY School of Medicine and Dentistry, Rochester, NY.
Increasing numbers of children who depend on respiratory technology live and are cared for at home rather than in the hospital. Families’ and caregivers’ concern for developmental and psychosocial advantages and insurance companies’ concern for cost savings have motivated the shift to home care. Coincidental advances in technology have facilitated this change. Although a child’s need may be simple—perhaps just nocturnal oxygen—for many children, respiratory technology is only one aspect of a complicated, multi-faceted care plan.
This review describes our centers’ approaches to several aspects of chronic home therapy, including oxygen therapy, tracheostomy, and mechanical ventilation. Most of these approaches have not been studied critically, and the practices of various centers across the country may vary considerably.
Oxygen
CANDIDATES
Oxygen, usually delivered by nasal cannula, frequently is indicated to correct the hypoxemia of chronic lung diseases in childhood and, more rarely, that which is associated with resolving acute lung disease or obstructive sleep apnea.
Infants who have bronchopulmonary dysplasia (BPD) comprise the largest group benefiting from home oxygen therapy. Adequate oxygenation in these infants improves growth, prevents the development of right ventricular hypertrophy (or prevents its worsening), and improves sleep. A liter-flow and delivery system to maintain oxygen saturations in the mid or high 90s with, at most, minor adjustments for feeding and sleep should be chosen. Safe discharge from the nursery can be considered when an infant is stable and has demonstrated growth on therapy that the family can provide at home.
Children who have other forms of chronic lung disease such as cystic fibrosis or interstitial lung disease and who exhibit hypoxemia also will benefit from home oxygen therapy. In many instances, oxygen is required only during sleep or with exercise. Oxygen supplementation during exercise may allow individuals who otherwise would limit their activity or the intensity or duration of …
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