1997 OPEN FORUM Abstracts
Invasive bi-level pressure ventilation in neonates, infants and children. A retrospective on three years utilization
Curtis Bauer, M.A., C.R.T.T., Monday, December 8, 1997.
BACKGROUND: The ventilation of infant and pediatric patients at home has become a standard practice for respiratory care practitioners. Conventional pressure ventilation, when applied at home, poses inherent variables: 1) noise, size and weight of compressor and oxygen systems; 2) a detailed, ventilatory, humidification and alarm system; 3) limited mobility and patient access; 4) transportation constraints; 5) frequent hospital readmissions for either respiratory or other systemic complications; 6) a fusion at crib side of patient care area and the infant's safe area which fosters parental and family bonding. Since 1993, we have successfully used an invasive bi-level ventilatory support system as an effective, safe alternative to conventional pressure ventilation at home.
METHOD: Four infants ventilated at home via invasive bi-level pressure were selected for retrospective case examination and parental interview.
PROCEDURAL HISTORY AND REVIEW: All four infants were either born, or transported and cared for in a level 3 neonatal intensive care unit at a regional, tertiary care facility. Respiratory stabilization and treatment history included high frequency ventilation (N=3) and conventional ventilation (N=4). Once acute respiratory and systemic problems were controlled and the need for prolonged pressure ventilation at home was determined, the infants were transitioned to the Respironic's Bi-Pap S/T ventilation system modified for invasive application. Parental consent was obtained and a waiver of liability was signed prior to institution of Bi-Pap ventilation. Patient tolerance was monitored throughout the NICU stay via capnography, pulse oximetry and capillary gases. Once patient tolerance was documented and systemic problems corrected, the patient and family were prepared for discharge following standard homecare policy and procedure for home ventilation.
DATA AND Results: Diagnosis for home ventilation included: Congenital Myopathy (N=1), BPD (N=2) and Hypertrophic Cardiomyopathy (N=1). Average length of hospital stay was 264 days. Average days of conventional pressure ventilation was 193 days. Average days of bi-level pressure ventilation prior to discharge was 54 days. High frequency ventilation averaged 3 days. All infants showed positive weight and height growth records corrected for age. 3 infants were ventilated and subsequently weaned at home. Decannulation occurred at 19, 20 and 29 months. Average length of home bi-level pressure ventilation was 23 months. One infant death occurred at 15 months of age following 155 days of bi-level ventilation at home secondary to cardiomyopathy. Hospital readmission data: tracheitis (N=1), VP shunt revision (N=1), fundoplication (N=2), bronchospasm unrelieved by conventional therapy at home (N=4), RSV (N=3), chronic ottitis with PE tube insertion (N=1), respiratory infection (N=2), tracheal reconstruction surgery (N=1), bronchoscopy (N=1), and decannulation observation (N=2). Parental interview related: 1) increased ease of mobility and locomotion; 2) increased opportunity for parental and family bonding; 3) increased opportunity for restoration of the family unit; 4) increased ease of care at bedside; 5) decreased complaints of physical, mechanical or technical problems; 6 ) overall sense of ease with home ventilation environment versus NICU atmosphere.
CONCLUSION: The Bi-Pap S/T ventilation system augmented for invasive application has proven to be an effective means of pressure ventilation in our neonatal, infant and child populations. The system alleviates many of the inherent problems associated with in home conventional pressure ventilation and contributes to an environment conducive to medical, physical and social development.
AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.