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Russell J, Barber V, Chan E, Khair K, Rendle G, Wray J. What are the experiences of non-invasive ventilation for sleep-disordered breathing in children and young people and what outcomes matter? Perspectives of children and young people, their parents and the staff who care for them. Child Care Health Dev 2024; 50:e13292. [PMID: 38927003 DOI: 10.1111/cch.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 04/25/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Non-invasive ventilation (NIV) for sleep-disordered breathing (SDB) in children and young people (CYP) can result in multiple health outcomes; however, adherence to NIV can be challenging. Suboptimally treated SDB may increase the risk of adverse consequences. Placing children's and parents' goals at the core of their SDB treatment may support adherence to NIV. To identify these health outcomes, it is necessary to gain a greater understanding of CYP's experiences of using NIV, whether they perceive any benefits from NIV use, as well as the outcomes that their parents and NIV staff identify as important. METHODS Semi-structured qualitative interviews were conducted with nine CYP (aged 4-16 + years), 13 parents and nine healthcare professionals (HCPs); verbatim transcripts were analysed using Framework Analysis. RESULTS CYP predominantly reported an improvement in levels of energy, focus and ability to concentrate whereas parents also identified outcomes of mood and behaviour. The majority of children showed understanding of the reasons for being prescribed NIV. A subset of children did not notice their SDB. The health outcomes identified by HCPs and parents that could result from improved overnight gas exchange are subjective measures that rely on parent and child report. Measuring these health outcomes focussed on the impact of improved sleep rather than measuring improved sleep itself. CONCLUSIONS It is important for HCPs administering NIV to ascertain whether CYP have noticed any of their sleep-disordered breathing symptoms and any improvements from using NIV, including the relationship between benefits and side effects. Focussing on promoting understanding for CYP who are unable to link their wellbeing to their previous night's sleep may be futile and HCP strategies should concentrate on the process of tolerating the device. Parents, CYP and HCPs should collaborate to identify treatment goals specifically tailored for the child and monitor any progress against these goals.
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Affiliation(s)
- Jessica Russell
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Victoria Barber
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Elaine Chan
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Kate Khair
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Garry Rendle
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jo Wray
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
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2
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Khirani S, Ducrot V. Mask interfaces and devices for home noninvasive ventilation in children. Pediatr Pulmonol 2024; 59:1528-1540. [PMID: 38546008 DOI: 10.1002/ppul.26984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 05/28/2024]
Abstract
Home noninvasive ventilation (NIV), including continuous (CPAP) and bilevel (BPAP) positive airway pressure, is increasingly used in children worldwide. In this narrative review, we present a comprehensive summary of the equipment available for home NIV in pediatrics, excluding neonates. NIV may be challenging in young children, as the majority of the equipment has been developed for adults. Regarding the interfaces, only a few masks have been specifically developed for young children in recent years, while older children may benefit from a large variety of interfaces. Even though much progress has been made, skin injuries are still present, and need to be managed rapidly. Several studies addressed the management of the side effects, but recent studies are lacking regarding orofacial anomalies. No recent study reported the available interfaces for young children and the strategies for an optimal mask fit. Regarding the devices, an adapted NIV device to pediatrics that allows an adequate patient's breathing detection should guarantee optimal ventilatory efficiency and monitoring of NIV. A close follow-up and regular monitoring should be mandatory to rule out the potential issues, optimize NIV therapy and ascertain the efficacy of NIV. However, studies are lacking to guide the choice of devices in young children and the optimal management of home NIV in pediatrics. We summarized the characteristics of the different interfaces available for young children and the limitations of NIV devices. We finally addressed potential areas for future research on long-term home NIV in children.
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Affiliation(s)
- Sonia Khirani
- ASV Santé, Gennevilliers
- Pediatric noninvasive ventilation and sleep unit, AP-HP Necker Hospital, Paris
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3
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Toussaint M, van Hove O, Leduc D, Ansay L, Deconinck N, Fauroux B, Khirani S. Invasive versus non-invasive paediatric home mechanical ventilation: review of the international evolution over the past 24 years. Thorax 2024; 79:581-588. [PMID: 38365452 DOI: 10.1136/thorax-2023-220888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/21/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Home mechanical ventilation (HMV) is the treatment for chronic hypercapnic alveolar hypoventilation. The proportion and evolution of paediatric invasive (IMV) and non-invasive (NIV) HMV across the world is unknown, as well as the disorders and age of children using HMV. METHODS Search of Medline/PubMed for publications of paediatric surveys on HMV from 2000 to 2023. RESULTS Data from 32 international reports, representing 8815 children (59% boys) using HMV, were analysed. A substantial number of children had neuromuscular disorders (NMD; 37%), followed by cardiorespiratory (Cardio-Resp; 16%), central nervous system (CNS; 16%), upper airway (UA; 13%), other disorders (Others; 10%), central hypoventilation (4%), thoracic (3%) and genetic/congenital disorders (Gen/Cong; 1%). Mean age±SD (range) at HMV initiation was 6.7±3.7 (0.5-14.7) years. Age distribution was bimodal, with two peaks around 1-2 and 14-15 years. The number and proportion of children using NIV was significantly greater than that of children using IMV (n=6362 vs 2453, p=0.03; 72% vs 28%, p=0.048), with wide variations among countries, studies and disorders. NIV was used preferentially in the preponderance of children affected by UA, Gen/Cong, Thoracic, NMD and Cardio-Resp disorders. Children with NMD still receiving primary invasive HMV were mainly type I spinal muscular atrophy (SMA). Mean age±SD at initiation of IMV and NIV was 3.3±3.3 and 8.2±4.4 years (p<0.01), respectively. The rate of children receiving additional daytime HMV was higher with IMV as compared with NIV (69% vs 10%, p<0.001). The evolution of paediatric HMV over the last two decades consists of a growing number of children using HMV, in parallel to an increasing use of NIV in recent years (2020-2023). There is no clear trend in the profile of children over time (age at HMV). However, an increasing number of patients requiring HMV were observed in the Gen/Cong, CNS and Others groups. Finally, the estimated prevalence of paediatric HMV was calculated at 7.4/100 000 children. CONCLUSIONS Patients with NMD represent the largest group of children using HMV. NIV is increasingly favoured in recent years, but IMV is still a prevalent intervention in young children, particularly in countries indicating less experience with NIV.
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Affiliation(s)
- Michel Toussaint
- Department of Neurology, Centre de référence Neuromusculaire, Erasme Hospital, Bruxelles, Belgium
| | | | - Dimitri Leduc
- Department of Pulmonology, Erasme Hospital, Bruxelles, Belgium
| | - Lise Ansay
- Centre for Physiotherapy La Bulle Kiné, Nice, France
| | | | - Brigitte Fauroux
- Paediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sonia Khirani
- Necker-Enfants Malades Hospitals, Paris, France
- ASV Santé, Gennevilliers, France
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4
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Fauroux B, Vedrenne-Cloquet M. Positive end-expiratory pressure in chronic care of children with obstructive sleep apnoea. Paediatr Respir Rev 2024; 49:2-4. [PMID: 36702717 DOI: 10.1016/j.prrv.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
Positive end-expiratory pressure (PEEP) consists of the delivery of a constant positive pressure in the airways by means of a noninvasive interface aiming to maintain airway patency throughout the entire respiratory cycle. PEEP is increasingly used in the chronic care of children with anatomical or functional abnormalities of the upper airways to correct severe persistent obstructive sleep apnea despite optimal management which commonly includes adenotonsillectomy in young children. PEEP may be used at any age, due to improvements in equipment and interfaces. Criteria for CPAP/NIV initiation, optimal setting, follow-up and monitoring, as well as weaning criteria have been established by international experts, but validated criteria are lacking. As chronic PEEP is a highly specialised treatment, patients should be managed by an expert pediatric multidisciplinary team.
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Affiliation(s)
- Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, AP-HP, Paris, France; Université de Paris, EA 7330 VIFASOM, F-75004 Paris, France.
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5
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Nart L, Desikan M, Pietrusz A, Savvatis K, Quinlivan R. Neurodiversity, treatment compliance and survival in adults with Duchenne muscular dystrophy: a single-centre retrospective cohort review. Neuromuscul Disord 2024; 35:13-18. [PMID: 38194731 DOI: 10.1016/j.nmd.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/24/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024]
Abstract
Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy worldwide. With increasing survival, there is now a greater awareness of associated neurodevelopmental co-morbidities. Despite this, there is currently a limited understanding of how these co-morbidities might potentially impact on health outcomes. This study reviewed the characteristics of 37 adults with DMD who died between 2011 and 2022. The median age of death was 22.25 years, and those with neurodevelopmental co-morbidities had statistically poorer survival than those without a neurodevelopmental disorder. Notably, the proportion of patients within this cohort with a diagnosis of a neurodevelopmental disorder was higher than previously reported studies in living cohorts. This study suggests that patients with a co-morbid neurodevelopmental disorder may have worse health outcomes than those who do not.
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Affiliation(s)
- Luca Nart
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
| | - Mahalekshmi Desikan
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Aleksandra Pietrusz
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - Konstantinos Savvatis
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; Barts Heart Centre, Saint Bartholomew's Hospital, London, United Kingdom
| | - Ros Quinlivan
- Neuromuscular Complex Care Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
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6
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MacLean JE, Fauroux B. Long-term non-invasive ventilation in children: Transition from hospital to home. Paediatr Respir Rev 2023; 47:3-10. [PMID: 36806331 DOI: 10.1016/j.prrv.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
Long-term non-invasive ventilation (NIV) is an accepted therapy for sleep-related respiratory disorders and respiratory insufficiency or failure. Increase in the use of long-term NIV may, in part, be driven by an increase in the number of children surviving critical illness with comorbidities. As a result, some children start on long-term NIV as part of transitioning from hospital to home. NIV may be used in acute illness to avoid intubation, facilitate extubation or support tracheostomy decannulation, and to avoid the need for a tracheostomy for long-term invasive ventilation. The decision about whether long-term NIV is appropriate for an individual child and their family needs to be made with care. Preparing for transition from the hospital to home involves understanding how NIV equipment is obtained and set-up, education and training for parents/caregivers, and arranging a plan for clinical follow-up. While planning for these transitions is challenging, the goals of a shorter time in hospital and a child living well at home with their family are important.
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Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, AP-HP, Paris, France; Université de Paris, EA 7330 VIFASOM, F-75004 Paris, France
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van den Biggelaar R, Hazenberg A, Duiverman ML. The role of telemonitoring in patients on home mechanical ventilation. Eur Respir Rev 2023; 32:32/168/220207. [PMID: 37019457 PMCID: PMC10074164 DOI: 10.1183/16000617.0207-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/13/2022] [Indexed: 04/07/2023] Open
Abstract
There is a growing number of patients being treated with long-term home mechanical ventilation (HMV). This poses a challenge for the healthcare system because in-hospital resources are decreasing. The application of digital health to assist HMV care might help. In this narrative review we discuss the evidence for using telemonitoring to assist in initiation and follow-up of patients on long-term HMV. We also give an overview of available technology and discuss which parameters can be measured and how often this should be done. To get a telemonitoring solution implemented in clinical practice is often complex; we discuss which factors contribute to that. We discuss patients' opinions regarding the use of telemonitoring in HMV. Finally, future perspectives for this rapidly growing and evolving field will be discussed.
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Affiliation(s)
- Ries van den Biggelaar
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anda Hazenberg
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke L Duiverman
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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8
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Perry MA, Jones B, Jenkins M, Devan H, Neill A, Ingham T. Health System Factors Affecting the Experience of Non-Invasive Ventilation Provision of People with Neuromuscular Disorders in New Zealand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4758. [PMID: 36981666 PMCID: PMC10048586 DOI: 10.3390/ijerph20064758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Non-invasive ventilation (NIV) is a critical therapy for many patients with neuromuscular disorders (NMD), supporting those with respiratory failure to achieve adequate respiration and improve their quality of life. The aim of this study was to explore the experiences of access to, consent, uptake, maintenance and safe use of non-invasive ventilation by people with NMD. Semi-structured individual interviews were conducted with 11 people with NMD, each using NIV for more than 12 months. A critical realism ontological paradigm with contextualism epistemology guided the Reflexive Thematic Analysis. An Equity of Health Care Framework underpinned the analysis. Three themes were interpreted: Uptake and informed consent for NIV therapy; Practicalities of NIV; and Patient-clinician relationships. We identified issues at the system, organization and health professional levels. Conclusions: We recommend the development of national service specifications with clear standards and dedicated funding for patients with NMD and call on the New Zealand Ministry of Health to proactively investigate and monitor the variations in service delivery identified. The specific areas of concern for patients with NMD suggest the need for NMD-related NIV research and service provision responsive to the distinct needs of this population.
