Clinical applications of home mechanical ventilation in children

With advances in perinatal and pediatric critical care, the population of children with medical complexity who require chronic respiratory support has increased substantially.Home mechanical ventilation (HMV) has emerged as a viable option for pediatric patients with chronic respiratory failure, offering prolonged survival and improved quality of life compared with prolonged hospitalization.This review provides a practical guide for implementing HMV in pediatric patients, with a focus on pathophysiology-based patient selection, ventilator application, and troubleshooting.HMV in children encompasses both noninvasive and invasive mechanical ventilation delivered outside the hospital setting for patients who require long-term ventilatory support after medical stabilization.The underlying conditions are diverse and include chronic lung disease, neuromuscular disorders, spinal cord injury, craniofacial abnormalities, and central respiratory control defects.Patient selection should be based on a comprehensive assessment of symptoms, growth patterns, hospitalization frequency, and disease prognosis, rather than relying solely on arterial blood gas thresholds.This review discusses practical aspects of ventilator application, including circuit types, triggering and cycling mechanisms, and commonly used ventilation modes such as pressure-controlled ventilation, volume-controlled ventilation, spontaneous breathing modes, and volume-assured pressure support (average volume-assured pressure support/intelligent volume-assured pressure support).Comprehensive troubleshooting strategies are presented for common alarms, including circuit disconnection, leak-related issues, hypoventilation or hyperventilation, pressure abnormalities, power failure, and equipment malfunction.Proper alarm management and caregiver education are essential to ensuring safe home ventilation.Establishing standardized education programs, multidisciplinary care teams, and community-based support systems will be critical for optimizing outcomes in this growing patient population.