Changing Practice, Changing Lives
New portable ventilator funded through Country 105 Caring for Kids Radiothon helps critically ill children get moving toward recovery
In any given week, there may be as many as 10 children in the Pediatric Intensive Care Unit (PICU) in severe respiratory distress. To stay alive, they need breathing tubes and ventilators to keep air flowing into their lungs. Traditionally, children who were intubated were kept sedated and asleep for days until they no longer required intensive breathing assistance. This was often an extremely difficult time for families as they sat bedside, unable to interact with their child and gauge how they were doing.
Prompted by new research suggesting that the longer a child is sedated, the higher their risk of experiencing frightening hallucinations, post-traumatic stress disorder, or long-term learning difficulties, the PICU team at the Alberta Children’s Hospital launched a pilot program to allow children to be more awake and comfortable while intubated.
Laurie Lee is the Nurse Practitioner who heads up the pilot. “Our PICU team firmly believes it is no longer good enough for kids to simply survive the PICU. They need to have a better quality of life once they go home. While it may take a lot more work to make this possible, we are committed to giving our kids the best possible outcomes.”
With a coordinated effort from physicians, nurses, respiratory therapists, child life specialists, music therapists and the entire PICU team, children are being kept alert and occupied while intubated – sitting on the edge of their beds, even walking or wheeling around the hospital. As a result, they are healing faster, with fewer long-term effects. In fact, reducing sedation is helping to reduce agitation and enabling kids to be extubated much sooner.
Just two years ago, only 20 percent of intubated children would be awake on the unit. In order to move children out of their rooms, several staff members were required to transport a bulky critical care ventilator with limited battery life and several large and cumbersome oxygen supply tanks.
“These portable ventilators have made it possible for more kids to have a much better recovery.”
– Laurie Lee, nurse practitioner
With help from the new portable ventilator funded by Radiothon donors, the PICU is a much busier place. Today, 80 percent of intubated patients are up and around. The new ventilator can be managed by one staff member, has a five-hour battery life and only requires one oxygen tank. Walks around the unit and even down the hall to the fish tank are now the norm for children on life-saving breathing support.
“Seeing children leave the unit earlier and stronger is very gratifying,” says Lee. “These portable ventilators have made it possible for more kids to have a much better recovery.”
Born with Cystic Fibrosis (CF), 14-year-old Caleb has relied on care from the Alberta Children’s Hospital his whole life. This past spring, he caught a viral infection that put him in the PICU. The combination of his CF and a very high fever compromised his breathing to the point that he needed specialized one-on-one critical care.
By the end of June, he had missed six weeks of school. Understandably, he was feeling low and missing his friends. Thanks to the portable ventilator and a very determined team of PICU nurses, physicians and respiratory therapists (RT), a plan was devised to get Caleb to the last day of Grade 8. Although Caleb was not intubated, he was dependent on the ventilator for high-flow oxygen support. Without the new portable ventilator, multiple tanks of oxygen would have been required, making even a short visit impossible.
On the last day before summer break, a smiling Caleb arrived at school supported by an RT and nurse, who he referred to as his “entourage.” Seeing him arrive by ambulance caused quite a commotion at first, but within minutes Caleb and his friends were busy catching up. They were able to hang out for a couple of hours, enjoying snacks and playing board games. Caleb felt incredibly special with so many people working hard to make the outing possible.
“I’d been in the hospital for such a long time, it was really nice to get to school and just feel normal for awhile,” he says. His mom, Kristy, agrees. “It was great to see a smile on his face. I know his friends were concerned about him, so it was nice for them to see him, too. This portable equipment is making a really big difference for kids like Caleb.”
Intensive care specialists from across North America are contacting Lee and her team about their success with their new initiative. “What we are doing here is being shared widely,” says Lee. “Kids far beyond Calgary are benefiting from what we are learning.”