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Affiliation(s)
- Meredith A. Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin 9016, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago—Wellington, Wellington 6242, New Zealand
- Foundation for Equity & Research New Zealand, Wellington 6147, New Zealand
| | - Matthew Jenkins
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin 9016, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin 9016, New Zealand
| | - Alister Neill
- Department of Medicine, University of Otago—Wellington, Wellington 6242, New Zealand
- Department of Respiratory Medicine, Te Whatu Ora Capital, Coast and Hutt Valley, Wellington 6140, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago—Wellington, Wellington 6242, New Zealand
- Foundation for Equity & Research New Zealand, Wellington 6147, New Zealand
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9
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Barker N, Sinha A, Jesson C, Doctor T, Narayan O, Elphick HE. Changes in UK paediatric long-term ventilation practice over 10 years. Arch Dis Child 2023; 108:218-224. [PMID: 36446480 DOI: 10.1136/archdischild-2021-323562] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/10/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To provide up-to-date information on the use of long-term ventilation (LTV) in the UK paediatric population and to compare the results with data collected 10 and 20 years previously. DESIGN A single timepoint census completed by LTV centres in the UK, carried out via an online survey. SETTING AND PATIENTS All patients attending paediatric LTV services in the UK. RESULTS Data were collected from 25 LTV centres in the UK. The total study population was 2383 children and young people, representing a 2.5-fold increase in the last 10 years. The median age was 9 years (range 0-20 years). Notable changes since 2008 were an increase in the proportion of children with central hypoventilation syndrome using mask ventilation, an increase in overall numbers of children with spinal muscular atrophy (SMA) type 1, chronic lung disease of prematurity and cerebral palsy being ventilated, and a 4.2-fold increase in children using LTV for airway obstruction. The use of 24-hour ventilation, negative pressure ventilation and tracheostomy as an interface had declined. 115 children had received a disease-modifying drug. The use of ataluren and Myozyme did not influence the decision to treat with LTV, but in 35% of the children with SMA type 1 treated with nusinersin, the clinician stated that the use of this drug had or may have influenced their decision to initiate LTV. CONCLUSION The results support the need for national database for children and young people using LTV at home to inform future recommendations and assist in resource allocation planning.
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Affiliation(s)
- Nicki Barker
- Respiratory Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Aditi Sinha
- Respiratory Medicine, Royal Manchester Children's Hospital, Manchester, UK
| | - Catherine Jesson
- Respiratory Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Tahera Doctor
- Respiratory Medicine, Evelina London Children's Hospital, London, UK
| | - Omendra Narayan
- Respiratory Medicine, Royal Manchester Children's Hospital, Manchester, UK
| | - Heather E Elphick
- Respiratory Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
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10
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Viegas P, Ageno E, Corsi G, Tagariello F, Razakamanantsoa L, Vilde R, Ribeiro C, Heunks L, Patout M, Fisser C. Highlights from the Respiratory Failure and Mechanical Ventilation 2022 Conference. ERJ Open Res 2023; 9:00467-2022. [PMID: 36949961 PMCID: PMC10026011 DOI: 10.1183/23120541.00467-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
The Respiratory Intensive Care Assembly of the European Respiratory Society gathered in Berlin to organise the second Respiratory Failure and Mechanical Ventilation Conference in June 2022. The conference covered several key points of acute and chronic respiratory failure in adults. During the 3-day conference, ventilatory strategies, patient selection, diagnostic approaches, treatment and health-related quality of life topics were addressed by a panel of international experts. Lectures delivered during the event have been summarised by Early Career Members of the Assembly and take-home messages highlighted.
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Affiliation(s)
- Pedro Viegas
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Elisa Ageno
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriele Corsi
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Federico Tagariello
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Léa Razakamanantsoa
- Unité Ambulatoire d'Appareillage Respiratoire de Domicile (UAARD), Service de Pneumologie (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Paris, France
| | - Rudolfs Vilde
- Centre of Pulmonology and Thoracic Surgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Riga Stradiņš University, Riga, Latvia
| | - Carla Ribeiro
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Leo Heunks
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Corresponding author: Christoph Fisser ()
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11
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Carmona H, Graustein AD, Benditt JO. Chronic Neuromuscular Respiratory Failure and Home Assisted Ventilation. Annu Rev Med 2023; 74:443-455. [PMID: 36706747 DOI: 10.1146/annurev-med-043021-013620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Chronic respiratory failure is a common, important complication of many types of neuromuscular and chest wall disorders. While the pathophysiology of each disease may be different, these disorders can variably affect all muscles involved in breathing, including inspiratory, expiratory, and bulbar muscles, ultimately leading to chronic respiratory failure and hypoventilation. The use of home assisted ventilation through noninvasive interfaces aims to improve the symptoms of hypoventilation, improve sleep quality, and, when possible, improve mortality. An increasing variety of interfaces has allowed for improved comfort and compliance. In a minority of scenarios, noninvasive ventilation is either not appropriate or no longer effective due to disease progression, and a transition to tracheal ventilation should be considered.
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Affiliation(s)
- Hugo Carmona
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA; ,
| | - Andrew D Graustein
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA; , .,VA Puget Sound Health Care System, Seattle, Washington, USA;
| | - Joshua O Benditt
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA; ,
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12
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Long term noninvasive ventilation and continuous positive airway pressure in children with neuromuscular diseases in France. Neuromuscul Disord 2022; 32:886-892. [PMID: 36270935 DOI: 10.1016/j.nmd.2022.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 12/31/2022]
Abstract
The aim of the study was to describe the characteristics of children with neuromuscular diseases treated with long term noninvasive ventilation or continuous positive airway pressure in France. On June 1st 2019, 387 patients (63% boys, mean age 11.2 ± 5.5 years) were treated with long term noninvasive ventilation/continuous positive airway pressure. Thirty three percent of patients had spinal muscular atrophy, 30% congenital myopathy/dystrophy, 20% Duchenne muscular dystrophy, 7% Steinert myotonic dystrophy, and 9% other neuromuscular diseases. Ninety-four percent of patients were treated with long term noninvasive ventilation and 6% with continuous positive airway pressure. Treatment was initiated electively for 85% of patients, mainly on an abnormal overnight gas exchange recording (38% of patients). Noninvasive ventilation/continuous positive airway pressure was initiated during a respiratory exacerbation in 15% of patients. Mean duration of noninvasive ventilation/continuous positive airway pressure was 3.3 ± 3.1 years. Mean objective long term noninvasive ventilation/continuous positive airway pressure use was 8.0 ± 3.1 h/24. Spinal muscular atrophy, congenital myopathy/dystrophy, and Duchenne muscular dystrophy represented 83% of children with neuromuscular diseases treated with long term noninvasive ventilation in France. Screening for nocturnal hypoventilation was satisfactory as noninvasive ventilation /continuous positive airway pressure was predominantly initiated electively.
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13
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Ribeiro C, Jácome C, Castro L, Conde S, Windisch W, Nunes R. Long-term health-related quality of life in patients on home mechanical ventilation. BMC Pulm Med 2022; 22:433. [DOI: 10.1186/s12890-022-02236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
It is fundamental to optimize and retain health-related quality of life (HRQoL) in the long term in patients with home mechanical ventilation (HMV). Therefore, this study aimed to evaluate the evolution of the HRQoL in patients already established on HMV across a period of 5 years and whether the HRQoL is associated with mortality.
Methods
This was a 5-year longitudinal cohort study conducted in an Outpatient Ventilation Clinic. Consecutive patients on HMV for at least 30 days responded to the Severe Respiratory Insufficiency (SRI) questionnaire at inclusion and again at 5 years.
Results
A total of 104 patients were included (male 56.7%, median age 69 [P25;P75] [61;77] years). Almost half of the patients had COPD (49.0%). Patients were on HMV for a median of 43.5 [22;85.5] months, with overall good adherence (median 8 [6;9] daily hours). Fifty-seven (54.8%) patients were alive at 5 years. In surviving patients, the only difference with statistical significance was in the attendant symptoms and sleep subscale, with patients scoring 7.1 [-4.5;25] points higher in the final questionnaire (p = 0.002). Survivors had significantly better scores in the SRI at inclusion than deceased patients (median 59.6 [49.2;71.7] vs 48.7 [38.4;63.2]; p = 0.004).
Conclusions
These results shows that HRQoL remains stable in surviving patients with HMV at five years. It also suggests that SRI can be of important prognostic value and help predict the terminal phase of the disease course in patients with long-term HMV.
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14
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Perry MA, Jenkins M, Jones B, Bowick J, Shaw H, Robinson E, Rowan M, Spencer K, Neill A, Ingham T. "Me and ' that' machine": the lived experiences of people with neuromuscular disorders using non-invasive ventilation. Disabil Rehabil 2022; 45:1847-1856. [PMID: 35649702 DOI: 10.1080/09638288.2022.2076939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Neuromuscular disorders (NMD) encompasses a wide range of conditions, with respiratory weakness a common feature. Respiratory care can involve non-invasive ventilation (NIV) resulting in fewer hospital admissions, a lower mortality rate and improved quality of life. The aim of this study was to explore the 'lived experience' of NIV by people with NMD. METHODS Interpretive Phenomenological Analysis (IPA) with semi-structured, face to face interviews with 11 people with NMD, using bi-level positive airway pressure for NIV for more than 12 months. RESULTS Three themes were interpreted: (i) Alive, with a life; (ii) Me and 'that' machine; and (iii) Precariousness of this life. NIV enabled hope, independence and the opportunity to explore previously perceived unattainable life experiences. Yet, participants felt dependent on the machine. Furthermore, practical considerations and fear of NIV failure created a sense of precariousness to life and a reframing of personal identity. CONCLUSION The findings highlight the broad ranging positive and negative effects that may occur for people with NMD when using this important therapy. Ongoing non-judgemental support and empathy are required from health professionals as the use of NIV challenged concepts such as 'living life well' for people with NMD. IMPLICATIONS FOR REHABILITATIONNeuromuscular disorders may result in respiratory weakness requiring non-invasive ventilation (NIV).When prescribed early, NIV can results in fewer hospital admissions, a lower mortality rate and improved quality of life.The relationship of people with NMD with their NIV machine is complex and impacts on and requires adjustment to their identity.NIV users acknowledged that NIV provided hope but simultaneously recognised the precariousness of NIV on their life.In order to better support people with NMD healthcare professionals need to better understand how the physical, psychological and social implications of NIV affect an individual's life.
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Affiliation(s)
- Meredith A Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Matthew Jenkins
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago, Wellington, New Zealand.,Foundation for Equity & Research New Zealand, Wellington, New Zealand
| | - Jarrod Bowick
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hannah Shaw
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Emma Robinson
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Morgan Rowan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kate Spencer
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Alister Neill
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago, Wellington, New Zealand.,Foundation for Equity & Research New Zealand, Wellington, New Zealand
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15
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Mattson J, Lunnelie J, Löfholm T, Andersson ES, Aune RE, Björling G. Quality Of Life in Children With Home Mechanical Ventilation – A Scoping Review. SAGE Open Nurs 2022; 8:23779608221094522. [PMID: 35493542 PMCID: PMC9047042 DOI: 10.1177/23779608221094522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/20/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Home mechanical ventilation is an established method to support children suffering from chronic respiratory insufficiency, still more research is needed regarding mechanically ventilated children's and adolescents’ quality of life (QoL). Therefore, the aim of this scoping review was to explore research regarding QoL and lived experience of children and adolescents with home mechanical ventilation. Methods A scoping review with systematic searches for research studies published between year 2000–2020 was performed in Cinahl, Medline, and PubMed. Studies that met the inclusion criteria were quality assessed and a thematic analysis was performed. Results In total, ten articles were quality assessed and included in the results. Four themes emerged: Children's self-reported QoL, Parents’ perception and parent-proxy report, Differences between the child's and parent's perception, and challenges in daily life. Children with home mechanical ventilation reported a lower QoL than healthy children and children with other chronic diseases. Generally, parents rate their child's QoL lower than the children themselves. Conclusion This is the first literature review focusing on HMV in the paediatric population. It is clear that HMV does not only affect the treated child or adolescent but also the whole family. It is important to regularly measure and evaluate QoL in children and adolescents with HMV to provide person-centered care. More research is needed to improve these children's and adolescents’ QoL.
