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Taylor JB, Ingram DG, Kupfer O, Amin R. Neuromuscular Disorders in Pediatric Respiratory Disease. Clin Chest Med 2024; 45:729-747. [PMID: 39069334 DOI: 10.1016/j.ccm.2024.02.021] [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] [Indexed: 07/30/2024]
Abstract
Respiratory sequelae are a frequent cause of morbidity and mortality in children with NMD. Impaired cough strength and resulting airway clearance as well as sleep disordered breathing are the two main categories of respiratory sequelae. Routine clinical evaluation and diagnostic testing by pulmonologists is an important pillar of the multidisciplinary care required for children with NMD. Regular surveillance for respiratory disease and timely implementation of treatment including pulmonary clearance techniques as well as ventilation can prevent respiratory related morbidity including hospital admissions and improve survival. Additionally, novel disease modifying therapies for some NMDs are now available which has significantly improved the clinical trajectories of patients resulting in a paradigm shift in clinical care. Pulmonologists are 'learning' the new natural history for these diseases and adjusting clinical management accordingly.
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Affiliation(s)
- Jane B Taylor
- Division of Pulmonology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - David G Ingram
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Oren Kupfer
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Division of Respiratory Medicine, Department of Pediatrics, University of Toronto, Toronto, Canada
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2
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Pigmans RRWP, Smith JM, Markhorst DG, van Woensel JBM, Dijkman CD, Elphick HE, Bem RA. Current Advances and Gaps in Knowledge on Personalizing Masks for Noninvasive Respiratory Support. Respir Care 2024; 69:1201-1211. [PMID: 38729663 PMCID: PMC11349599 DOI: 10.4187/respcare.11886] [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: 01/19/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024]
Abstract
Noninvasive respiratory support delivered through a face mask has become a cornerstone treatment for adults and children with acute or chronic respiratory failure. However, an imperfect mask fit by using commercially available interfaces is frequently encountered, which may result in patient discomfort and treatment inefficiency or failure. To overcome this challenge, over the past decade, increasing attention has been given to the development of personalized face masks, which are custom-made to address the specific facial dimensions of an individual patient. With this scoping review, we aim to provide a comprehensive overview of the current advances and gaps in knowledge with regard to the personalization masks for CPAP and NIV. We performed a systematic search of the literature and identified and summarized a total of 23 studies. Most studies included were involved in the development of nasal masks. Studies that targeted adult respiratory care mainly focused on chronic (home) ventilation and included some clinical testing in a relevant subject population. In contrast, pediatric studies focused mostly on respiratory support in the acute setting, whereas testing was limited to bench or case studies only. Most studies were positive with regard to the performance (ie, comfort, level of air leak, and mask pressure applied to the skin) of personalized masks in bench testing or in human, healthy or patient, subjects. Advances in the field of 3-dimensional scanning and soft material printing were identified, but important gaps in knowledge remain. In particular, more insight into cushion materials, headgear design, clinical feasibility, and cost-effectiveness is needed before definite recommendations can be made with regard to implementation of large-scale clinical programs that personalize noninvasive respiratory support masks for adults and children.
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Affiliation(s)
- Rosemijne R W P Pigmans
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Jonathan M Smith
- Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Dick G Markhorst
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Job B M van Woensel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Coen D Dijkman
- Department for Medical Innovation and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Heather E Elphick
- Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
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3
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Zhang C, Wei CJ, Jin Z, Ma J, Shen YE, Yu Q, Fan YB, Xiong H, Que CL. Characteristics and feasibility of ambulatory respiratory assessment of paediatric neuromuscular disease: an observational retrospective study. Int J Neurosci 2023; 133:1045-1054. [PMID: 35289716 DOI: 10.1080/00207454.2022.2042691] [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: 09/21/2021] [Revised: 01/12/2022] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the characteristics of respiratory involvement in Chinese paediatric neuromuscular disease (NMD) at early stage and to explore convenient monitoring methods. MATERIALS AND METHODS Children with NMD (age < 18) diagnosed at a multidisciplinary joint NMD clinic at Peking University First Hospital from January 2016 to April 2021 were included. Overnight polysomnography (PSG) and pulmonary function test (PFT) data were analysed, and the characteristics of four groups: congenital muscular dystrophy (CMD), congenital myopathy, spinal muscular atrophy, and Duchenne muscular dystrophy (DMD) were compared. RESULTS A total of 83 children with NMD were referred for respiratory assessment, of who 80 children underwent PSG; 41 performed spirometry and 38, both. The duration of pulse oxygen saturation (SpO2) <90% over apnoea and hypopnoea index (AHI) was lowest in DMD and significantly different from CMD (p = 0.033). AHI was positively correlated with the oxygen desaturation index (ODI) (r = 0.929, p = 0.000). The peak expiratory flow (PEF) were positively correlated with forced vital capacity (FVC), both as actual values and percent pred, respectively (r = 0.820, 0.719, p = 0.000). ROC derived sensitivity and specificity of prediction of AHI > 15/h or duration of SpO2<90% ≥ 60 min from FVC <51% pred was 75.8% and 85.7%, respectively. CONCLUSIONS AHI and hypoxia burden were independent factors in children with NMD in PSG and attention needed to be paid in both. FVC might be a daytime predictor for significant sleep-disordered breathing or hypoxia. Nocturnal consecutive oximetry with diurnal peak flow measurement may be convenient and effective for home monitoring at early stage of respiratory involvement.
