Çocuk Hastalarda Evde İnvaziv Mekanik Ventilasyon Uygulamaları: Güncel Rehberler ve Yol Haritası

Evde mekanik ventilasyon (EMV) desteği uygulanan çocukların sayısında son 25 yıl içinde artış olduğu bilinmektedir. Bu çocukların güvenli bir şekilde taburcu olmaları ve evde etkin bir şekilde takip edilmelerini sağlamak amacıyla, kanıta dayalı klinik uygulama rehberleri geliştirilmiştir. Son yıllarda yapılan araştırmalar, hastaların güvenliğini tehlikeye sokmadan taburcu edilme süreçlerinin hızlandırılması üzerine odaklanmıştır. Bu amaçla; hastanede ve toplumda farklı disiplinlerde çalışan ekipler arasında işbirliği sağlanması, olgu koordinatörleri, güvenli trakeostomi için kalite geliştirme girişimleri gibi uygulamalar ile hastaların takip süreçleri yönetilmeye başlanmıştır. Ayrıca, hastanın bakımını sağlayacak kişilere eğitim verilmesinin (simülasyon eğitimleri, taburculuk sonrasında eğitimlere devam edilmesi, kompleks bakım merkezleri kurulması, elektronik sistemler ve teletıp) evde hemşirelik bakımı, dayanıklı tıbbi ekipman sağlanması gibi uygulamalarla desteklenmesinin de süreç üzerinde olumlu etkileri olduğu tespit edilmiştir. Diğer taraftan, Amerika Birleşik Devletleri ve Avrupa Birliği’ne dahil ülkelerde, EMV uygulaması konusundaki süreçlerin ve yapıların değerlendirilmesi amacıyla gerçekleştirilen anket çalışmalarında sağlık hizmetlerinin yetersiz kaldığı ve bakım kalitesinin geliştirilmesi için mevcut program ve yöntemlerin ciddi bir şekilde gözden geçirilmesi gerektiği sonucuna varılmıştır. EMV uygulamalarına ilişkin rehberler kaynak alınarak hazırlanan bu derlemede, güncel bilgilerin aktarılmasının yanı sıra, söz konusu hastaların morbiditelerinin azaltılabilmesi için, mevcut koşullar altında ülkemizde yapılabilecek düzenlemelere dair önerilerin paylaşılması amaçlanmıştır.

Pediatric Home Invasive Ventilation: Current Guidelines and Road Map

The number of children requiring long-term home ventilation (HMV) has consistently increased over the last 25 years. Evidence-based clinical practice guidelines are developed for the safe hospital discharge and home management of children requiring chronic invasive ventilation. Recent studies have focused on improving discharge processes without jeopardizing patient safety by means of establishing standardized discharge processes (multidisciplinary collaborative teams providing both primary and subspecialty care, case coordinators, quality improvement initiatives of safe tracheostomy practices, etc.), emphasizing caregiver education and consistency of care (training programmes including the use of simulation training, ongoing education of family and in-home professional caregivers in the outpatient setting, complex care centres, novel approaches such as electronic systems, telemedicine), and advocacy efforts for providing home nursing and durable medical equipment. On the other hand, survey studies conducted in United States of America and European Union countries have assessed the structures and processes of care in place for these children and concluded that health services are not yet coping with this growing number of children and that rigorous evaluation of current programs and practices is needed in order to improve care quality. In the current review, we aim to establish best practices required for enhanced care to reduce morbidities in this vulnerable population in our country according to the recent published studies and guidelines.

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