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Affiliation(s)
- Janet Mattson
- Department of Health Sciences, Swedish Red Cross University, Sweden
- Department of Learning, Informatics, and Medical Education, Karolinska Institutet, Sweden
| | - Johan Lunnelie
- Department of Health Sciences, Swedish Red Cross University, Sweden
| | - Tim Löfholm
- Department of Health Sciences, Swedish Red Cross University, Sweden
| | | | - Ragnhild E. Aune
- Department of Material Science, Norwegian University of Science and Technology, Norway
| | - Gunilla Björling
- Department of Health Sciences, Swedish Red Cross University, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
- Kilimanjaro Christian Medical University College, Faculty of Nursing, Tanzania
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16
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Saddi V, Thambipillay G, Martin B, Blecher G, Teng A. Pediatric Average Volume Assured Pressure Support. Front Pediatr 2022; 10:868625. [PMID: 35601414 PMCID: PMC9114489 DOI: 10.3389/fped.2022.868625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Average volume assured pressure support (AVAPS) is a modality of non-invasive ventilation that enables the machine to deliver a pre-set tidal volume by adjusting the inspiratory pressure support within a set range. Data on its use in the pediatric population are limited to case reports and single centre case series. This article reviews paediatric data on use of AVAPS and highlights the need for validation to help develop specific guidelines on use of AVAPS in children.
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Affiliation(s)
- Vishal Saddi
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
| | - Ganesh Thambipillay
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
| | - Bradley Martin
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
| | - Gregory Blecher
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
| | - Arthur Teng
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
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17
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Fauroux B, Abel F, Amaddeo A, Bignamini E, Chan E, Corel L, Cutrera R, Ersu R, Installe S, Khirani S, Krivec U, Narayan O, MacLean J, Perez De Sa V, Pons-Odena M, Stehling F, Trindade Ferreira R, Verhulst S. ERS Statement on pediatric long term noninvasive respiratory support. Eur Respir J 2021; 59:13993003.01404-2021. [PMID: 34916265 DOI: 10.1183/13993003.01404-2021] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/03/2021] [Indexed: 11/05/2022]
Abstract
Long term noninvasive respiratory support, comprising continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), in children is expanding worldwide, with increasing complexities of children being considered for this type of ventilator support and expanding indications such as palliative care. There have been improvements in equipment and interfaces. Despite growing experience, there are still gaps in a significant number of areas: there is a lack of validated criteria for CPAP/NIV initiation, optimal follow-up and monitoring; weaning and long term benefits have not been evaluated. Therapeutic education of the caregivers and the patient is of paramount importance, as well as continuous support and assistance, in order to achieve optimal adherence. The preservation or improvement of the quality of life of the patient and caregivers should be a concern for all children treated with long term CPAP/NIV. As NIV is a highly specialised treatment, patients are usually managed by an experienced pediatric multidisciplinary team. This Statement written by experts in the field of pediatric long term CPAP/NIV aims to emphasize on the most recent scientific input and should open up to new perspectives and research areas.
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Affiliation(s)
- Brigitte Fauroux
- AP-HP, Hôpital Necker, Pediatric noninvasive ventilation and sleep unit, Paris, France .,Université de Paris, EA 7330 VIFASOM, Paris, France
| | - François Abel
- Respiratory Department, Sleep & Long-term Ventilation Unit, Great Ormond Street Hospital for Children, London, UK
| | - Alessandro Amaddeo
- Emergency department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Elisabetta Bignamini
- Pediatric Pulmonology Unit Regina Margherita Hospital AOU Città della Salute e della Scienza Turin Italy
| | - Elaine Chan
- Respiratory Department, Sleep & Long-term Ventilation Unit, Great Ormond Street Hospital for Children, London, UK
| | - Linda Corel
- Pediatric ICU, Centre for Home Ventilation in Children, Erasmus university Hospital, Rotterdam, the Netherlands
| | - Renato Cutrera
- Pediatric Pulmonology Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Refika Ersu
- Division of Respiratory Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa Canada
| | - Sophie Installe
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Sonia Khirani
- AP-HP, Hôpital Necker, Pediatric noninvasive ventilation and sleep unit, Paris, France.,Université de Paris, EA 7330 VIFASOM, Paris, France.,ASV Santé, Gennevilliers, France
| | - Uros Krivec
- Department of Paediatric Pulmonology, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Omendra Narayan
- Sleep and Long Term Ventilation unit, Royal Manchester Children's Hospital and University of Manchester, Manchester, UK
| | - Joanna MacLean
- Division of Respiratory Medicine, Department of Pediatrics, University of Alberta, Edmonton Canada
| | - Valeria Perez De Sa
- Department of Pediatric Anesthesia and Intensive Care, Children's Heart Center, Skåne University Hospital, Lund, Sweden
| | - Marti Pons-Odena
- Pediatric Home Ventilation Programme, University Hospital Sant Joan de Déu, Barcelona, Spain.,Respiratory and Immune dysfunction research group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Childreńs Hospital, University of Duisburg-Essen, Essen, Germany
| | - Rosario Trindade Ferreira
- Pediatric Respiratory Unit, Department of Paediatrics, Hospital de Santa Maria, Academic Medical Centre of Lisbon, Portugal
| | - Stijn Verhulst
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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18
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Tsang YP, To CY, Tsui CK, Leung SY, Kwok KL, Ng DKK. Feasibility of long-term home noninvasive ventilation program in a general pediatric unit: 21 years' experience in Hong Kong. Pediatr Pulmonol 2021; 56:3349-3357. [PMID: 34339596 DOI: 10.1002/ppul.25593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/19/2021] [Accepted: 07/20/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Long-term home noninvasive ventilation (NIV) is increasingly employed in children with sleep-disordered breathing and chronic respiratory failure. While studies suggest its successful implementation in tertiary care centers, little is known about the situation in a general care setting. Hence, we aim to evaluate the clinical profiles of these children in a general pediatric unit over the past two decades. METHODS Data collected retrospectively on patients younger than 18 years old receiving long-term home NIV from January 1, 1997 to December 31, 2017 in a Hong Kong regional general pediatric unit were reviewed. RESULTS The number of children on home NIV increased more than 10-fold over the past two decades. In total, 114 children were commenced on NIV during the 21-year period. Upper airway obstruction was the most common cause (77%), followed by neuromuscular diseases (16%), pulmonary disorders (4%), and abnormal ventilatory control (3%). Continuous positive airway pressure was the most common NIV type (59%). To date, 46% of the children remained in our NIV program, while 18% discontinued NIV support. NIV adherence increased significantly with follow-up (median of 78.6% and 82.5% at baseline and last follow-up, respectively). Sixty-five percent of the children used NIV for at least 4 h on 70% of the days monitored. Higher body mass index was associated with lower adherence. CONCLUSION Pediatric home NIV is feasible in the general care setting with good outcomes and adherence. As the demand for NIV service grows, input from local hospitals will be of increasing importance and should be considered upon healthcare planning.
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Affiliation(s)
- Yuk-Ping Tsang
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR.,Department of Paediatrics & Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong SAR
| | - Ching-Yee To
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR.,Ambulatory Care Center, Hong Kong Children's Hospital, Hong Kong, Hong Kong SAR
| | - Cheuk-Kiu Tsui
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR
| | - Shuk-Yu Leung
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR
| | - Ka-Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR
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19
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Chawla J, Edwards EA, Griffiths AL, Nixon GM, Suresh S, Twiss J, Vandeleur M, Waters KA, Wilson AC, Wilson S, Tai A. Ventilatory support at home for children: A joint position paper from the Thoracic Society of Australia and New Zealand/Australasian Sleep Association. Respirology 2021; 26:920-937. [PMID: 34387937 PMCID: PMC9291882 DOI: 10.1111/resp.14121] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/04/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022]
Abstract
The goal of this position paper on ventilatory support at home for children is to provide expert consensus from Australia and New Zealand on optimal care for children requiring ventilatory support at home, both non-invasive and invasive. It was compiled by members of the Thoracic Society of Australia and New Zealand (TSANZ) and the Australasian Sleep Association (ASA). This document provides recommendations to support the development of improved services for Australian and New Zealand children who require long-term ventilatory support. Issues relevant to providers of equipment and areas of research need are highlighted.
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Affiliation(s)
- Jasneek Chawla
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth A Edwards
- New Zealand Respiratory & Sleep Institute, Starship Children's Hospital, Auckland, New Zealand
| | - Amanda L Griffiths
- Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Sadasivam Suresh
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jacob Twiss
- New Zealand Respiratory & Sleep Institute, Starship Children's Hospital, Auckland, New Zealand
| | - Moya Vandeleur
- Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Karen A Waters
- Sleep Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Andrew C Wilson
- Respiratory & Sleep Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Susan Wilson
- Child Youth Mental Health Services, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew Tai
- Respiratory & Sleep Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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20
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Djkowich M, Olmstead D, Castro-Codesal ML, Scott S. Who is using noninvasive ventilation? A descriptive study examining the population enrolled in a pediatric noninvasive ventilation program. J SPEC PEDIATR NURS 2021; 26:e12326. [PMID: 33493391 DOI: 10.1111/jspn.12326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/08/2020] [Accepted: 01/05/2021] [Indexed: 12/30/2022]
Abstract
DESIGN AND METHODS This study used a retrospective design and involved reviewing the charts of infants and children enrolled in the noninvasive ventilation (NIV) program at a quaternary pediatric hospital located in Western Canada in 2017. Demographic and clinical variables were collected, along with variables related to adherence to NIV therapy. For data storage and analysis purposes, a comprehensive database was created. Descriptive statistics were used to analyze and better understand patterns within the data. RESULTS Findings included a comprehensive description of the population of infants and children enrolled in this NIV program in 2017, including demographic and clinical variables as well as follow-up and adherence data. This study identified that the NIV program at this pediatric center has unique characteristics which provide an exciting opportunity for further research into the population that requires NIV support. PRACTICE IMPLICATIONS This study presents new knowledge, gathered by examining the clinical characteristics of a pediatric population that requires NIV, which can be used to inform practice, support NIV program planning, and health resource allocation, as well as suggest directions for future research on pediatric NIV therapy.
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Affiliation(s)
- Mikelle Djkowich
- Alberta Health Services, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Deborah Olmstead
- Alberta Health Services, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Shannon Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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21
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Outcomes of Long-term Non-invasive Ventilation Use in Children with Neuromuscular Disease: Systematic Review and Meta-analysis. Ann Am Thorac Soc 2021; 19:109-119. [PMID: 34181865 DOI: 10.1513/annalsats.202009-1089oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine whether children with neuromuscular disorders using long-term non-invasive ventilation, continuous or bilevel positive airway pressure, have improved health outcomes compared to alternative treatment strategies. DATA SOURCES This systematic review is an extension of a scoping review. The search strategy used Medical Subject Headings (MeSH) and free-text terms for "child" and "non-invasive ventilation." Studies of humans from 1990 onward were searched in MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), Cochrane Library (Wiley), and PubMed. The results were reviewed for articles reporting on neuromuscular disorders and health outcomes including mortality, hospitalization, quality of life, lung function, sleep study parameters, and healthcare costs. DATA EXTRACTION Extracted data included study design, study duration, sample size, age, type of non-invasive ventilation, follow-up period, primary disease, and primary and secondary outcome measures. Studies were grouped by primary disease into 3 groups: spinal muscular atrophy, Duchenne muscular dystrophy, and other/multiple neuromuscular diseases. DATA SYNTHESIS A total of 50 articles including 1412 children across 36 different neuromuscular disorders are included in the review. Mortality is lower for children using long-term non-invasive ventilation compared to supportive care across all neuromuscular disease types. Overall, mortality does not differ when comparing the use of non-invasive ventilation to invasive mechanical ventilation though heterogeneity suggests that mortality with non-invasive ventilation is higher for spinal muscular atropy type-1 and lower for other/multiple neuromuscular diseases. The impact of long-term non-invasive ventilation on hospitalization rate differed by neuromuscular disease type with lower rates compared to invasive mechanical ventilation but higher rates compared to invasive mechanical ventilation use for spinal muscular atrophy type 1, and lower rates compared to before NIV for other/multiple neuromuscular diseases. Overall, lung function was unaltered and sleep study parameters were improved from baseline by long-term non-invasive ventilation use. There are few data to assess the impact of long-term non-invasive ventilation use on quality of life and healthcare costs. CONCLUSION Long-term non-invasive ventilation for children provides benefit for mortality, hospitalizations, and sleep study parameters for some sub-groups of children with neuromuscular disorders. High risk of bias and low study quality preclude strong conclusions.
