(What’s wrong with oxygen?) Jonathan Finder, MD Professor of Pediatrics University of Pi7sburgh School of Medicine Children’s Hospital of Pi7sburgh !A
  voidable !  Preventable !  Treatable !   Most serious illness is respiratory !   New technologies & paradigms !   Specialized tesMng Kevin, age 14
1.  Support airway clearance 2.  Support breathing !   Preferably using a non-­‐
invasive approach 1.  Normal respiratory funcMon -­‐ 
Birth to age 10 or so 2.  Weak cough -­‐ 
Early teens 3.  Inadequate breathing in sleep -­‐ 
Mid teens 4.  Inadequate breathing all the Mme -­‐ 
Mid-­‐late teens/20’s !   Physical therapy directed to chest wall !   A good idea to get immunized against influenza annually and to receive Pneumovax once !   Annual screening Pulmonary func1on tests > age 6 !   Find a respiratory specialist for your child !  May not know unMl you get a cold !  Predictable with pulmonary funcMon tesMng !  Main risk is PNEUMONIA !  Difficulty clearing secreMons with colds Manually assisted cough: deep breath (AMBU bag) followed by forced exhalaMon. Mechanically assisted cough: !
!
Respironics CoughAssistTM -­‐-­‐ (courtesy of John Bach, MD). !   Nippy Clearway ! Dima Italia Pegaso Cough !
!
!
h7p://www.healthcare.philips.com/main/homehealth/
respiratory_care/coughassist/default.wpd h7p://www.nippyvenMlator.com/about-­‐us/nippy-­‐clearway/ Deep breath with Ambu bag then a forced exhale Abdominal thrust while stabilizing chest
In-exsufflator
Thoracic squeeze CoughAssist E70 !
!
!
!
!
!
  Smaller, portable   PaMent triggered   Can run off car power   No knobs – all electronic   Foot pedal   Smart card h7p://coughassiste70.respironics.com
Pegaso Cough by Dima Italia !   Assisted cough (CoughAssistTM) USE IT DAILY and especially with colds !   The best way of prevenMng pneumonia, most reliable means… !   ImmunizaMons (influenza and Pneumovax) !   Prompt medical a7enMon and resp. support with colds/lower resp. infecMons !   My paMent are given a home pulse oximeter. !   SaturaMon < 95% = aggressive airway clearance (CoughAssist) ! DO NOT USE O2 as a subsMtute for cough or weak breathing muscles ! Too much oxygen in a paMent with CO2 retenMon can precipitate respiratory failure and arrest! !   Symptoms may be subtle !   faMgue, lack of resoul sleep, morning headache, nightmares, increased awakenings !   Easy to detect (overnight, in-­‐home pulse oximetry or sleep study in hospital) !   Most common soluMon is BiPAP !   Bilevel PosiMve Airway Pressure Getting the interface to match
!   This stage open occurs following a severe infecMon, like a pneumonia !   Respiratory insufficiency can be shown with PFT’s !   No longer is tracheostomy mandated at this stage !   Nearly all paMents at this stage will require nutriMonal support via gastrostomy Portable venMlator with a mouthpiece a7ached (like a microphone) to wheelchair !   E.g., PulmoneMc LTV 1150; Respironics Trilogy !   Tremendous improvement in energy level and quality of
life Patrick, age 26, graduaMng from Pi7 Law, 2004 AJRCCM, 2004. Finder, et al.
!   ANTICIPATORY approach to care !   NON-­‐INVASIVE approach to care !   COLLABORATIVE approach to care: !
!
!
!
!
 
 
 
 
 
Pulmonologist NutriMonal support Cardiologist Orthopedist Physical, speech, and occupaMonal therapists; psychiatry, pastoral care as needed !   2010 update published Pediatr Pulmonol. 2010 Aug;45(8):739-­‐48. doi: 10.1002/ppul.21254. !  BE AN ADVOCATE !
!
!
!
!
  An9cipate respiratory needs   Don’t wait for a crisis   Take a preven9ve approach Get the technology you need to stay healthy   IdenMfy a respiratory care professional interested in the care of MD paMents