Hemodynamic stability during the past 2 weeks
Stable ventilatory parameters for the past 3 weeks, with FiO2 lower than 0.4. Last arterial blood gasses without acidosis
Permeable airway, mature tracheotomy
Negative viral respiratory study made during epidemic period
Carriage of multi-resistant bacteria study (enterococcus, positive ESBL, MRSA) performed during the 7 days prior to transfer
Ethics committee if necessary
Agreement to transfer by parents or guardians
Updated psychosocial report
Goals of Chronic Hospitalization
Perform weaning, decannulation or programmed oxygen assistance removal when possible.
Restore swallowing, phonation, general and respiratory musculature.
Insert the patient in a preschool or school environment as applicable.
Collaborate both in the social and psychological recovery of the child and their family.
Transferring the patient home, ideally after overcoming the reasons for admittance.
In order to reach these goals, the hospital or unit must have a highly specialized multidisciplinary team with defined roles, monitoring teams and ventilatory support, while also having access to support diagnosis and therapeutical units.
The leader of the team must be a pediatric pulmonologist, coordinating diagnosis, treatment, and rehabilitation, designating the starting and end point of mechanical ventilation and oxygen, picking out the team and ventilatory strategy, organizing diagnostic and therapeutic procedures, while also performing, interpreting, and reporting tests on pulmonary function, bronchoscopy, polysomnography, oximetry, and continuous capnography.
The team’s pediatrician is in charge of giving clinical attention, diagnosing, and treating respiratory exacerbations, coordinating health attention related to the general pathologies occurring from the child’s developmental status.
The team’s child neurologist must organize the neurorehabilitation team and evaluate, diagnose, and indicate pharmacological treatment of the neurological pathology.
The physiatrist is in charge of managing the rehabilitation team, performing diagnosis, indicating orthosis, and carrying out the necessary therapeutical procedures such as applying botox.
The nutritionist manages the clinical nutrition team and performs the nutritional evaluation and monitoring, diagnosing, as well as indicating the nutritional therapy to follow (energy intake and supplements). The dietitian is also in charge of defining the specifications and means of feeding.
Role of the Professional Team
Nurse: Manages care on the basis of models as the primary nurse and self-care, coordinates and supervises daily attention to the child, involving specific techniques and procedures. Trains professionals, technicians, and caregivers.
Respiratory physiotherapist: Delivers respiratory care and ventilatory therapy, implements manual and assisted airway permeation techniques, performs pulmonary function tests, and assists in the rehabilitation of respiratory musculature. Performs and monitors weaning and decannulation.
Motor physiotherapist: Determines motor diagnosis in the area of neurorehabilitation in order to develop the treatment plan. Intervenes in the case of a sensorimotor disfunction that limits patient functionality.
Occupational therapist: Promotes the acquisition of daily life skills (independence and autonomy). Designs, elaborates, and applies technical assistance (orthosis). Promotes play, social participation, and schooling of the child.
Dietist: Supervises the implementation of the diet as indicated by the nutritionist. Collaborates in diagnosis and prescription of nutritional therapy with the physician.
Speech-language pathologist: Performs rehabilitation of swallowing and phonation with or without assistance devices (like phonation valves).
Psychologist: Does psychological and social diagnoses. Gives psychological therapy to children in prolonged hospitalization. Comforts and supports parents and relatives of the patients.
Social worker: Evaluates habitability through the use of instruments and support networks’ management.