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22
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Saddi V, Thambipillay G, Pithers S, Moody M, Martin B, Blecher G, Teng A. Average volume-assured pressure support vs conventional bilevel pressure support in pediatric nocturnal hypoventilation: a case series. J Clin Sleep Med 2021; 17:925-930. [PMID: 33393900 DOI: 10.5664/jcsm.9084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Average volume-assured pressure support (AVAPS) is a modality of noninvasive ventilation that provides a targeted tidal volume by automatically adjusting the inspiratory pressure support within a set range. Pediatric studies evaluating the efficacy of AVAPS in treating nocturnal hypoventilation are confined to case reports. The aim of this study was to compare AVAPS to conventional bilevel positive airway pressure (BPAP) support in improving hypercarbia in a cohort of pediatric patients with nocturnal hypoventilation. METHODS Retrospective review of patient records at an established tertiary pediatric sleep laboratory over a 6-year period. Ventilatory and sleep study parameters from AVAPS and conventional BPAP titration studies were compared. AVAPS was used only if hypoventilation was not controlled using conventional BPAP. Inspiratory pressures, tidal volumes, and adherence were downloaded on final titrated ventilatory settings. Comparisons were made using paired t test. RESULTS A total of 19 patients (11 boys, 8 girls; median age 10.5 years, range 1 to 20 years) were identified. Diagnoses included neuromuscular disease (n = 9), obstructive hypoventilation (n = 5), parenchymal lung disease (n = 4), and congenital central hypoventilation syndrome (n = 2). AVAPS demonstrated significant improvement in peak (P = .009) and mean (P = .001). Transcutaneous CO₂ parameters compared to conventional bilevel. Oxygenation on AVAPS showed positive trend but did not reach statistical significance. AVAPS delivered higher tidal volumes (P = .04) using similar pressures. There was no statistically significant difference in obstructive apnea-hypopnea index, respiratory arousal index, sleep efficiency, and adherence between AVAPS and conventional BPAP. CONCLUSIONS AVAPS was an effective alternative to conventional BPAP in improving hypercarbia in our selective cohort of pediatric patients. Prospective, longitudinal studies are needed to evaluate the benefits of AVAPS feature in the pediatric population.
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Affiliation(s)
- Vishal Saddi
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ganesh Thambipillay
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sonia Pithers
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Miles Moody
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Bradley Martin
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gregory Blecher
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Arthur Teng
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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23
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Fauroux B, Khirani S, Amaddeo A, Massenavette B, Bierme P, Taytard J, Stremler N, Baravalle-Einaudi M, Mazenq J, Ioan I, Schweitzer C, Lampin ME, Binoche A, Mordacq C, Bergounioux J, Mbieleu B, Rubinsztajn R, Sigur E, Labouret G, Genevois A, Becourt A, Hullo E, Pin I, Debelleix S, Galodé F, Bui S, Moreau J, Renoux MC, Matecki S, Lavadera ML, Heyman R, Pomedio M, Le Clainche L, Bokov P, Masson A, Hangard P, Menetrey C, Jokic M, Gachelin E, Perisson C, Pervillé A, Fina A, Giovannini-Chami L, Fleurence E, Barzic A, Breining A, Ollivier M, Labbé G, Coutier L, Aubertin G. Paediatric long term continuous positive airway pressure and noninvasive ventilation in France: A cross-sectional study. Respir Med 2021; 181:106388. [PMID: 33848922 DOI: 10.1016/j.rmed.2021.106388] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the characteristics of children treated with long term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in France. DESIGN Cross-sectional national survey. SETTING Paediatric CPAP/NIV teams of 28 tertiary university hospitals in France. PATIENTS Children aged <20 years treated with CPAP/NIV since at least 3 months on June 1st, 2019. INTERVENTION An anonymous questionnaire was filled in for every patient. RESULTS The data of 1447 patients (60% boys), mean age 9.8 ± 5.8 years were analysed. The most frequent underlying disorders were: upper airway obstruction (46%), neuromuscular disease (28%), disorder of the central nervous system (13%), cardiorespiratory disorder (7%), and congenital bone disease (4%). Forty-five percent of the patients were treated with CPAP and 55% with NIV. Treatment was initiated electively for 92% of children, while 8% started during an acute illness. A poly(somno)graphy (P(S)G) was performed prior to treatment initiation in 26%, 36% had a P(S)G with transcutaneous carbon dioxide monitoring (PtcCO2), while 23% had only a pulse oximetry (SpO2) with PtcCO2 recording. The decision of CPAP/NIV initiation during an elective setting was based on the apnea-hypopnea index (AHI) in 41% of patients, SpO2 and PtcCO2 in 25% of patients, and AHI with PtcCO2 in 25% of patients. Objective adherence was excellent with a mean use of 7.6 ± 3.2 h/night. Duration of CPAP/NIV was 2.7 ± 2.9 years at the time of the survey. CONCLUSION This survey shows the large number of children treated with long term CPAP/NIV in France with numerous children having disorders other than neuromuscular diseases.
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Affiliation(s)
- Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France; Université de Paris, VIFASOM, F-75004, Paris, France.
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France; Université de Paris, VIFASOM, F-75004, Paris, France; ASV Santé, F-92000, Gennevilliers, France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France; Université de Paris, VIFASOM, F-75004, Paris, France
| | - Bruno Massenavette
- Paediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, 69677, Bron, France
| | - Priscille Bierme
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, 69677, Bron, France
| | - Jessica Taytard
- Pediatric Pulmonology Department, AP-HP, Hôpital Armand Trousseau, F-75012, Paris, France; Sorbonne Université, INSERM UMR-S, 1158, Paris, France
| | - Nathalie Stremler
- Pediatric Ventilation Unit, Pediatric Department, AP-HM, Hôpital La Timone, 13385, Marseille, France
| | | | - Julie Mazenq
- Pediatric Ventilation Unit, Pediatric Department, AP-HM, Hôpital La Timone, 13385, Marseille, France
| | - Iulia Ioan
- Pediatric Department, University Children's Hospital, CHRU Nanc, Université de Lorraine, DevAH, F-54000, Nancy, France
| | - Cyril Schweitzer
- Pediatric Department, University Children's Hospital, CHRU Nanc, Université de Lorraine, DevAH, F-54000, Nancy, France
| | - Marie Emilie Lampin
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, 59037, Lille Cédex, France
| | - Alexandra Binoche
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, 59037, Lille Cédex, France
| | - Clemence Mordacq
- Pediatic Pulmonology and Allergology Unit, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, 59037, Lille Cédex, France
| | - Jean Bergounioux
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, F-92380, Garches, France
| | - Blaise Mbieleu
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, F-92380, Garches, France
| | | | - Elodie Sigur
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, 31000, Toulouse, France
| | - Geraldine Labouret
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, 31000, Toulouse, France
| | - Aline Genevois
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, 31000, Toulouse, France
| | - Arnaud Becourt
- Pediatric Pulmonology, CHU Amiens Picardie, 80054, France
| | - Eglantine Hullo
- Pediatric Pulmonology Unit, Hôpital Couple-Enfant, CHU Grenoble, 38000, Grenoble, France
| | - Isabelle Pin
- Pediatric Pulmonology Unit, Hôpital Couple-Enfant, CHU Grenoble, 38000, Grenoble, France; INSERM, Institute for Advanced Biosciences, 38000, Grenoble, France; Grenoble Alpes University, 38000, Grenoble, France
| | - Stéphane Debelleix
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, CIC-P Bordeaux 1401, CHU de Bordeaux, 33076, Bordeaux, France
| | - François Galodé
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, CIC-P Bordeaux 1401, CHU de Bordeaux, 33076, Bordeaux, France
| | - Stéphanie Bui
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, CIC-P Bordeaux 1401, CHU de Bordeaux, 33076, Bordeaux, France
| | - Johan Moreau
- Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000, Montpellier, France; Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, 34000, Montpellier, France
| | - Marie Catherine Renoux
- Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000, Montpellier, France
| | - Stefan Matecki
- Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000, Montpellier, France; Functional Exploration Laboratory, Physiology Department, University Hospital, 34000, Montpellier, France
| | - Marc Lubrano Lavadera
- Respiratory Diseases, Allergy and CF Unit, Pediatric Department, University Hospital Charles Nicolle, 76000, Rouen, France
| | - Rachel Heyman
- Pediatric Unit, Department of Physical Medicine and Rehabilitation, Hôpital Pontchaillou, Rennes, 35033, Rennes, France
| | - Michael Pomedio
- Pediatric Intensive Care Unit, American Memorial Hospital, CHU Reims, 51000, Reims, France
| | - Laurence Le Clainche
- Pediatric Noninvasive Ventilation, AP-HP, Hôpital Robert Debré, F-75018, Paris, France
| | - Plamen Bokov
- Pediatric Noninvasive Ventilation, AP-HP, Hôpital Robert Debré, F-75018, Paris, France
| | - Alexandra Masson
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, 87042, Limoges, France
| | - Pauline Hangard
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, 87042, Limoges, France
| | - Celine Menetrey
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, 87042, Limoges, France
| | - Mikael Jokic
- Pediatric Intensive Care Unit, CHU de Caen Normandie, 14033, Caen, France
| | - Elsa Gachelin
- Pediatric Department, CHU Félix Guyon, F-97404, Saint Denis, La Réunion, France
| | - Caroline Perisson
- Pediatric Department, CHU Sud Réunion, F-97448, Saint Pierre, La Réunion, France
| | - Anne Pervillé
- Hôpital d'Enfants - ASFA, F-97404, Saint Denis, La Réunion, France
| | - Agnes Fina
- Pediatric Pulmonology and Allergology Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
| | - Lisa Giovannini-Chami
- Pediatric Pulmonology and Allergology Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
| | | | - Audrey Barzic
- Pediatric Department, CHU Brest, 29200, Brest, France
| | - Audrey Breining
- Pediatric Department, CHU Strasbourg, 67000, Strasbourg, France
| | - Morgane Ollivier
- Pediatric Intensive Care Unit, CHU Angers, 49100, Angers, France
| | - Guillaume Labbé
- Pediatric Pulmonology and Allergology Unit, CHU d'Estaing, 63003, Clermont-Ferrand, France
| | - Laurianne Coutier
- Paediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, 69677, Bron, France
| | - Guillaume Aubertin
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, 69677, Bron, France; Sorbonne Université, INSERM UMR-S 938, Centre de Recherche Saint-Antoine (CRSA), F-75014, Paris, France; Centre de Pneumologie de l'enfant, Ramsay Générale de Santé, 92100, Boulogne-Billancourt, France
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Langzeitbeatmung bei Kindern und Jugendlichen – ein Fall für die Rehabilitation? Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-020-01112-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Popejoy E, Marufu TC, Thomas DA, Gregory R, Frost A, McNarry N, Hurley M, Bean D, Manning JC. A regional evaluation of the health care utilization and outcomes of children and young people with long-term ventilation needs. Child Care Health Dev 2021; 47:70-76. [PMID: 33107083 DOI: 10.1111/cch.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Globally, the number of children and young people (CYP) with long-term ventilation (LTV) needs is increasing, with high associated health care costs, due to frequent hospital admissions and contact with community health care services. However, demographic, health care utilization and outcome details of the CYP cared for locally is unknown. This study aimed to examine health care utilization and outcomes for this patient population. METHODS Routinely collected data from 2014 to 2018 were extracted from local LTV team records and from hospital electronic patient records. Descriptive and inferential statistical analysis was performed using SPSS 17. RESULTS A total of 112 CYP aged 0-17 years old were included in the evaluation. Sixty per cent (n = 67) commenced ventilation in hospital, and 62% (n = 69) had at-least one hospitalization event whilst they were on LTV, with a median length of stay of 3 days. Most hospitalizations were unplanned and respiratory in nature. Ninety-five per cent (n = 106) of CYP accessed at least one clinic appointment whilst on LTV, with a median of 20 outpatient clinic appointments during the study period. The majority of CYP received time-intensive support from LTV nurses and physiotherapists during the period that they received LTV. Minimal seasonal variation existed in relation to hospital admissions. Year on year increasing trend of hospital admissions was noted. The observed mortality rate was 3.6% (n = 4), 72.3% (n = 81) remained active on LTV, 14% (n = 16) were liberated from their ventilation and 9% (n = 10) transitioned to adult care by the end of the study. CONCLUSION The study highlights the most common modes of health care utilization for CYP with LTV needs. To enable formalization of future resource planning and accurate assessment of health care utilization in evaluations, there is an urgent need to create a systematic approach for relevant LTV data collection.
