HJAR Sep/Oct 2023

HEALTHCARE JOURNAL OF ARKANSAS  I  SEP / OCT 2023 51 Amit Agarwal, MD, FAAP Pediatric Pulmonologist Arkansas Children’s Hospital care at the hospital and home. Teams should work closely with durable medical equipment companies and home health nurses to ensure equipment works prop- erly. A variety of care professionals provide expertise, education, communication, and collaboration to support families, bringing high-tech respiratory care into the home. Some common diagnoses of patients that benefit from advanced home ventila- tor programs can include: • Bronchopulmonary dysplasia. • Cerebral palsy. • Congenital central hypoventilation syndrome. • Neuromuscular disorders: • Muscular dystrophy. • Spinal muscular atrophy. • Diaphragmatic weakness or paral- ysis. • Spina bifida. • Spinal cord injury. • Traumatic brain injury. • Bronchiectasis (non-cystic fibrosis). • Interstitial lung disease. • Primary ciliary dyskinesia. A primary pulmonologist and a team of knowledgeable and skilled professionals are generally assigned to each patient. The teamwill assist the primary care physician in obtaining medically necessary services and coordinating with other specialists. Respiratory technology-dependent pa- tients typically have pulmonary clinic vis- its every three to four months. Using telemedicine to advance ventilator care Telemedicine components enable pe- diatric pulmonologists to assess patients remotely, eliminating transportation bar- riers to care, reducing emergency room visits, and weaning children off ventilators earlier than expected. The advanced home ventilator program focuses on three critical steps for main- taining positive patient outcomes. First, providers establish the patient’s optimal respiratory status at discharge to ensure patients are safe to discharge on the med- ical equipment. Establishing this status is critical because patients are essentially taking the ICU home. The extensive family education system is the second step. Caregivers must be edu- cated in all aspects of care because they’re the ones taking care of children at home. Telemedicine plays a crucial role in the final step toward positive outcomes. Care- givers have a communication resource to help them create a medically and develop- mentally safe home environment. The idea to add a telemedicine com- ponent to the advanced home ventilator program was to improve the efficiency of care for this patient population and allevi- ate the complexities of transporting chil- dren on chronic ventilators to the hospital every time they needed to see someone. Through telemedicine, medical experts assess patients at home and determine if their problems can be solved virtually or if they need to be seen in the ER. Data from the ventilators also helps experts assess how patients are doing. At Arkansas Children’s, this remote pro- gram has reduced the number of ER visits and ultimately decreased lifetime ventila- tor use. Of the 12 patients initially enrolled, eight have been weaned off ventilators within 12-16 months of initial hospital dis- charge. Helping children breathe easy Clinical-translational research is vital to advanced home ventilator programs. It allows clinicians to collaborate in local and multi-center studies to examine the disease mechanisms that result in chronic respiratory failure and identify novel ther- apies. Arkansas Children’s has continued to measure outcomes, regularly reevaluate, and enhance its program by participating in multiple quality improvement projects, including high-fidelity simulation exer- cises in caregiver training, remote home oxygen monitoring, and decreasing the duration of narcotics/sedative use in chil- dren. A collaborator in pediatric pulmon- ology care, the advanced home ventilator program at Arkansas Children’s extends its expertise through participation in the national Bronchopulmonary Dysplasia Collaborative. The team measures read- missions, ER visits, and decreased ventila- tor use to keep track of decannulations and preventable death. The goal is ultimately to get pediatric patients off a ventilator, allowing them to enjoy their lives more fully. n AmitAgarwal,MD,FAAP, is a pediatric pulmonologist atArkansas Children’s Hospital (ACH) and assistant professor in the department of pediatrics at the Uni- versity ofArkansas for Medical Sciences in Little Rock. He is the medical director of the chronic ventilator program in the department of pediatric and sleep medicine at ACH. He is a member of ACH broncho- pulmonary dysplasia (BPD) care team, working in collaboration with neonatology to guide care from initial diagnosis and continuation of care.