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Affiliation(s)
- Cheng Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Cui-Jie Wei
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhe Jin
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jing Ma
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yan-E Shen
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Qing Yu
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yan-Bin Fan
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hui Xiong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Cheng-Li Que
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
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4
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Rozycki HJ, Kotecha S. Domiciliary management of infants and children with chronic respiratory diseases. Paediatr Respir Rev 2023; 47:1-2. [PMID: 37246024 DOI: 10.1016/j.prrv.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/30/2023]
Affiliation(s)
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
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Wollinsky K, Fuchs H, Schönhofer B. [Transition of long-term ventilated children to adult medical care]. Pneumologie 2023; 77:554-561. [PMID: 37295444 DOI: 10.1055/a-2081-0904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Through advances in long-term ventilation, the number of children with chronic respiratory insufficiency reaching adult age has increased tremendously. Therefore, transition of children from pediatric to adult care has become inevitable. Transition is necessary for medicolegal reasons, to increase autonomy of the young patients and because of change in the disease as a result of increasing age. Transition bears the risks of uncertainty of patients and parents, loss of the medical home or even loss of complete medical care. Good structural conditions, professional preparation of patient and parents, a comprehensive formalized transfer and patient coaching are prerequisites for a successful professional transition. This article discusses issues of transition with focus on long-term ventilated children.
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Affiliation(s)
- Kurt Wollinsky
- Klinik für Anästhesiologie, Intensivmedizin & Schmerztherapie, RKU - Universitätsklinikum Ulm, Ulm, Deutschland
| | - Hans Fuchs
- Klinik für Allgemeine Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Bernd Schönhofer
- Klinik für Innere Medizin, Pneumologie und Intensivmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum Ost Westphalen-Lippe (OWL), Bielefeld, Deutschland
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Piotto M, Gambadauro A, Rocchi A, Lelii M, Madini B, Cerrato L, Chironi F, Belhaj Y, Patria MF. Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors. CHILDREN (BASEL, SWITZERLAND) 2023; 10:955. [PMID: 37371187 DOI: 10.3390/children10060955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase "sleep-disordered breathing (SDB)" indicates a wide array of conditions characterized by snoring and/or respiratory distress due to increased upper airway resistance and pharyngeal collapsibility; these range from primary snoring to obstructive sleep apnea (OSA) and occur in all age groups. In the general pediatric population, the prevalence of OSA varies between 2% and 5%, but in some particular clinical conditions, it can be much higher. While adenotonsillar hypertrophy ("classic phenotype") is the main cause of OSA in preschool age (3-5 years), obesity ("adult phenotype") is the most common cause in adolescence. There is also a "congenital-structural" phenotype that is characterized by a high prevalence of OSA, appearing from the earliest ages of life, supported by morpho-structural abnormalities or craniofacial changes and associated with genetic syndromes such as Pierre Robin syndrome, Prader-Willi, achondroplasia, and Down syndrome. Neuromuscular disorders and lysosomal storage disorders are also frequently accompanied by a high prevalence of OSA in all life ages. Early recognition and proper treatment are crucial to avoid major neuro-cognitive, cardiovascular, and metabolic morbidities.