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Affiliation(s)
- Emma Popejoy
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Takawira C Marufu
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David A Thomas
- Long Term Ventilation Service, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rachel Gregory
- Long Term Ventilation Service, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adele Frost
- Long Term Ventilation Service, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola McNarry
- Long Term Ventilation Service, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Hurley
- Long Term Ventilation Service, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dorothy Bean
- School of Nursing, Buckinghamshire New University, UK
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
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Praud JP. Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications. Front Pediatr 2020; 8:584334. [PMID: 33224908 PMCID: PMC7674588 DOI: 10.3389/fped.2020.584334] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/22/2020] [Indexed: 01/15/2023] Open
Abstract
This review focuses on the delivery of non-invasive ventilation-i.e., intermittent positive-pressure ventilation-in children lasting more than 3 months. Several recent reviews have brought to light a dramatic escalation in the use of long-term non-invasive ventilation in children over the last 30 years. This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT-NIV equipment that can be used at home. While significant gaps in availability persist for smaller children and especially infants, home LT-NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care. While long-term NIV is usually delivered during sleep, it can also be delivered 24 h a day in selected patients. Close collaboration between the hospital complex-care team, the home LT-NIV program, and family caregivers is of the utmost importance for successful home LT-NIV. Long-term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation, with the aim to increase life expectancy and maximize quality of life. LT-NIV is considered for conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall anomalies). Relative contraindications for LT-NIV include the inability of the local medical infrastructure to support home LT-NIV and poor motivation or inability of the patient/caregivers to cooperate or understand recommendations. Anatomic abnormalities that interfere with interface fitting, inability to protect the lower airways due to excessive airway secretions and/or severely impaired swallowing, or failure of LT-NIV to support respiration can lead to considering invasive ventilation via tracheostomy. Of note, providing home LT-NIV during the COVID 19 pandemic has become more challenging. This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS-CoV-2 during NIV. Delay in initiating LT-NIV, decreased frequency of home visits by the home ventilation program, and decreased availability of polysomnography and oximetry/transcutaneous PCO2 monitoring are observed. Teleconsultations and telemonitoring are being developed to mitigate these challenges.
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Affiliation(s)
- Jean-Paul Praud
- Division of Pediatric Pulmonology, University of Sherbrooke, Sherbrooke, QC, Canada
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Foy CM, Koncicki ML, Edwards JD. Liberation and mortality outcomes in pediatric long-term ventilation: A qualitative systematic review. Pediatr Pulmonol 2020; 55:2853-2862. [PMID: 32741115 PMCID: PMC7891895 DOI: 10.1002/ppul.25003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/30/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To provide a systematic review of liberation from positive pressure ventilation and mortality of children with chronic respiratory failure who used long-term invasive and noninvasive ventilation (LTV). METHODS Papers published from 1980 to 2018 were identified using Pubmed MEDLINE, Ovid MEDLINE, Embase, and Cochrane databases. Search results were limited to English-language papers with (a) patients less than 22 years at initiation, (b) patients who used invasive ventilation (IV) via tracheostomy or noninvasive ventilation (NIV), and (c) data on mortality or liberation from LTV. Data were presented using descriptive statistics; changes in outcomes over time were explored using linear regression. Follow-up variability, cohort heterogeneity, and insufficient data precluded combining data to estimate incidences or rates. RESULTS One hundred and thirty papers with 12 704 patients were included. The median number of patients was 37 (interquartile range [IQR] 17-74, range 6-3802). Twenty-five percent of patients were initiated on IV; 75% on NIV. The maximum follow-up ranged from 0.5 to 31.8 years (median 8.8 years). The median proportion of patients liberated in these papers was 3% (IQR 0%-21%). The median proportion of mortality was 18% (IQR 8%-27%). Proportions of liberation and mortality did not significantly change over time. Progression of underlying disease (44%), respiratory illness (19%), and LTV accident (11%) were the most common causes of death. CONCLUSIONS These papers collectively show most patients survive for many years using LTV; in many subgroups, death is a more common outcome than liberation. However, the limitations of these papers preclude robust prognostication.
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Affiliation(s)
- Candice M Foy
- Division of Pediatric Hospital Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Monica L Koncicki
- Section of Critical Care, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jeffrey D Edwards
- Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Valegos College of Physician and Surgeons, New York, New York
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Israelsson‐Skogsberg Å, Persson C, Markström A, Hedén L. Children with home mechanical ventilation-Parents' health-related quality of life, family functioning and sleep. Acta Paediatr 2020; 109:1807-1814. [PMID: 31955457 DOI: 10.1111/apa.15177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 11/28/2022]
Abstract
AIM Children requiring home mechanical ventilation (HMV) have grown in number and complexity. Parents of children with HMV are often responsible for the advanced homecare. This study explored the health-related quality of life (HRQoL), family functioning and sleep in parents of children with HMV. A secondary aim was to explore the impact on HRQoL, family functioning and sleep of selected potential determinants. METHODS Questionnaires were completed by 45 mothers and 40 fathers, to 55 children receiving HMV. Parents were identified via respiratory clinics in the Swedish national quality register for oxygen and home respiratory treatment and invited to participate between December 2016 and December 2018. RESULTS There were no differences between mothers and fathers overall HRQoL or family functioning reports, although differences within the physical (P < .043) and cognitive (P < .009) functioning dimensions were found. One of four parents reported moderate or severe insomnia. The variability in HRQoL and family functioning was predicted by HMV mode and sleep quality to an extent of 45% and 21%, respectively. CONCLUSION Sleep quality and the child's HMV mode predicted parental HRQoL and family functioning. The results underscore the importance of evaluating parents' sleep and of being aware that invasive ventilation influences parental HRQoL and family functioning.
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Affiliation(s)
| | - Carina Persson
- Faculty of Health and Life Sciences Linnaeus University Kalmar Sweden
| | - Agneta Markström
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research Uppsala University Uppsala Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Lena Hedén
- Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
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Park S, Suh ES. Home mechanical ventilation: back to basics. Acute Crit Care 2020; 35:131-141. [PMID: 32907307 PMCID: PMC7483009 DOI: 10.4266/acc.2020.00514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Over recent decades, the use of home mechanical ventilation (HMV) has steadily increased worldwide, with varying prevalence in different countries. The key indication for HMV is chronic respiratory failure with alveolar hypoventilation (e.g., neuromuscular and chest wall disease, obstructive airway diseases, and obesity-related respiratory failure). Most modern home ventilators are pressure-targeted and have sophisticated modes, alarms, and graphics, thereby facilitating optimization of the ventilator settings. However, different ventilators have different algorithms for tidal volume estimation and leak compensation, and there are also several different circuit configurations. Hence, a basic understanding of the fundamentals of HMV is of paramount importance to healthcare workers taking care of patients with HMV. When choosing a home ventilator, they should take into account many factors, including the current condition and prognosis of the primary disease, the patient’s daily performance status, time (hr/day) needed for ventilator support, family support, and financial costs. In this review, to help readers understand the basic concepts of HMV use, we describe the indications for HMV and the factors that influence successful delivery, including interface, circuits, ventilator accessories, and the ventilator itself.
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Affiliation(s)
- Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eui-Sik Suh
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
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Leske V, Guerdile MJ, Gonzalez A, Testoni F, Aguerre V. Feasibility of a pediatric long-term Home Ventilation Program in Argentina: 11 years' experience. Pediatr Pulmonol 2020; 55:780-787. [PMID: 31977167 DOI: 10.1002/ppul.24662] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/12/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pediatric home ventilation (HV) has increased worldwide. A Home Ventilation Program (HVP) was started in the Pulmonary Department of the "Hospital de Pediatría Prof. Dr. J. P. Garrahan," Argentina, in 2007. This is the largest Argentine national pediatric tertiary care referral center. Limited studies on pediatric HV from Latin American countries have been published. OBJECTIVE This study describes and analyzes the cohort of children admitted to the HVP during an 11 years period. METHODS Longitudinal study. POPULATION all patients (pts) admitted to the HVP between 2007 and 2018. We analyzed demographic and clinical variables, sleep study results, ventilation setting, and start manner collected in a prospective data base. RESULTS A total of 244 pts were admitted. Median age at ventilation start was 9.41 (3.47-14.08) years, 84% of pts had health insurance. The most frequent underlying diseases were neuromuscular disease (43%) and genetic syndromes (23%). Home-hospital distance was 100-500 km in 16% of cases and greater than 500 km in 34%. Seventy percent of pts had sleep studies before ventilation initiation. Ventilation was started in our general pediatric ward in 83.6%. Noninvasive ventilation was used in 86.1%. The actual number of pts still on follow up is 133 of 244 (54.5%), 16.8% dropped out, 16.4% were transitioned to adult care, 5.32% resolved their sleep-disordered breathing, and 5.32% died. CONCLUSIONS The HVP admitted pts from all the country. Ventilation was started on the basis of clinical and objective sleep measures. This long-term experience underlines the feasibility of a HVP in an emergent country.
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Affiliation(s)
- Vivian Leske
- Sleep Unit, Department of Pulmonology, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - María J Guerdile
- Sleep Unit, Department of Pulmonology, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Adriana Gonzalez
- Department of Physical Therapy, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Fernanda Testoni
- Department of Physical Therapy, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Verónica Aguerre
- Department of Pulmonology, Prof. Dr. J. P. Garrahan Pediatric Hospital, Buenos Aires, Argentina
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Lu M, Yee BJ, Fitzgerald DA. Transition to adult care in sleep medicine. Paediatr Respir Rev 2020; 33:9-15. [PMID: 31806562 DOI: 10.1016/j.prrv.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022]
Abstract
More children with chronic and complex care needs are transitioned to adulthood due to advancements in medical technology including the use of non-invasive ventilation [NIV] at home and innovative medical therapies. Sleep medicine is becoming a common and at times vital component of the management plan. Various challenges are experienced in transitioning sleep patients depending on the underlying condition. These include the direct conflict between the desires of a young person for independence and their declining ability to provide self-care in neuromuscular patients, the behavioural challenges inherent in the management of children with various syndromes and the funding of equipment, care needs and multidisciplinary team input in an already resource limited adult setting. These patients should be transitioned in an early and coordinated approach following core principles of transition. Ongoing advocacy is required to raise awareness of the increased trend for technology supported young people being transitioned. Further research is required to track and assess the transition process in patients with various sleep conditions.
