title: An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation.
abstract: 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.
  
  
  OBJECTIVE
  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 questions of clinical importance and used an 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.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Sterni
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Collaco
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Baker
authors.forename: John L
authors.initials: JL
authors.lastname: Carroll
authors.forename: Girish D
authors.initials: GD
authors.lastname: Sharma
authors.forename: Jan L
authors.initials: JL
authors.lastname: Brozek
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Finder
authors.forename: Veda L
authors.initials: VL
authors.lastname: Ackerman
authors.forename: Raanan
authors.initials: R
authors.lastname: Arens
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Boroughs
authors.forename: Jodi
authors.initials: J
authors.lastname: Carter
authors.forename: Karen L
authors.initials: KL
authors.lastname: Daigle
authors.forename: Joan
authors.initials: J
authors.lastname: Dougherty
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.forename: Katharine
authors.initials: K
authors.lastname: Kevill
authors.forename: Richard M
authors.initials: RM
authors.lastname: Kravitz
authors.forename: Tony
authors.initials: T
authors.lastname: Kriseman
authors.forename: Ian
authors.initials: I
authors.lastname: MacLusky
authors.forename: Katherine
authors.initials: K
authors.lastname: Rivera-Spoljaric
authors.forename: Alvaro J
authors.initials: AJ
authors.lastname: Tori
authors.forename: Thomas
authors.initials: T
authors.lastname: Ferkol
authors.forename: Ann C
authors.initials: AC
authors.lastname: Halbower
mesh_terms: D017028:Caregivers; D002648:Child; D002908:Chronic Disease; D006699:Home Care Services; D006801:Humans; D010351:Patient Discharge; D010372:Pediatrics; D012121:Respiration, Artificial; D012952:Societies; D014481:United States
keywords: children; discharge planning; mechanical ventilators; medical home; respiratory insufficiency