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Neuromuscular Compromise and Respiratory Failure Clinical Pathway – Inpatient and PICU

Inpatient and PICU Clinical Pathway for Management of Patients with Neuromuscular Compromise and Respiratory Failure

 
 
 
 
Baseline respiratory status
 
 
Admitted to
Pulmonary Service
 
 
Respiratory distress
 
 
Admitted to PICU with
Acute Respiratory Failure
 
 
Continue baseline support and secretion clearance therapies
 
 
Optimize NIV
  • Critical Assessment Team indications
    • Increased EPAP by ≥ 2 cm H2O
    • FiO2 requirement > 0.40 for > 1 hr, despite PRN secretion clearance
    • Inability to sprint for
      2 hrs BID, if applicable
Maximize NIV
Invasive Ventilation Considerations
Initially or after maximizing
NIV based on trajectory
 
 
Invasive Ventilation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Transition to chronic management: Determine long term plan for airway clearance
Airway Clearance Management: Mechanical, Pharmacologic Interventions
 
 

Definitions

  • NIV
    Non-invasive ventilation
  • IPAP
    Inspiratory positive airway pressure
  • EPAP
    Expiratory positive airway pressure
  • HFCWO/HFCWC (Vest)
    High-frequency chest wall oscillation/high-frequency chest wall compression
  • IPV
    Intrapulmonary percussive ventilation
  • CPT
    Chest physiotherapy
  • Pe
    Exsufflation pressure
  • Pi
    Insufflation pressure

 

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