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Affiliation(s)
- Mimi Lu
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Brendon J Yee
- Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Pavone M, Verrillo E, Onofri A, Caggiano S, Chiarini Testa MB, Cutrera R. Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome. Ital J Pediatr 2020; 46:12. [PMID: 32005269 PMCID: PMC6995086 DOI: 10.1186/s13052-020-0778-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Children with chronic respiratory failure and/or sleep disordered breathing due to a broad range of diseases may require long-term ventilation to be managed at home. Advances in the use of long-term non-invasive ventilation has progressively leaded to a reduction of the need for invasive mechanical ventilation through tracheostomy. In this study, we sought to characterize a cohort of children using long-term NIV and IMV and to perform an analysis of those children who showed significant changes in ventilatory support management. Methods We performed a retrospective cohort study of pediatric (within 18 years old) patients using long-term, NIV and IMV, hospitalized in our center between January 1, 2000 and December 31, 2017. A total of 432 children were included in the study. Long Term Ventilation (LTV) was defined as IMV or NIV, performed on a daily basis, at least 6 h/day, for a period of at least 3 months. Results 315 (72.9%) received non-invasive ventilation (NIV); 117 (27.1%) received invasive mechanical ventilation (IMV). Children suffered mainly from neuromuscular (30.6%), upper airway (24.8%) and central nervous system diseases (22.7%). Children on IMV were significantly younger when they start LTV [NIV: 6.4 (1.2–12.8) years vs IMV 2.1 (0.8–7.8) years] (p < 0.001)]. IMV was likely associated with younger age at starting ventilatory support (aOR 0.9428; p = 0.0220), and being a child with home health care (aOR 11.4; p < 0.0001). Overtime 39 children improved (9%), 11 children on NIV (3.5%) received tracheostomy; 62 children died (14.3%); and 74 children (17.1%) were lost to follow-up (17.8% on NIV, 15.4% on IMV). Conclusions Children on LTV suffered mainly from neuromuscular, upper airways, and central nervous system diseases. Children invasively ventilated usually started support younger and were more severely ills.
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Affiliation(s)
- Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Elisabetta Verrillo
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Alessandro Onofri
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Serena Caggiano
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Maria Beatrice Chiarini Testa
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy
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Krivec U, Caggiano S. Noninvasive Ventilation in Palliative Care and Ethical Dilemma. Front Pediatr 2020; 8:483. [PMID: 33014921 PMCID: PMC7493667 DOI: 10.3389/fped.2020.00483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022] Open
Abstract
Significant difference exists between validated indications for noninvasive ventilation (NIV) use in children and current real life practice. Lately, dedicated centers have reported exponential growth of NIV use in children and adolescents. Upper airway obstruction, neuromuscular diseases, chronic lung/thoracic conditions, and central respiratory drive failure remain the most prevalent indications. However, the need to alleviate respiratory failure related distress has been increasingly recognized in several other conditions. Palliative care in children with life limiting disorders is a complex continuum of activities. In order to provide the most appropriate care for the patients and their families, the management often oscillates between actively curative and purely supportive actions. Despite unprecedented therapeutic advancements, several neurologic, metabolic, hemato-oncologic, respiratory, and other rare diseases remain with no curative options. Besides, attentiveness to relive suffering, awareness, and availability have moved the boundaries of NIV use toward conditions formerly not considered suitable for such care. Still, NIV has limitations and can, if sustained in inappropriate circumstances, fail to provide relief. A structured professional frameshift should be available for support and ethical guidance in order to provide confidence to patients, families and all the involved caregivers.
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Affiliation(s)
- Uros Krivec
- Department of Pediatric Pulmology, University Children's Hospital Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Serena Caggiano
- Laboratory Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
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Khirani S, Amaddeo A, Griffon L, Lanzeray A, Teng T, Fauroux B. Follow-Up and Monitoring of Children Needing Long Term Home Ventilation. Front Pediatr 2020; 8:330. [PMID: 32656168 PMCID: PMC7322995 DOI: 10.3389/fped.2020.00330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/20/2020] [Indexed: 12/23/2022] Open
Abstract
Once continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) is started in a child, and the child is discharged home, follow-up needs to be organized with regular visits in order to check the tolerance and efficacy of the treatment. But there is a lack of validated clinical guidelines, mainly because of the heterogeneity of the ventilator servicing, the costs and health care systems among countries. Therefore, visits timing and strategies to monitor CPAP/NIV are not clearly defined. Moreover, depending on various factors such as the underlying disorder, the medical stability, the age of the child, and socio-economic factors, follow-up usually ranges between 1 month and 3-6 months, or even 1 year following treatment initiation, with an overnight hospital stay, an out-patient visit, a home visit, via telemonitoring or telemedicine, alone or in combination. Apart from clinical evaluation, nocturnal oximetry and capnography monitoring and/or poly(somno)graphy (P(S)G) are usually carried out during the follow-up visits to monitor the delivered pressure, leaks, residual respiratory events and synchrony between the patient and the ventilator. Built-in software data of CPAP/NIV devices can be used to assess the adherence of treatment, to monitor pressure efficiency, leaks, asynchronies, and to estimate the presence of residual respiratory events under CPAP/NIV if P(S)G is not available or in alternance with P(S)G. The possibility of CPAP/NIV weaning should be assessed on a regular basis, but no criteria for the timing and procedures have been validated. Weaning timing depends on the clinical condition that justified CPAP/NIV initiation, spontaneous improvement with growth, and the possibility and efficacy of various upper airway, maxillofacial and/or neurosurgical procedures. Weaning may be allowed in case of the disappearance of nocturnal and daytime symptoms of sleep-disordered breathing (SDB) after several nights without CPAP/NIV and the objective correction of SDB on a P(S)G. But no parameters are defined. In any case, a long term follow-up is necessary to ascertain the weaning success. Large prospective studies, together with international and national guidelines, are required in order to build evidence for standardizing practice for the follow-up and weaning of CPAP/NIV in children.
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Affiliation(s)
- Sonia Khirani
- ASV Santé, Gennevilliers, France.,Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Agathe Lanzeray
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Theo Teng
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
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Fauroux B, Khirani S, Griffon L, Teng T, Lanzeray A, Amaddeo A. Non-invasive Ventilation in Children With Neuromuscular Disease. Front Pediatr 2020; 8:482. [PMID: 33330262 PMCID: PMC7717941 DOI: 10.3389/fped.2020.00482] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
The respiratory muscles are rarely spared in children with neuromuscular diseases (NMD) which puts them at risk of alveolar hypoventilation. The role of non-invasive ventilation (NIV) is then to assist or "replace" the weakened respiratory muscles in order to correct alveolar hypoventilation by maintaining a sufficient tidal volume and minute ventilation. As breathing is physiologically less efficient during sleep, NIV will be initially used at night but, with the progression of respiratory muscle weakness, NIV can be extended during daytime, preferentially by means of a mouthpiece in order to allow speech and eating. Although children with NMD represent the largest group of children requiring long term NIV, there is a lack of validated criteria to start NIV. There is an agreement to start long term NIV in case of isolated nocturnal hypoventilation, before the appearance of daytime hypercapnia, and/or in case of acute respiratory failure requiring any type of ventilatory support. NIV is associated with a correction in night- and daytime gas exchange, an increase in sleep efficiency and an increase in survival. NIV and/or intermittent positive pressure breathing (IPPB) have been shown to prevent thoracic deformities and consequent thoracic and lung hypoplasia in young children with NMD. NIV should be performed with a life support ventilator appropriate for the child's weight, with adequate alarms, and an integrated (±additional) battery. Humidification is recommended to improve respiratory comfort and prevent drying of bronchial secretions. A nasal interface (or nasal canula) is the preferred interface, a nasobuccal interface can be used with caution in case of mouth breathing. The efficacy of NIV should be assessed on the correction of alveolar ventilation. Patient ventilator synchrony and the absence of leaks can be assessed on a sleep study with NIV or on the analysis of the ventilator's in-built software. The ventilator settings and the interface should be adapted to the child's growth and progression of respiratory muscle weakness. NIV should be associated with an efficient clearance of bronchial secretions by a specific program on the ventilator, IPPB, or mechanical insufflation-exsufflation. Finally, these children should be managed by an expert pediatric multi-disciplinary team.
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Affiliation(s)
- Brigitte Fauroux
- Pediatric Non-invasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Sonia Khirani
- Pediatric Non-invasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France.,ASV Sante, Gennevilliers, France
| | - Lucie Griffon
- Pediatric Non-invasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Theo Teng
- Pediatric Non-invasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Agathe Lanzeray
- Pediatric Non-invasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Alessandro Amaddeo
- Pediatric Non-invasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
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Bush A, Fitzgerald D. Twenty-five years of Respirology: Advances in paediatric lung disease. Respirology 2019; 25:35-37. [PMID: 31840887 DOI: 10.1111/resp.13739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew Bush
- Department of Paediatrics, Imperial College, London, UK.,Department of Paediatrics, Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Dominic Fitzgerald
- Department of Paediatric Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Banfi P, Pierucci P, Volpato E, Nicolini A, Lax A, Robert D, Bach J. Daytime noninvasive ventilatory support for patients with ventilatory pump failure: a narrative review. Multidiscip Respir Med 2019; 14:38. [PMID: 31798866 PMCID: PMC6884796 DOI: 10.1186/s40248-019-0202-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
Over the past three decades, the use of noninvasive ventilation or "NIV" to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechanical ventilation. NVS, along with mechanical insufflation-exsufflation, now provides a noninvasive option for the management of both chronic and acute respiratory failure for these patients. The most common diagnoses for which these methods are useful include chest wall deformities, neuromuscular diseases, morbid obesity, high level spinal cord injury and idiopathic, primary or secondary disorders of the ventilatory control. Thus, NVS is being used in diverse settings: critical care units, medical wards, at home, and in extended care. The aim of this review is to examine the techniques used for daytime support.
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Affiliation(s)
- Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Paola Pierucci
- Cardio Thoracic Department, Respiratory and Sleep Disorders Unit, Bari Policlinic, Bari, Italy
| | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Antonello Nicolini
- Respiratory Rehabilitation Unit, ASL 4 Chiavarese, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Agata Lax
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Dominique Robert
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - John Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, USA
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Onofri A, Tan HL, Cherchi C, Pavone M, Verrillo E, Ullmann N, Testa MBC, Cutrera R. Transition to adult care in young people with neuromuscular disease on non-invasive ventilation. Ital J Pediatr 2019; 45:90. [PMID: 31337423 PMCID: PMC6647168 DOI: 10.1186/s13052-019-0677-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Long-term mechanical ventilation (LTV) with non-invasive ventilation (NIV) prolongs survival in patients with Neuromuscular Diseases (NMDs). Transition from paediatric to adult healthcare system is an undervalued and challenging issue for children with chronic conditions on mechanical ventilation. METHODS this retrospective study aims to compare issues of young adults in age to transition to adult care (≥ 15 years old) affected by NMDs on NIV in two different Paediatric Respiratory Units in two different countries: Bambino Gesù Children's Hospital, Research Institute, (Rome, Italy) (BGCH) and the Paediatric Respiratory Unit of the Royal Brompton Hospital (London, UK) (RBHT). RESULTS The median (min-max) age at starting ventilation was significantly different in the two groups (16 years old vs 12, p = 0.0006). We found significant difference in terms of median age at the time of observation (18 (15-22) vs 17 (15-19) years, p = 0.0294) and of type of referral (all the patients from the BGCH group were referred to paediatric services (n = 15, 100%), median age 18 (15-22); only 6 patients, in the RBHT group, with a median age 15.50 (15-17) years, were entirely referred to paediatric service). We found different sleep-disordered breathing assessments 6 full Polysomnographies, 7 Cardio-Respiratory Polygraphies and 2 oximetry with capnography (SpO2-tcCO2) studies in the BCGH group, while all patients of RBHT group were assessed with an SpO2-tcCO2 study. All patients from both groups underwent multidisciplinary assessment. CONCLUSIONS In conclusion, patients with NMDs on NIV in age to transition to adult require complex multidisciplinary management: significant efforts are needed to achieve the proper transition to adult care.
