PICU Pathway for SMA Patient Admitted
with Acute Respiratory Failure
with Acute Respiratory Failure
SMA Patient:
Core Assessments & Management
-
Consults, Nursing Considerations, Nutrition, Postop Care, Initial Respiratory Assessment
Airway Clearance Management- Mechanical Strategies – MI-E (CoughAssist), IPV, CPT, Suction, HFCWO (Vest®)
- Pharmacologic Strategies – Mucolytic agents
- Oxygenation Goals – SpO2 > 95% in room air
Admitted to PICU with Acute Respiratory Failure
Maximize Non-invasive Ventilation (NIV):
Artificial Airway
Consider Invasive Ventilation
(initially or after maximizing NIV based on trajectory)
- Persistent tachycardia
- Fatigue
- Diaphoresis
- Increased airway clearance needs
- Impaired gas exchange
- FiO2 40-60% not weaning
- IPAP > 24 / EPAP > 10 or above baseline
- Peri-extubation to NIV
- Immediate Post-extubation
- Airway Clearance
- Frequent MI-E (CoughAssist) treatments may be needed
Definitions
-
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
-
MI-E: Mechanical insufflation-exsufflation (CoughAssist)
-
Pe: Exsufflation pressure
-
Pi: Insufflation pressure
- Transition to chronic management: Determine long-term plan for airway clearance
- Continue First and Second Line Management Strategies
- Discussing a Tracheostomy with Family
Posted: October 2017
Revised: September 2021
Authors: O. Mayer, MD; H. Panitch, MD; L. Rhodes, RRT; C. Dominick, RRT; H. Wolfe, MD; K. Martin, MD; N. McGowan, RRT; M. Bernstein, RN
Revised: September 2021
Authors: O. Mayer, MD; H. Panitch, MD; L. Rhodes, RRT; C. Dominick, RRT; H. Wolfe, MD; K. Martin, MD; N. McGowan, RRT; M. Bernstein, RN