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Affiliation(s)
- Marta Piotto
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Antonella Gambadauro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Alessia Rocchi
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mara Lelii
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Barbara Madini
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Lucia Cerrato
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Federica Chironi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Youssra Belhaj
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maria Francesca Patria
- Pediatria Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Ehrlich S, Golan Tripto I, Lavie M, Cahal M, Shonfeld T, Prais D, Levine H, Mei-Zahav M, Bar-On O, Gendler Y, Zalcman J, Sarsur E, Aviram M, Goldbart A, Stafler P. High flow nasal cannula therapy in the pediatric home setting. Pediatr Pulmonol 2023; 58:941-948. [PMID: 36564183 DOI: 10.1002/ppul.26282] [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: 05/10/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) therapy may be better tolerated than traditional noninvasive ventilation (NIV) and is rapidly gaining acceptance in pediatric acute care. In Israel, HFNC is approved for domestic use. We aim to describe its indications, efficacy, parental satisfaction, and safety. METHODS Retrospective study of children treated with home HFNC therapy in three pediatric centers. Data included demographic parameters, indication of use, weight and days of hospitalization before and after initiation. Safety, tolerability, and parental satisfaction were assessed via standardized telephone questionnaire. RESULTS Median (interquartile range [IQR]) age of initiating home HFNC in 75 children was 8.3 (2.2, 29.6) months. Indications were obstructive sleep apnea (33; 44%), airway malacia (19; 25%), chronic lung disease (15; 20%), neuromuscular disease (4; 5%), and postextubation support (4; 5%). Weight standard deviation score rose from -2.3 pre-HFNC to -1.7 at 6.7 months post-HFNC initiation, p < 0.001. Hospital admission days during the 2 months pre- versus post-HFNC initiation were 22 (5.5, 60) and 5 (0, 14.7) respectively, p < 0.008. Median (IQR) parental satisfaction score was 5/5 (4, 5). Fifty of 60 (83%) respondents would recommend home HFNC to other families in a similar situation. There were no serious adverse events. CONCLUSION In our population, domestic HFNC appeared safe and well tolerated for a variety of indications. Its introduction was associated with improved weight gain, fewer hospitalization days and high parental satisfaction. Further work is required to characterize groups of children most likely to benefit from HFNC, as opposed to traditional modes of NIV.
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Affiliation(s)
- Shay Ehrlich
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Inbal Golan Tripto
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Moran Lavie
- Pulmonology Institute, Dana-Dwek, Children's Hospital, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Cahal
- Pulmonology Institute, Dana-Dwek, Children's Hospital, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tommy Shonfeld
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dario Prais
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Levine
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Mei-Zahav
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Bar-On
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Gendler
- The Department of Nursing, School of Health Sciences, Ariel University, Ariel, Israel
| | - Jonatan Zalcman
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Eahab Sarsur
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Micha Aviram
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Aviv Goldbart
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Patrick Stafler
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Xiao L, Amin R, Nonoyama ML. Long-term mechanical ventilation and transitions in care: A narrative review. Chron Respir Dis 2023; 20:14799731231176301. [PMID: 37170874 PMCID: PMC10184211 DOI: 10.1177/14799731231176301] [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] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Individuals dependent on long-term mechanical ventilation (LTMV) for their day-to-day living are a heterogenous population who go through several transitions over their lifetime. This paper describes three transitions: 1) institution/hospital to community/home, 2) pediatric to adult care, and 3) active treatment to end-of-life for ventilator-assisted individuals (VAIs). METHODS A narrative review based on literature and the author's collective practical and research experience. Four online databases were searched for relevant articles. A manual search for additional articles was completed and the results are summarized. RESULTS Transitions from hospital to home, pediatric to adult care, and to end-of-life for VAIs are complex and challenging processes. Although there are several LTMV clinical practice guidelines highlighting key components for successful transition, there still exists gaps and inconsistencies in care. Most of the literature and experiences reported to date have been in developed countries or geographic areas with funded healthcare systems. CONCLUSIONS For successful transitions, the VAIs and their support network must be front-and-center. There should be a coordinated, systematic, and holistic plan (including a multi-disciplinary team), life-time follow-up, with bespoke consideration of jurisdiction and individual circumstances.