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Affiliation(s)
- Alessandro Onofri
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, 156726 UK
| | - Claudio Cherchi
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Elisabetta Verrillo
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Maria Beatrice Chiarini Testa
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital “Bambino Gesù” Research Institute, Piazza S. Onofrio 4, 00165 Rome, Italy
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Eckerland M, Bock C, Olivier M, Pichlmaier L, Steindor M, Stehling F. Reducing the frequency of respiratory tract infections in severe neurological disorders by inhaled antibiotics: a retrospective data analysis. ERJ Open Res 2019; 5:00149-2018. [PMID: 31360698 PMCID: PMC6646963 DOI: 10.1183/23120541.00149-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/14/2019] [Indexed: 01/25/2023] Open
Abstract
Background In patients with severe neurological impairment, recurrent respiratory tract infections frequently occur as a result of impaired clearance of airway secretions and microbial airway colonisation. We hypothesised that inhaled antibiotic therapy may improve the morbidity of these patients. Methods A retrospective data analysis of 20 patients (11 nontracheotomised and nine tracheotomised) with neurological impairment and microbial airway colonisation was carried out at a children's university hospital. Two questionnaires that asked about the number of respiratory tract infections, antibiotic therapies and hospitalisations were distributed to the patients/caregivers: a first questionnaire representing the 12 months prior to the initiation of inhaled antibiotics and a second questionnaire describing the first 12 months under therapy. Results During the first 12 months of therapy, the frequency of respiratory tract infections among all participants was reduced from a mean of 6.8 episodes (median (interquartile range (IQR)) 6.0 (4.0–10.0) episodes) to a mean of 2.5 episodes (median (IQR) 2.0 (1.0–3.0) episodes; p<0.001). In addition, a significant decrease of systemic antibiotic therapies (mean 7.7, median (IQR) 6.0 (4.0–10.0) versus 2.5, 2.5 (0.0–3.75) episodes; p<0.001) and hospitalisations (mean 3.9, median (IQR) 3.5 (1.0–5.0) versus 0.9, 0.0 (0.0–1.0) episodes; p<0.001) was noted. This significant therapeutic effect could be demonstrated in a subgroup analysis in both tracheotomised and nontracheotomised subjects. The reduction of respiratory tract infections and systemic antibiotic therapies (and thus the therapeutic success) was significantly greater in the nontracheotomised group compared with the tracheotomised group. Conclusions The presented data suggest that inhaled antibiotics might play a role in treating recurrent respiratory tract infections in neuromuscular diseases. Inhaled antibiotic therapy offers a novel approach to the prevention of respiratory tract infections in patients with severe neurological impairment who have chronic microbial airway colonisation and recurrent respiratory tract infectionshttp://bit.ly/2HQRyz0
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Affiliation(s)
- Maximilian Eckerland
- Dept of Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Children's Hospital, Essen, Germany
| | - Claudia Bock
- Dept of Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Children's Hospital, Essen, Germany
| | - Margarete Olivier
- Dept of Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Children's Hospital, Essen, Germany
| | - Leopold Pichlmaier
- Dept of Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Children's Hospital, Essen, Germany
| | - Mathis Steindor
- Dept of Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Children's Hospital, Essen, Germany
| | - Florian Stehling
- Dept of Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Children's Hospital, Essen, Germany
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Tan GP, Soon LHY, Ni B, Cheng H, Tan AKH, Kor AC, Chan Y. The pattern of use and survival outcomes of a dedicated adult Home Ventilation and Respiratory Support Service in Singapore: a 7-year retrospective observational cohort study. J Thorac Dis 2019; 11:795-804. [PMID: 31019767 DOI: 10.21037/jtd.2019.02.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background In Singapore, a dedicated adult multidisciplinary Home Ventilation and Respiratory Support Service (HVRSS) was set-up to assist individuals with chronic ventilatory failure. We aimed to study the use, survival outcomes and identify factors influencing survival in our cohort of ventilator-assisted individuals (VAIs). Methods We retrospectively reviewed all referrals to HVRSS from 2009 to 2015. All VAIs were included and divided into 4 categories: (I) amyotrophic lateral sclerosis (ALS); (II) other neuromuscular and chest wall disease (NMCW); (III) spinal cord injury (SCI); and (IV) complex intensive care unit (ICU) groups for comparison of baseline characteristics, co-morbidities, therapy details and survival outcomes. Cox proportional analysis was used to identify important factors influencing survival for ALS and non-ALS VAIs. Results There were 112 VAIs; most were male (63%) and ethnic Chinese (83%). At baseline, median [interquartile range (IQR)] age was 61 [46-69] years, body mass index was 20.2 (17.1-23.8) kg/m2 and forced vital capacity was 38 [24-65] %predicted. The three most common diseases were ALS (43%), SCI (13%) and congenital muscular dystrophies (6%). Seventy-four (66%) VAIs received non-invasive ventilation (NIV). Median survival for ALS, Complex ICU, SCI and NMCW VAIs were 1.8, 2.6, 4.2 and 6.7 years respectively. In ALS, NIV conversion to invasive mechanical ventilation (IMV) was associated with longer survival [hazard ratio (HR) 0.24]. In non-ALS VAIs, older age (HR 1.40) and cardiovascular comorbidities (HR 2.61) were poor prognostic factors. Conclusions The HVRSS managed a heterogenous group of VAIs in Singapore and survival is comparable to published cohorts. ALS had the worst survival whereas NMCW had the best survival with Complex ICU and SCI groups in between. Transition from NIV to IMV, age and cardiovascular disease were important prognostic factors.
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Affiliation(s)
- Geak Poh Tan
- Department of Respiratory and Critical Care Medicine, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lydia Hse Yin Soon
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Nursing Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bin Ni
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Nursing Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hong Cheng
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Nursing Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Adrian Kok Heng Tan
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Continuing and Community Care, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ai Ching Kor
- Department of Respiratory and Critical Care Medicine, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yeow Chan
- Home Ventilation and Respiratory Support Service, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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Lee BR, Shin SH, Kim MJ, Kim E, Choi YJ, Park JD, Suh DI. Clinical characteristics of pediatric pneumothorax during a noninvasive positive pressure ventilation. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.1.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bo Ra Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - So Hyun Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eunji Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | | | - June Dong Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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Maynard R, Christensen E, Cady R, Jacob A, Ouellette Y, Podgorski H, Schiltz B, Schwantes S, Wheeler W. Home Health Care Availability and Discharge Delays in Children With Medical Complexity. Pediatrics 2019; 143:peds.2018-1951. [PMID: 30509929 DOI: 10.1542/peds.2018-1951] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5849572914001PEDS-VA_2018-1951Video Abstract BACKGROUND: An increasing proportion of pediatric hospital days are attributed to technology-dependent children. The impact that a pediatric home care nursing (HCN) shortage has on increasing length of hospital stay and readmissions in this population is not well documented. METHODS We conducted a 12-month multisite prospective study of children with medical complexity discharging with home health. We studied the following 2 cohorts: new patients discharging for the first time to home nursing and existing patients discharging from the hospital to previously established home nursing. A modified delay tool was used to categorize causes, delayed discharge (DD) days, and unplanned 90-day readmissions. RESULTS DD occurred in 68.5% of 54 new patients and 9.2% of 131 existing patients. Lack of HCN was the most frequent cause of DD, increasing costs and directly accounting for an average length of stay increase of 53.9 days (range: 4-204) and 35.7 days (3-63) for new and existing patients, respectively. Of 1582 DDs, 1454 (91.9%) were directly attributed to lack of HCN availability. DD was associated with younger age and tracheostomy. Unplanned 90-day readmissions were due to medical setbacks (96.7% of cases) and occurred in 53.7% and 45.0% of new and existing patients, respectively. CONCLUSIONS DD and related costs are primarily associated with shortage of HCN and predominantly affect patients new to HCN. Medical setbacks are the most common causes of unplanned 90-day readmissions. Increasing the availability of home care nurses or postacute care facilities could reduce costly hospital length of stay.
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Affiliation(s)
- Roy Maynard
- Children's Minnesota, Minneapolis, Minnesota; .,Pediatric Home Service, Roseville, Minnesota
| | - Eric Christensen
- College of Continuing and Professional Studies, Health Services Management, University of Minnesota, St Paul, Minnesota
| | - Rhonda Cady
- Gillette Children's Specialty Healthcare, St Paul, Minnesota
| | - Abraham Jacob
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota; and
| | | | - Heather Podgorski
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota; and
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Grychtol R, Chan EY. Use of non-invasive ventilation in cerebral palsy. Arch Dis Child 2018; 103:1170-1177. [PMID: 29886412 DOI: 10.1136/archdischild-2017-313959] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/19/2018] [Accepted: 05/21/2018] [Indexed: 11/04/2022]
Abstract
Patients with cerebral palsy (CP), especially those at the severe end of the spectrum (Gross Motor Function Classification System levels IV-V equivalent), frequently suffer from sleep disturbance and sleep-disordered breathing (SDB). Non-invasive ventilation (NIV) is increasingly used in this patient group, albeit with little published evidence of its effectiveness in CP. This article aims to review the current evidence in the use of NIV in children with CP, highlighting areas of uncertainties, as well as the balance of potential risks, challenges and benefits. We would also share our experience and practical considerations in using NIV to manage SDB in this group of patients. Between January 2010 and December 2016, 21 patients (median age 11.1 (range 1.7-16.1) years) with CP were initiated on NIV at Great Ormond Street Hospital for Children following diagnosis of moderate to severe SDB on cardiorespiratory polygraphy. Over half of our patients with CP (n=11) failed to establish on NIV either due to intolerance of mask and/or ventilation pressure at the initial trial in hospital, or poor adherence during follow-up, in contrast to the overall failure rate of 8.7% among total patient population commenced on NIV. Children with CP constitute a relatively small but challenging group of patients. Decision to undertake NIV should be individualised, based on benefit outweighing the risk and burden of the treatment.
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Affiliation(s)
- Ruth Grychtol
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Elaine Y Chan
- Respiratory Unit, Great Ormond St Hospital for Children, London, UK
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44
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Lindahl B, Kirk S. When technology enters the home – a systematic and integrative review examining the influence of technology on the meaning of home. Scand J Caring Sci 2018; 33:43-56. [DOI: 10.1111/scs.12615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Berit Lindahl
- Faculty of Caring Sciences Work Life & Social Welfare University of Borås Borås Sweden
| | - Sue Kirk
- Division of Nursing Midwifery & Social Work University of Manchester Manchester UK
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45
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Wright M, Manzur A, Bush A. Case of paediatric neuromuscular disease with a surprising clinical outcome: time to challenge the dogma? Thorax 2018; 73:788-790. [DOI: 10.1136/thoraxjnl-2017-211058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 11/04/2022]
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46
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Ikeda A, Tsuji M, Goto T, Iai M. Long-term home non-invasive positive pressure ventilation in children: Results from a single center in Japan. Brain Dev 2018; 40:558-565. [PMID: 29636207 DOI: 10.1016/j.braindev.2018.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Non-invasive positive pressure ventilation (NPPV) in children has recently increased worldwide and is used not only for neuromuscular diseases but for various other diseases. However, there have been few observational studies on long-term NPPV in children in Japan. METHODS Based on medical records, we retrospectively evaluated patients aged ≤20 years who were initiated long-term NPPV at our hospital from January 2001 to December 2015. RESULTS A total of 53 patients on long-term NPPV were identified; 38 (72%) had severe motor and intellectual disabilities (SMID). Compared to those with non-neuromuscular diseases, those with neuromuscular diseases had significantly more planned initiations and less frequent use of oxygen. Regarding patient outcome, 34 patients continued NPPV (64%), and there were three discontinues (6%), seven tracheostomies (13%), and nine deaths (17%). The continuation rate was high among those with neuromuscular disorders (15/19 cases, 79%) and that of tracheotomy was high in those with metabolic/degenerative diseases (3/9 cases, 33%). Ten patients transitioned to adult care, accounting for 29% of the 34 continuing patients. CONCLUSION This is the first observational study on long-term NPPV use in children in Japan that examined outcomes in patients with a range of disorders. The initiation situation, management, and outcomes differed between patients with neuromuscular and non-neuronal muscular diseases. Long-term use of NPPV is possible in many cases, including children with SMID, but can be challenging to continue in patients with progressive diseases such as metabolic/degenerative diseases. Careful discussions regarding the management of each patient are necessary.
