Transitioning children using home invasive mechanical ventilation from hospital to home: Discharge criteria, disparities, and ethical considerations
Corresponding Author
Jennifer Henningfeld MD
Department of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Correspondence Jennifer Henningfeld, MD, Department of Pediatric Pulmonology and Sleep Medicine, Medical College of Wisconsin, 9000 W Wisconsin Ave., Milwaukee, WI 53226, USA.
Email: [email protected]
Search for more papers by this authorAnnie B. Friedrich PhD
Center for Bioethics and Medical Humanities and Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorGrace Flanagan RRT
Department of Respiratory Care Services, Children's Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorCynthia Griffith RN
Department of Respiratory Care Services, Children's Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorAnna Hughes PNP
Paediatric Respiratory Department, Royal Manchester Children's Hospital, Manchester, UK
Search for more papers by this authorLisa Molkentine RRT
Department of Respiratory Care Services, Children's Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorRebecca Steuart MD
Section of Special Needs and Complex Care Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorStuart Wilkinson MD
Paedaitric Respiratory Department, Royal Manchester Childrens Hospital, Manchester University, Manchester, UK
Search for more papers by this authorChristopher D. Baker MD
Department of Pediatrics—Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorCorresponding Author
Jennifer Henningfeld MD
Department of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Correspondence Jennifer Henningfeld, MD, Department of Pediatric Pulmonology and Sleep Medicine, Medical College of Wisconsin, 9000 W Wisconsin Ave., Milwaukee, WI 53226, USA.
Email: [email protected]
Search for more papers by this authorAnnie B. Friedrich PhD
Center for Bioethics and Medical Humanities and Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorGrace Flanagan RRT
Department of Respiratory Care Services, Children's Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorCynthia Griffith RN
Department of Respiratory Care Services, Children's Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorAnna Hughes PNP
Paediatric Respiratory Department, Royal Manchester Children's Hospital, Manchester, UK
Search for more papers by this authorLisa Molkentine RRT
Department of Respiratory Care Services, Children's Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorRebecca Steuart MD
Section of Special Needs and Complex Care Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Search for more papers by this authorStuart Wilkinson MD
Paedaitric Respiratory Department, Royal Manchester Childrens Hospital, Manchester University, Manchester, UK
Search for more papers by this authorChristopher D. Baker MD
Department of Pediatrics—Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorAbstract
Children using home invasive mechanical ventilation (HIMV), a valuable therapeutic option for chronic respiratory failure, constitute a growing population. Transitioning children using HIMV from hospital to home care is a complex process that requires a multidisciplinary approach involving healthcare professionals, caregivers, and community resources. Medical stability, caregiver competence, and home environment suitability are essential factors in determining discharge readiness. Caregiver education and training play a pivotal role in ensuring safe and effective home care. Simulation training and staged education progression are effective strategies for equipping caregivers with necessary skills. Resource limitations, inadequate home nursing support, and disparities in available community resources are common obstacles to successful HIMV discharge. International perspectives shed light on diverse healthcare systems and challenges faced by caregivers worldwide. While standardizing guidelines for HIMV discharge may be complex, collaboration among healthcare providers and the development of evidence-based regional guidelines can improve outcomes for children using HIMV and their caregivers. This review seeks to synthesize literature, provide expert guidance based on experience, and highlight components to safely discharge children using HIMV. It further assesses disparities and divergences within regional and international healthcare systems while addressing relevant ethical considerations.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no data sets were generated or analyzed during the current study.
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