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Affiliation(s)
- Lena Xiao
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mika Laura Nonoyama
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
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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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Wyatt KD, Goel NN, Whittle JS. Recent advances in the use of high flow nasal oxygen therapies. Front Med (Lausanne) 2022; 9:1017965. [PMID: 36300187 PMCID: PMC9589055 DOI: 10.3389/fmed.2022.1017965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
High flow nasal oxygen is a relatively new option for treating patients with respiratory failure, which decreases work of breathing, improves tidal volume, and modestly increases positive end expiratory pressure. Despite well-described physiologic benefits, the clinical impact of high flow nasal oxygen is still under investigation. In this article, we review the most recent findings on the clinical efficacy of high flow nasal oxygen in Type I, II, III, and IV respiratory failure within adult and pediatric patients. Additionally, we discuss studies across clinical settings, including emergency departments, intensive care units, outpatient, and procedural settings.
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Affiliation(s)
- Kara D. Wyatt
- Scientific Consultant, Chattanooga, TN, United States
| | - Neha N. Goel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jessica S. Whittle
- Department of Emergency Medicine, University of Tennessee, Chattanooga, TN, United States
- Vapotherm, Inc., Exeter, NH, United States
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11
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Hypoventilation and sleep hypercapnia in a case of congenital variant-like Rett syndrome. Ital J Pediatr 2022; 48:167. [PMID: 36071486 PMCID: PMC9450235 DOI: 10.1186/s13052-022-01359-7] [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: 12/02/2021] [Accepted: 08/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background Breathing disturbances are often a primary clinical concern especially during wakefulness of the classic form of Rett syndrome, but data for atypical forms are lacking. Case presentation We report the case of a 20-month-old female affected by Rett syndrome with congenital variant-like onset, characterized by severe hypotonia and neurodevelopment impairment. She presented hypoventilation, persistent periodic breathing, and sustained desaturation during sleep, without obstructive or mixed events. Pulse oximetry and capnography during wakefulness were strictly normal. To the best of our knowledge, this is the first case of a patient affected by a congenital variant of Rett syndrome presenting sleep hypercapnia. Hypotonia may play a major role in the genesis of hypoventilation and hypoxemia in our patient. Non-invasive ventilation led to quality-of-life improvements. Conclusions Thus, we suggest screening patients with congenital-like Rett syndrome through transcutaneous bedtime carbon dioxide and oxygen monitoring. Moreover, assisted control mode was a breakthrough to achieve adequate ventilation in our case.
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12
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Han JG, Park H, Yang JS, Kim JS, Park B, Park DY, Kim HJ. Verification for Diagnosis of Sleep-Related Hypoventilation and Carbon Dioxide Partial Pressure During Sleep in Children Using End-Tidal Carbon Dioxide. SLEEP MEDICINE RESEARCH 2022. [DOI: 10.17241/smr.2022.01277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Objective From the past, several researchers have studied and measured the partial pressure of carbon dioxide during sleep in normal children to establish diagnostic criteria for hypoventilation in children. Here we tried to verify the existing definition of sleep-related hypoventilation in Asian by evaluating and analyzing the carbon dioxide partial pressure in pediatric subjects who underwent polysomnography.Methods We retrospectively analyzed clinical information of 196 children who underwent polysomnography at our hospital from Feb 2011 to Apr 2021. Among Asian pediatric subjects, those with serious chronic or genetic diseases, craniofacial deformities, and hypoventilation confirmed by polysomnography were excluded. We evaluated partial pressure of carbon dioxide in target group by end-tidal carbon dioxide (EtCO2) measured with a stream capnometer through nasal cannula. The target group was classified by apnea-hypopnea index and analyzed.Results The mean value of the time with EtCO<sub>2</sub> ≥ 45 mm Hg in total sleep time was 47.00% which is higher than previous studies. The mean value of the time with EtCO<sub>2</sub> ≥ 50 mm Hg in total sleep time was 2.77% which is similar to previous studies. Also, our subjects showed the highest mean EtCO<sub>2</sub> value in non-rapid eye movement (NREM) stage and lowest mean EtCO<sub>2</sub> value when wake.Conclusions In this study, the diagnostic criteria for sleep-related hypoventilation at the American Academy of Sleep Medicine (AASM) in 2017 established by measuring the EtCO<sub>2</sub> in western children seems appropriate to apply to Asian children to define hypoventilation.