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Affiliation(s)
- Azusa Ikeda
- Institution for Children with Profound Multiple Disabilities, Kanagawa Children's Medical Center, Japan; Department of Neurology, Kanagawa Children's Medical Center, Japan.
| | - Megumi Tsuji
- Institution for Children with Profound Multiple Disabilities, Kanagawa Children's Medical Center, Japan; Department of Neurology, Kanagawa Children's Medical Center, Japan
| | - Tomohide Goto
- Department of Neurology, Kanagawa Children's Medical Center, Japan
| | - Mizue Iai
- Institution for Children with Profound Multiple Disabilities, Kanagawa Children's Medical Center, Japan; Department of Neurology, Kanagawa Children's Medical Center, Japan
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47
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Koncicki ML, Zachariah P, Lucas AR, Edwards JD. A multi-institutional analysis of children on long-term non-invasive respiratory support and their outcomes. Pediatr Pulmonol 2018; 53:498-504. [PMID: 29341504 PMCID: PMC5898633 DOI: 10.1002/ppul.23925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/16/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To characterize a multi-institutional cohort of children with chronic respiratory failure that use long-term, non-invasive respiratory support, perform a time-to-event analysis of transitions to transtracheal ventilation and identify factors associated with earlier transition to transtracheal ventilation. STUDY DESIGN A retrospective cohort study of patients less than 21 years of age with diagnoses associated with chronic respiratory failure and discharged on non-invasive respiratory support was performed using data from the Pediatric Health Information System (PHIS) between 2007 and 2015. Demographic and clinical characteristics, as well as times from index discharge on non-invasive support to transtracheal ventilation were presented. A competing risk regression model was fitted to estimate factors associated with earlier transition to transtracheal ventilation. RESULTS A total of 3802 patients were identified. Their median age at index discharge was 10.4 years (interquartile range [IQR] 4.1-14.9). Of these patients, 337 (8.9%) transitioned to transtracheal ventilation and transitioned at a median of 11.5 months (IQR 4.6-26) post-index discharge, or a median age of 9.3 years (IQR 4.2-14.5). Competing risk modeling demonstrated that patients who were older or whose discharge occurred later in the study period had lower hazards of earlier transition to transtracheal ventilation, whereas patients with anoxia/encephalopathy and quadriplegia had higher hazards of earlier transitioning. CONCLUSIONS Most patients on long-term, non-invasive respiratory support who progress to transtracheal ventilation transition do so within a few years of support initiation. Various characteristics were associated with earlier risk of transitioning to transtracheal ventilation. This information may enhance anticipatory guidance for this population.
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Affiliation(s)
- Monica L Koncicki
- Section of Pediatric Critical Care, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Philip Zachariah
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Adam R Lucas
- Department of Statistics, University of California, Berkeley, California
| | - Jeffrey D Edwards
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, New York
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48
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Trucco F, Pedemonte M, Fiorillo C, Tan HL, Carlucci A, Brisca G, Tacchetti P, Bruno C, Minetti C. Detection of early nocturnal hypoventilation in neuromuscular disorders. J Int Med Res 2018; 46:1153-1161. [PMID: 29210305 PMCID: PMC5972237 DOI: 10.1177/0300060517728857] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/02/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Nocturnal hypoventilation (NH) is a complication of respiratory involvement in neuromuscular disorders (NMD) that can evolve into symptomatic daytime hypercapnia if not treated proactively with non-invasive ventilation. This study aimed to assess whether NH can be detected in the absence of other signs of nocturnal altered gas exchange. Methods We performed nocturnal transcutaneous coupled (tc) pCO2/SpO2 monitoring in 46 consecutive cases of paediatric-onset NMD with a restrictive respiratory defect (forced vital capacity < 60%). Nocturnal hypoventilation was defined as tcPCO2 > 50 mmHg for > 25% of recorded time, and hypoxemia as tcSpO2 < 88% for > 5 minutes. Daytime symptoms and bicarbonate were recorded after overnight monitoring. Results Twenty-nine of 46 consecutive patients showed NH. Twenty-three patients did not have nocturnal hypoxemia and 18 were clinically asymptomatic. In 20 patients, PaCO2 in daytime blood samples was normal. Finally, 13/29 patients with NH had isolated nocturnal hypercapnia without nocturnal hypoxia, clinical NH symptoms, or daytime hypercapnia. Conclusions Paediatric patients with NMD can develop NH in the absence of clinical symptoms or significant nocturnal desaturation. Therefore, monitoring of NH should be included among nocturnal respiratory assessments of these patients as an additional tool to determine when to commence non-invasive ventilation.
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MESH Headings
- Adolescent
- Blood Gas Monitoring, Transcutaneous
- Carbon Dioxide/blood
- Child
- Female
- Humans
- Hypercapnia/blood
- Hypercapnia/diagnosis
- Hypercapnia/physiopathology
- Hypoventilation/blood
- Hypoventilation/diagnosis
- Hypoventilation/physiopathology
- Male
- Muscular Dystrophies/blood
- Muscular Dystrophies/diagnosis
- Muscular Dystrophies/physiopathology
- Muscular Dystrophy, Duchenne/blood
- Muscular Dystrophy, Duchenne/diagnosis
- Muscular Dystrophy, Duchenne/physiopathology
- Myopathies, Structural, Congenital/blood
- Myopathies, Structural, Congenital/diagnosis
- Myopathies, Structural, Congenital/physiopathology
- Oximetry/methods
- Oxygen/blood
- Retrospective Studies
- Sclerosis/blood
- Sclerosis/diagnosis
- Sclerosis/physiopathology
- Spinal Muscular Atrophies of Childhood/blood
- Spinal Muscular Atrophies of Childhood/diagnosis
- Spinal Muscular Atrophies of Childhood/physiopathology
- Vital Capacity/physiology
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Affiliation(s)
| | - Marina Pedemonte
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
| | - Chiara Fiorillo
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
| | - Hui-leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Giacomo Brisca
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
| | - Paola Tacchetti
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
| | - Claudio Bruno
- Center of Myology and Neurodegenerative Disorders, Istituto Giannina Gaslini, Genova, Italy
| | - Carlo Minetti
- Unit of Pediatric Neurology and Muscle Disease, Istituto Giannina Gaslini, Genova, Italy
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49
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Bedi PK, Castro-Codesal ML, Featherstone R, AlBalawi MM, Alkhaledi B, Kozyrskyj AL, Flores-Mir C, MacLean JE. Long-term Non-Invasive Ventilation in Infants: A Systematic Review and Meta-Analysis. Front Pediatr 2018; 6:13. [PMID: 29484287 PMCID: PMC5816035 DOI: 10.3389/fped.2018.00013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/12/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of long-term non-invasive ventilation (NIV) to treat sleep and breathing disorders in children has increased substantially in the last decade; however, less data exist about its use in infants. Given that infants have distinct sleep and breathing patterns when compared to older children, the outcomes of infants on long-term NIV may differ as well. The aim of this study is to systematically review the use and outcomes of long-term NIV in infants. METHODS Ovid Medline, Ovid Embase, CINAHL (via EbscoHOST), PubMed, and Wiley Cochrane Library were systematically searched from January 1990 to July 2017. Studies on infants using long-term NIV outside of an acute care setting were included. Data were extracted on study design, population characteristics, and NIV outcomes. RESULTS A total of 327 studies were full-text reviewed, with final inclusion of 60. Studies were distributed across airway (40%), neuromuscular (28%), central nervous system (10%), cardio-respiratory (2%), and multiple (20%) disease categories. Of the 18 airway studies reporting on NIV outcomes, 13 (72%) reported improvements in respiratory parameters. Of the 12 neuromuscular studies exclusively on spinal muscular atrophy type 1 (SMA1), six (50%) reported decreased hospitalizations and nine (75%) reported on mortality outcomes. Risk of bias was moderate to serious, and quality of the evidence was low to very low for all studies. Most studies had an observational design with no control group, limiting the potential for a meta-analysis. CONCLUSION The outcomes reported in studies differed by the disease category being studied. Studies on airway conditions showed improvements in respiratory parameters for infants using NIV. Studies on neuromuscular disorder, which were almost exclusively on SMA1, reported decreased hospitalizations and prolonged survival. Overall, it appears that NIV is an effective long-term therapy for infants. However, the high risk of bias and low quality of the available evidence limited strong conclusions.
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Affiliation(s)
- Prabhjot K. Bedi
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Maria Luisa Castro-Codesal
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence, University of Alberta, Knowledge Translation Platform, Alberta SPOR SUPPORT Unit, Edmonton, AB, Canada
| | - Mohammed M. AlBalawi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Bashar Alkhaledi
- Pediatric Pulmonary and Sleep Unit, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Anita L. Kozyrskyj
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Carlos Flores-Mir
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Joanna E. MacLean
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB, Canada
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50
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Chatwin M, Toussaint M, Gonçalves MR, Sheers N, Mellies U, Gonzales-Bermejo J, Sancho J, Fauroux B, Andersen T, Hov B, Nygren-Bonnier M, Lacombe M, Pernet K, Kampelmacher M, Devaux C, Kinnett K, Sheehan D, Rao F, Villanova M, Berlowitz D, Morrow BM. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med 2018; 136:98-110. [PMID: 29501255 DOI: 10.1016/j.rmed.2018.01.012] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 12/13/2022]
Abstract
This is a unique state of the art review written by a group of 21 international recognized experts in the field that gathered during a meeting organized by the European Neuromuscular Centre (ENMC) in Naarden, March 2017. It systematically reports the entire evidence base for airway clearance techniques (ACTs) in both adults and children with neuromuscular disorders (NMD). We not only report randomised controlled trials, which in other systematic reviews conclude that there is a lack of evidence base to give an opinion, but also include case series and retrospective reviews of practice. For this review, we have classified ACTs as either proximal (cough augmentation) or peripheral (secretion mobilization). The review presents descriptions; standard definitions; the supporting evidence for and limitations of proximal and peripheral ACTs that are used in patients with NMD; as well as providing recommendations for objective measurements of efficacy, specifically for proximal ACTs. This state of the art review also highlights how ACTs may be adapted or modified for specific contexts (e.g. in people with bulbar insufficiency; children and infants) and recommends when and how each technique should be applied.
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Affiliation(s)
- Michelle Chatwin
- Academic and Clinical Department of Sleep and Breathing and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, UK.
| | - Michel Toussaint
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Miguel R Gonçalves
- Noninvasive Ventilatory Support Unit, Pulmonology Department, Emergency and Intensive Care Medicine Department, São João University Hospital, Faculty of Medicine, University of Porto, Portugal
| | - Nicole Sheers
- Institute for Breathing and Sleep and Victorian Respiratory Support Service, Austin Health, Melbourne, Australia
| | - Uwe Mellies
- Departement of Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center Essen, University of Essen, Germany
| | - Jesus Gonzales-Bermejo
- Sorbonne Université, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
| | - Jesus Sancho
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico Universitario, Valencia, Institute of Health Research INCLIVA, Valencia, Spain
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, Paris, Paris Descartes University, Paris Research Unit INSERM U 955, Team 13, Creteil, France
| | - Tiina Andersen
- Norwegian Centre of Excellence for Home Mechanical Ventilation, Thoracic Department and Department of Physiotherapy, Haukeland University Hospital, Bergen Norway, Department of Clinical Science, Medical Faculty, University of Bergen, Bergen, Norway
| | - Brit Hov
- Dept of Peadiatric Medicine, Oslo University Hospital, Oslo, Norway and Norwegian Centre of Excellence for Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway
| | - Malin Nygren-Bonnier
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Matthieu Lacombe
- Adult Intensive Care Unit, Raymond Poincaré Hospital (AP-HP) Garches, France
| | - Kurt Pernet
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Mike Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Christian Devaux
- Direction des Actions Médicales, Paramédicales et Psychologiques, Association Française Contre Les Myopathies-Téléthon, 91000 EVRY, France
| | - Kathy Kinnett
- Parent Project Muscular Dystrophy, 401 Hackensack Ave 9th Floor, Hackensack, NJ 07601, United States
| | - Daniel Sheehan
- Assisted Breathing Center, Women and Children's Hospital of Buffalo Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, United States
| | - Fabrizio Rao
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy
| | - Marcello Villanova
- Neuromuscular Rehabilitation Unit, Nigrisoli Hospital, Viale Ercolani 7/b - 40125, Bologna, Italy
| | - David Berlowitz
- Institute for Breathing and Sleep and Victorian Respiratory Support Service, Austin Health, Melbourne, Australia
| | - Brenda M Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, Cape Town, South Africa
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