ATS GUIDELINES Bundle

Pediatric Chronic Home Ventilation

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2 Key Points ➤ Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. ➤ Standardized hospital discharge criteria are suggested. ➤ An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child's care. ➤ Home equipment requires proper maintenance of all equipment and regular review of ventilator settings. Management Summary of Recommendations ➤ Recommendation 1: For children requiring chronic home invasive ventilation, we suggest a comprehensive Medical Home comanaged by the generalist and respiratory subspecialist. (conditional recommendation; very low quality evidence) • The Medical Home model can provide family-centered care for children with special health care needs, including children on home invasive ventilation. This recommendation places a high value on the possible medical and social benefits to this intervention and places low value on the potential risks, which may include increased provider time. ➤ Recommendation 2: For children requiring chronic invasive ventilation, we suggest the use of standardized discharge criteria to objectively assess readiness for care in the home. (conditional recommendation; very low quality evidence) • The Workgroup believed that comprehensive standardized discharge criteria would encourage a complete review of each patient's medical stability and home situation to facilitate safe discharge. The goal is to identify and eliminate important barriers to care in the home before discharge and consider alternate care arrangements if obstacles cannot be eliminated. Weight given to each component of the proposed criteria would vary from patient to patient. The recommendation places high value on the potential benefits of considering all facets of a child's care in the home before discharge and low value on the increased provider time and resource use that may be required.

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