Technology and Ventilator Dependent Children

The Division of Pediatric Pulmonary Medicine cares for a number of children who are dependent on various degrees of advanced technology for their health. This includes a large number of children using oxygen supplementation for chronic lung disease, CPAP or BiPAP for Obstructive Sleep Apnea, or with chronic tracheostomy and/or gastrostomy placement. These children are typically seen as consultation cases whenever they are hospitalized at LeBonheur, and followed on a regular basis as outpatients in the Pediatric Pulmonology Clinics.

The one special clinic is our Apnea Monitor Clinic, held at least monthly, to help manage the children who have been discharged from any area hospital with a home apnea monitor. With appropriate evaluation and care, most of these children can be successfully and safely weaned from these devices within a few visits.

The most complicated patients, with invasive mechanical ventilation, are followed in our regular Pediatric Pulmonology Clinics. We provide some extra services to these patients, including a review by a Respiratory Therapist at every clinic visit, measurement of resting oxygen saturation level and end-tidal capnometry, and special nursing and nutritional evaluation as needed. Ventilator settings or weaning protocols can be adjusted in the Clinic, with additional oxygen saturation and capnometry testing as required. Most of our ventilator-dependent patients are associated with a single Pulmonologist, and will have most or all of their Clinic appointments with that physician.

Le Bonheur Children's Hospital has a well-establish training program for Technology Dependent Children, which is strongly supported by our Critical Care Division and the Pulmonology Division. Nurse Practitioners are provided by LeBonheur to help the resident physician staff and attending physician staff provide this complex care and make all of the necessary arrangements for eventual home placement. Experienced Respiratory Therapists assist the dedicated nursing staff in training the families in all the necessary skills, and documenting the mastery achieved by the family prior to discharge. The Pulmonology Division is closely involved in this long process, rounding on every patient in the Transitional Care Unit at least weekly , with a focus on their long-term care needs, their pathophysiology and their long-term management/weaning plans.