{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T09:17:04Z","timestamp":1767777424420,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,5]],"date-time":"2022-11-05T00:00:00Z","timestamp":1667606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents.<\/jats:p>","DOI":"10.3390\/children9111700","type":"journal-article","created":{"date-parts":[[2022,11,7]],"date-time":"2022-11-07T02:43:51Z","timestamp":1667789031000},"page":"1700","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Long-Term Ventilation in Children with Medical Complexity: A Challenging Issue"],"prefix":"10.3390","volume":"9","author":[{"given":"Valeria","family":"Caldarelli","sequence":"first","affiliation":[{"name":"Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7779-728X","authenticated-orcid":false,"given":"Federica","family":"Porcaro","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00146 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola Di","family":"Filippo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Attanasi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, SS Annunziata Hospital, University of Chieti, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Fainardi","sequence":"additional","affiliation":[{"name":"Cystic Fibrosis Unit, Department of Paediatrics, Parma University Hospital, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcella","family":"Gallucci","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3976-5495","authenticated-orcid":false,"given":"Angelo","family":"Mazza","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1111-5690","authenticated-orcid":false,"given":"Nicola","family":"Ullmann","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00146 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8026-0715","authenticated-orcid":false,"given":"Stefania","family":"La Grutta","sequence":"additional","affiliation":[{"name":"Institute of Traslational Pharmacology IFT, National Research Council, 90146 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1542\/peds.2010-0910","article-title":"Children with Medical Complexity: An Emerging Population for Clinical and Research Initiatives","volume":"127","author":"Cohen","year":"2011","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1111\/dmcn.13201","article-title":"Children with medical complexity: Creating a framework for care based on the International Classification of Functioning, Disability and Health","volume":"58","author":"Glader","year":"2016","journal-title":"Dev. 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