Airway Colonization in Children with Medical Complexity: Challenges and Management Strategies

Over recent years, advances in medical care have significantly improved the survival of children with severe chronic conditions. These children, referred to as children with medical complexity (CMC), present unique and demanding healthcare challenges. Although definitions of CMC re-main inconsistent, these patients are typically characterized by chronic, often severe conditions requiring daily specialized treatments and the use of various medical devices. CMC represent a substantial burden for healthcare systems due to their high medical costs and place considerable strain on caregivers, who must provide continuous assistance. Airway colonization by pathogens such as Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), and Haemophilus influenzae is common in CMC and contributes to recurrent respiratory infections, increased hospi-talizations, and progressive lung damage. The management of airway colonization in this popula-tion is a topic of ongoing debate, often involving a combination of airway clearance techniques (ACT) and antibiotic therapies. Antibiotics may be administered systemically, nebulized, or in combination, depending on the clinical context and severity of the condition. This review highlights the complexities of managing airway colonization in CMC, emphasizing the need for tailored therapeutic approaches to mitigate respiratory complications and improve outcomes.