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13
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Cammarota G, Simonte R, De Robertis E. Comfort During Non-invasive Ventilation. Front Med (Lausanne) 2022; 9:874250. [PMID: 35402465 PMCID: PMC8988041 DOI: 10.3389/fmed.2022.874250] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 01/03/2023] Open
Abstract
Non-invasive ventilation (NIV) has been shown to be effective in avoiding intubation and improving survival in patients with acute hypoxemic respiratory failure (ARF) when compared to conventional oxygen therapy. However, NIV is associated with high failure rates due, in most cases, to patient discomfort. Therefore, increasing attention has been paid to all those interventions aimed at enhancing patient's tolerance to NIV. Several practical aspects have been considered to improve patient adaptation. In particular, the choice of the interface and the ventilatory setting adopted for NIV play a key role in the success of respiratory assistance. Among the different NIV interfaces, tolerance is poorest for the nasal and oronasal masks, while helmet appears to be better tolerated, resulting in longer use and lower NIV failure rates. The choice of fixing system also significantly affects patient comfort due to pain and possible pressure ulcers related to the device. The ventilatory setting adopted for NIV is associated with varying degrees of patient comfort: patients are more comfortable with pressure-support ventilation (PSV) than controlled ventilation. Furthermore, the use of electrical activity of the diaphragm (EADi)-driven ventilation has been demonstrated to improve patient comfort when compared to PSV, while reducing neural drive and effort. If non-pharmacological remedies fail, sedation can be employed to improve patient's tolerance to NIV. Sedation facilitates ventilation, reduces anxiety, promotes sleep, and modulates physiological responses to stress. Judicious use of sedation may be an option to increase the chances of success in some patients at risk for intubation because of NIV intolerance consequent to pain, discomfort, claustrophobia, or agitation. During the Coronavirus Disease-19 (COVID-19) pandemic, NIV has been extensively employed to face off the massive request for ventilatory assistance. Prone positioning in non-intubated awake COVID-19 patients may improve oxygenation, reduce work of breathing, and, possibly, prevent intubation. Despite these advantages, maintaining prone position can be particularly challenging because poor comfort has been described as the main cause of prone position discontinuation. In conclusion, comfort is one of the major determinants of NIV success. All the strategies aimed to increase comfort during NIV should be pursued.
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Hurvitz MS, Sunkonkit K, Massicotte C, Li R, Bhattacharjee R, Amin R. Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences? J Clin Sleep Med 2022; 18:609-616. [PMID: 34583806 PMCID: PMC8804981 DOI: 10.5664/jcsm.9678] [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: 02/03/2023]
Abstract
STUDY OBJECTIVES Individuals with Duchenne muscular dystrophy (DMD) frequently develop sleep-disordered breathing. Noninvasive ventilation is often prescribed for sleep-disordered breathing treatment based on the American Academy of Sleep Medicine (AASM) criteria. In 2018, DMD disease-specific criteria for sleep-disordered breathing were established. Our study aimed to examine the clinical interpretation differences using these different criteria. METHODS We performed a multicenter, retrospective chart review of children with DMD followed at The Hospital for Sick Children, Toronto, Canada, and Rady Children's Hospital, San Diego, California, who underwent polysomnography from August 1, 2012, to February 29, 2020. Baseline characteristics and polysomnography data were summarized using descriptive statistics. Agreement for the diagnosis of sleep-disordered breathing evaluated by kappa statistics and sensitivity/specificity analysis was assessed. RESULTS One hundred five male children with DMD (mean ± SD age: 12.1 ± 3.8 years; body mass index z score: 0.2 ± 2.3) were included. The proportions of children with DMD that met at least 1 AASM criterion and at least 1 DMD criterion were 45.7% and 67.6%, respectively. We found that 32.4% of children met neither AASM nor DMD criteria. Overall agreement between AASM and DMD criteria was moderate (k = 0.57). There was almost perfect agreement in sleep apnea diagnosis (k = 0.90); however, there was only slight agreement in hypoventilation diagnosis (k = 0.12) between AASM and DMD criteria. CONCLUSIONS There were more children with DMD diagnosed with nocturnal hypoventilation and prescribed noninvasive ventilation using DMD criteria compared with AASM criteria. Future studies should address whether the prescription of noninvasive ventilation for children with DMD based on both criteria is associated with different clinical outcomes. CITATION Hurvitz MS, Sunkonkit K, Massicotte C, Li R, Bhattacharjee R, Amin R. Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences? J Clin Sleep Med. 2022;18(2):609-615.
