Location of care within the D Strong High Triage depends upon SMA Type, clinical status, goals of care, and hospital institutional specific resources. All providers should be aware of SMA management. The NMD team should be consulted. Acute Respiratory Care C Strong High and aggressive respiratory protocols should be Protocols implemented. This should include proactive use of bi-level NIV and augmented secretion clearance prior to empiric oxygen supplementation. Augmented secretion clearance D Strong High Secretion mobilization and coughing device techniques should be the priority during acute respiratory illness. Family members as partners in D Strong High Parents and homecare providers should be engaged to aid in the management assessment and management by acute care providers. Role of the NMD team D Strong High care providers should contact NMD providers to assist with acute care protocols. Endotracheal intubation C# Strong High Threshold for endotracheal intubation should be established at admission. Extubation criteria D Strong High If pulmonary consolidation was demonstrated on radiograph, reexpansion should be established prior to extubation, and oxygen supplementation should be weaned to minimum or off. NIV should be implemented as transitional support following extubation. Nutrition / Aerodigestive Issues D Strong High Oral feeds for infants and those with possible oropharyngeal dysfunction should be held during acute illness due to risk of aspiration. Enteral tube or parenteral nutrition should be considered early. See Nutrition Section. Fluid management D Lack of Mid The role of early and aggressive fluid provision/repletion is consensus uncertain with the exception general sepsis management and fluid status assessment. Acute infectious disease D Lack of Mid The of expectorated sputum and viral studies to direct management consensus antimicrobial therapy is uncertain. Screening for viral pathogens may be considered based upon clinical presentation. Empiric antimicrobial coverage for resistant organisms may be considered. Discharge considerations D Strong Mid Discharge medical status will depend on the comfort and skill of family and outpatient medical care team, and consideration of available outpatient services, follow up care and indications for re-hospitalization.
Location of care within the hospital D Strong High Triage depends upon SMA Type, clinical status, goals of care, and institutional specific resources. All providers should be aware of SMA management. The NMD team should be consulted. Acute Respiratory Care Protocols C Strong High and aggressive respiratory protocols should be implemented. This should include proactive use of bi-level NIV and augmented secretion clearance prior to empiric oxygen supplementation. Augmented secretion clearance D Strong High Secretion mobilization and coughing device techniques should be the priority during acute respiratory illness. Family members as partners in management D Strong High Parents and homecare providers should be engaged to aid in the assessment and management by acute care providers. Role of the NMD team D Strong High care providers should contact NMD providers to assist with acute care protocols. Endotracheal intubation C# Strong High Threshold for endotracheal intubation should be established at admission. Extubation criteria D Strong High If pulmonary consolidation was demonstrated on radiograph, reexpansion should be established prior to extubation, and oxygen supplementation should be weaned to minimum or off. NIV should be implemented as transitional support following extubation. Nutrition / Aerodigestive Issues D Strong High Oral feeds for infants and those with possible oropharyngeal dysfunction should be held during acute illness due to risk of aspiration. Enteral tube or parenteral nutrition should be considered early. See Nutrition Section. Fluid management D Lack of consensus Mid The role of early and aggressive fluid provision/repletion is uncertain with the exception general sepsis management and fluid status assessment. Acute infectious disease management D Lack of consensus Mid The of expectorated sputum and viral studies to direct antimicrobial therapy is uncertain. Screening for viral pathogens may be considered based upon clinical presentation. Empiric antimicrobial coverage for resistant organisms may be considered. Discharge considerations D Strong Mid Discharge medical status will depend on the comfort and skill of family and outpatient medical care team, and consideration of available outpatient services, follow up care and indications for re-hospitalization.
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