Maria Giovanna Paglietti1, Federica Porcaro1, Aleksandar Sovtic2, Claudio Cherchi1, Elisabetta Verrillo1, Martino Pavone1, Sergio Bottero3, Renato Cutrera1. 1. Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy. 2. Department of Pulmonology, Mother and Child Health Institute and School of Medicine University of Belgrade, Serbia. 3. Airway Surgery Unit, Department Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Abstract
RATIONALE: Long-life ventilatory assistance is necessary for survival in pediatric patients with congenital central hypoventilation syndrome (CCHS). Invasive mechanical ventilation (IMV) through tracheostomy is the most used method, especially in the first years of life when the central nervous system is maturing. Nevertheless, IMV via tracheostomy is not ideal because tracheostomy in children is associated with impaired speech and language development, also frequent infections of the lower airway tract occur. OBJECTIVE: Only few reports describe the transition from IMV to the noninvasive method, ending with decannulation in CCHS affected patients. We aim to provide our experience regarding decannulation program in CCHS affected children and to describe a proposal of an algorithm concerning transition from invasive to noninvasive ventilation (NIV) in CCHS patients. METHODS: The study has been conducted retrospectively. Four children from two European centers underwent tracheostomy removal and decannulation, upon request of patients and their families. RESULTS: All children were trained to carry out tracheostomy capping before decannulation and underwent endoscopic assessment of upper and lower airway. Subsequently they started training to NIV at mean age of 106.25 months (±40.7 SD). Decannulation occurred 12 months after and no patients needed the reintroduction of tracheal cannula in either short or long term follow up. CONCLUSIONS: our study shows that effective liberation from IMV, the transition to NIV and decannulation are possible in CCHS affected children and offers a proposal of an algorithm which can be applied in selected centers.
RATIONALE: Long-life ventilatory assistance is necessary for survival in pediatric patients with congenital central hypoventilation syndrome (CCHS). Invasive mechanical ventilation (IMV) through tracheostomy is the most used method, especially in the first years of life when the central nervous system is maturing. Nevertheless, IMV via tracheostomy is not ideal because tracheostomy in children is associated with impaired speech and language development, also frequent infections of the lower airway tract occur. OBJECTIVE: Only few reports describe the transition from IMV to the noninvasive method, ending with decannulation in CCHS affected patients. We aim to provide our experience regarding decannulation program in CCHS affected children and to describe a proposal of an algorithm concerning transition from invasive to noninvasive ventilation (NIV) in CCHSpatients. METHODS: The study has been conducted retrospectively. Four children from two European centers underwent tracheostomy removal and decannulation, upon request of patients and their families. RESULTS: All children were trained to carry out tracheostomy capping before decannulation and underwent endoscopic assessment of upper and lower airway. Subsequently they started training to NIV at mean age of 106.25 months (±40.7 SD). Decannulation occurred 12 months after and no patients needed the reintroduction of tracheal cannula in either short or long term follow up. CONCLUSIONS: our study shows that effective liberation from IMV, the transition to NIV and decannulation are possible in CCHS affected children and offers a proposal of an algorithm which can be applied in selected centers.
Authors: Ajay S Kasi; Neesha Anand; Kelli-Lee Harford; April M Landry; Kristan P Alfonso; Melissa Taylor; Thomas G Keens; Roberta M Leu Journal: Sleep Breath Date: 2021-04-14 Impact factor: 2.816
Authors: Ha Trang; Martin Samuels; Isabella Ceccherini; Matthias Frerick; Maria Angeles Garcia-Teresa; Jochen Peters; Johannes Schoeber; Marek Migdal; Agneta Markstrom; Giancarlo Ottonello; Raffaele Piumelli; Maria Helena Estevao; Irena Senecic-Cala; Barbara Gnidovec-Strazisar; Andreas Pfleger; Raquel Porto-Abal; Miriam Katz-Salamon Journal: Orphanet J Rare Dis Date: 2020-09-21 Impact factor: 4.123