An official American thoracic society clinical practice guideline: Pediatric chronic home invasive ventilation

Laura M. Sterni, Joseph M. Collaco, Christopher D. Baker, John L. Carroll, Girish D. Sharma, Jan L. Brozek, Jonathan D. Finder, Veda L. Ackerman, Raanan Arens, Deborah S. Boroughs, Jodi Carter, Karen L. Daigle, Joan Dougherty, David Gozal, Katharine Kevill, Richard M. Kravitz, Tony Kriseman, Ian MacLusky, Katherine Rivera-Spoljaric, Alvaro J. ToriThomas Ferkol, Ann C. Halbower

Research output: Contribution to journalArticlepeer-review

169 Scopus citations


Background: Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. Purpose: To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation. Methods: The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questionsof clinical importance andusedan evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations. Results: Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed. Conclusions: Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child's care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available.

Original languageEnglish
Pages (from-to)e16-e35
JournalAmerican journal of respiratory and critical care medicine
Issue number8
StatePublished - Apr 15 2016


  • Children
  • Discharge planning
  • Mechanical ventilators
  • Medical home
  • Respiratory insufficiency


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