Abstract
Children with medical complexity (CMC) are a growing population of diagnostically heterogeneous children characterized by chronic conditions affecting multiple organ systems, the use of medical technology at home as well as intensive healthcare service utilization. Many of these children will experience either a respiratory-related complication and/or they will become established on respiratory technology at home during their care trajectory. Therefore, healthcare providers need to be familiar with the respiratory related complications commonly experienced by CMC as well as the indications, technical and safety considerations and potential complications that may arise when caring for CMC using respiratory technology at home. This review will outline the most common respiratory disease manifestations experienced by CMC, and discuss various respiratory-related treatment options that can be considered, including tracheostomy, invasive and non-invasive ventilation, as well as airway clearance techniques. The caregiver requirements associated with caring for CMC using respiratory technology at home will also be reviewed.
Highlights
Advances in medical care and technology have led to an increasing prevalence of children with medical complexity (CMC) [1]
Children with medical complexity are predisposed to sialorrhea often because of comorbid swallowing dysfunction, which can be attributed to a lack of coordinated control of the oropharyngeal musculature, lack of awareness of oral incompetence, impaired sensation to the lower lip or a functional and/or structural inability to close the mouth [38]
Children with medical complexity are at increased risk of developing respiratory problems, which may be related to sleep disordered breathing (SDB), impaired cough clearance, and aspiration
Summary
Advances in medical care and technology have led to an increasing prevalence of children with medical complexity (CMC) [1]. (1) chronic health conditions (diagnosed or suspected); (2) severe functional limitations often associated with technology dependence; (3) substantial healthcare needs and (4) high utilization of the healthcare resources [1] They are deemed the most complex of children with special health care needs (CSHCN), which describes a broad group of children with medical, developmental or psychiatric conditions [2]. Still quite small in absolute numbers (i.e., less than 1% of children), CMC accounts for a large proportion of all childhood healthcare expenditure [4]. They account for 10% of pediatric hospital admissions and approximately one-quarter will experience readmission within. The management of respiratory complications including respiratory technology options for home use will be detailed in this review
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