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Affiliation(s)
- Manju S. Hurvitz
- University of California San Diego, Division of Respiratory Medicine, Department of Pediatrics, Rady Children’s Hospital San Diego, San Diego, California
| | - Kanokkarn Sunkonkit
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada,Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Address correspondence to: Kanokkarn Sunkonkit, MD, Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8; Tel: 416-813-6346; kanokkarn.sun@cmu
| | - Colin Massicotte
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rhondda Li
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rakesh Bhattacharjee
- University of California San Diego, Division of Respiratory Medicine, Department of Pediatrics, Rady Children’s Hospital San Diego, San Diego, California
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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15
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Chin HL, Huynh S, Ashkani J, Castaldo M, Dixon K, Selby K, Shen Y, Wright M, Boerkoel CF, Hendson G, Jones SJM. An infant with congenital respiratory insufficiency and diaphragmatic paralysis: A novel BICD2 phenotype? Am J Med Genet A 2021; 188:926-930. [PMID: 34825470 DOI: 10.1002/ajmg.a.62578] [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] [Received: 04/18/2021] [Revised: 09/09/2021] [Accepted: 11/06/2021] [Indexed: 11/06/2022]
Abstract
Monoallelic pathogenic variants in BICD2 are associated with autosomal dominant Spinal Muscular Atrophy Lower Extremity Predominant 2A and 2B (SMALED2A, SMALED2B). As part of the cellular vesicular transport, complex BICD2 facilitates the flow of constitutive secretory cargoes from the trans-Golgi network, and its dysfunction results in motor neuron loss. The reported phenotypes among patients with SMALED2A and SMALED2B range from a congenital onset disorder of respiratory insufficiency, arthrogryposis, and proximal or distal limb weakness to an adult-onset disorder of limb weakness and contractures. We report an infant with congenital respiratory insufficiency requiring mechanical ventilation, congenital diaphragmatic paralysis, decreased lung volume, and single finger camptodactyly. The infant displayed appropriate antigravity limb movements but had radiological, electrophysiological, and histopathological evidence of myopathy. Exome sequencing and long-read whole-genome sequencing detected a novel de novo BICD2 variant (NM_001003800.1:c.[1543G>A];[=]). This is predicted to encode p.(Glu515Lys); p.Glu515 is located in the coiled-coil 2 mutation hotspot. We hypothesize that this novel phenotype of diaphragmatic paralysis without clear appendicular muscle weakness and contractures of large joints is a presentation of BICD2-related disease.
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Affiliation(s)
- Hui-Lin Chin
- Department of Medical Genetics and Provincial Medical Genetics Program, University of British Columbia and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Stephanie Huynh
- Department of Medical Genetics and Provincial Medical Genetics Program, University of British Columbia and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada
| | - Jahanshah Ashkani
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - Michael Castaldo
- Division of Neonatology, Department of Pediatrics, University of British Columbia and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Dixon
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - Kathryn Selby
- Division of Neurology, Department of Pediatrics, University of British Columbia and Children's Hospital of British Columbia, Vancouver, British Columbia, Canada
| | - Yaoqing Shen
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - Marie Wright
- Division of Respirology, Department of Pediatrics, University of British Columbia and Children's Hospital of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelius F Boerkoel
- Department of Medical Genetics and Provincial Medical Genetics Program, University of British Columbia and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada
| | - Glenda Hendson
- Department of Pathology, BC Children's Hospital, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Steven J M Jones
- Department of Medical Genetics and Provincial Medical Genetics Program, University of British Columbia and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada.,Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
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16
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Cobb MJ. Just Breathe: Tips and Highlights for Managing Pediatric Respiratory Distress and Failure. Emerg Med Clin North Am 2021; 39:493-508. [PMID: 34215399 DOI: 10.1016/j.emc.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anatomically, the airway is ever changing in size, anteroposterior alignment, and point of most narrow dimension. Special considerations regarding obesity, chronic and acute illness, underlying developmental abnormalities, and age can all affect preparation and intervention toward securing a definitive airway. Mechanical ventilation strategies should focus on limiting peak inspiratory pressures and optimizing lung protective tidal volumes. Emergency physicians should work toward minimizing risk of peri-intubation hypoxemia and arrest. With review of anatomic and physiologic principles in the setting of a practical approach toward evaluating and managing distress and failure, emergency physicians can successfully manage critical pediatric airway encounters.
