Mechanical Ventilation Invasive
Clinical Description – Mechanical ventilation invasive
Care of the hospitalized child experiencing the need for controlled or assisted breathing through an artificial airway.
Key Information
- Cuff must be deflated (if present) prior to using a speaking valve or capping a tracheostomy tube. Tubes used in children younger than 8 years of age may not have a cuff, as the tube is positioned in the narrowest portion of the cricoid cartilage and acts as the cuff.
- Laryngeal mask airways may be used for short-term use to facilitate breathing; however, they do not offer aspiration protection and should be changed to an endotracheal tube if there is a need for a prolonged artificial airway.
- To reduce the risk of pulmonary aspiration, a swallow evaluation should be performed prior to oral intake or feeding.
- Pediatric-sized and smaller tracheostomies may not have an inner cannula. If an inner cannula is not present, the tracheostomy tube should be changed on a regular schedule to prevent obstruction of the single lumen.
- Enteral feeding is preferred over parenteral due to physiologic benefits, such as gut integrity and function, stress ulcer prophylaxis and reduction of infection risk.
- In patients younger than 8 years of age, there is no evidence to support the use of cuffed or uncuffed tubes. Clinician discretion should be used.
- Evidence regarding pediatric ventilator-induced lung injury, lung protective measures and ventilator-associated pneumonia prevention originates from adult research.
Clinical Goals
By transition of care
A. The patient will demonstrate achievement of the following goals:
- Effective Communication
- Optimal Device Function
- Mechanical Ventilation Liberation
- Optimal Nutrition Delivery
- Absence of Device-Related Skin and Tissue Injury
- Absence of Ventilator-Induced Lung Injury
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