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Affiliation(s)
- Megan J Cobb
- University of Maryland School of Medicine, Department of Emergency Medicine; Maryland Emergency Medicine Network, Upper Chesapeake Emergency Medicine, 500 Upper Chesapeake Dr, Bel Air, MD 21014, USA.
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Toussaint M, Chatwin M, Gonçalves MR, Gonzalez-Bermejo J, Benditt JO, McKim D, Sancho J, Hov B, Sansone V, Prigent H, Carlucci A, Wijkstra P, Garabelli B, Escarrabill J, Pinto T, Audag N, Verweij-van den Oudenrijn L, Ogna A, Hughes W, Devaux C, Chaulet J, Andersen T. Mouthpiece ventilation in neuromuscular disorders: Narrative review of technical issues important for clinical success. Respir Med 2021; 180:106373. [PMID: 33798870 DOI: 10.1016/j.rmed.2021.106373] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
In neuromuscular disorders (NMDs), nocturnal non-invasive ventilation (NIV) via a nasal mask is offered when hypercapnic respiratory failure occurs. With disease progression, nocturnal NIV needs to be extended into the daytime. Mouthpiece ventilation (MPV) is an option for daytime NIV. MPV represents a difficult task for home ventilators due to rapidly changing load conditions resulting from intermittent connections and disconnections from MPV circuit. The 252nd ENMC International Expert Workshop, held March 6th to 8th 2020 in Amsterdam, reported general guidelines for management of daytime MPV in NMDs. This report could not present all the detail regarding the technical issues important for clinical success of MPV. Based on the expert workshop discussions and the evidence from existing studies, the current narrative review aims to identify the technical issues of MPV and offers guidance via a decisional algorithm and educational figures providing relevant information that is important for successful implementation of MPV.
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Affiliation(s)
- Michel Toussaint
- Neuromuscular Excellency Centre VUB- Inkendaal, Center for Home Mechanical Ventilation ZH Inkendaal Rehabilitation Hospital, Brussels, Belgium.
| | - Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing, Royal Brompton, London, UK.
| | - Miguel R Gonçalves
- Noninvasive Ventilatory Support Unit, Emergency and Intensive Care Medicine Department, Pulmonology Department, São João University Hospital. Faculty of Medicine, University of Porto, Portugal.
| | - Jésus Gonzalez-Bermejo
- Sorbonne-Université, Service de pneumologie et réanimation respiratoire, Groupe hospitalier de la Pitié-Salpêtrière-Charles Foix, Paris, France.
| | | | - Doug McKim
- University of Ottawa, CANVent Respiratory Services, The Ottawa Hospital Sleep Centre, Canada.
| | - Jesus Sancho
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Health Research Institute INCLIVA, Valencia, Spain.
| | - Brit Hov
- Paediatric Department, Oslo University Hospital, Oslo, Norway.
| | - Valeria Sansone
- The NEMO Clinical Center, Neurorehabilitation Unit, University of Milan, Italy.
| | - Hélène Prigent
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Raymond Poincaré, GHU PIFO, APHP, Garches, France; UFR Simone Veil, Université de Versailles, Saint Quentin en Yvelines, Montigny le Bretonneux, France.
| | - Annalisa Carlucci
- Pulmonary Rehabilitation and Weaning Center, Istituti Clinici Scientifici-Maugeri, Pavia, Italy.
| | - Peter Wijkstra
- Department of Home Mechanical Ventilation and Pulmonary Diseases, University Medical Center Groningen, Groningen, the Netherlands.
| | - Barbara Garabelli
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Niguarda Hospital, Milan, Italy.
| | - Joan Escarrabill
- Hospital Clínic-Barcelona & Master Plan For Respiratory Diseases, Ministry of Health (Government of Catalonia), Barcelona, Spain.
| | - Tiago Pinto
- Lung Function and Ventilation Unit - Pulmonology Department, São João University Hospital, Porto, Portugal.
| | - Nicolas Audag
- Unité de Pneumologie pédiatrique, Cliniques universitaires Saint-Luc, Brussels, Belgium.
| | | | - Adam Ogna
- Servizio di pneumologia, Ospedale Regionale di Locarno, Switzerland.
| | | | | | | | - Tiina Andersen
- Norwegian Advisory Unit on Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway.
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