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[Domiciliary assisted ventilation in children]
C Schweitzer1, M C Camoin-Schweitzer, F Beltramo
1Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, CHU de Nancy, Allée du Morvan, 54500 Vandoeuvre-lès-Nancy.
Insights
Home ventilation, especially non-invasive ventilatory assistance, is effective for treating chronic alveolar hypoventilation in children. Defining the optimal timing for initiating this therapy is crucial for successful long-term management.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Home Healthcare Technology
Background:
- Home-based assisted ventilation has become a standard practice.
- Previous studies highlight its utility in managing chronic respiratory conditions in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and application of home ventilation, particularly non-invasive methods, in a cohort of pediatric patients.
- To assess the indications and timing for initiating home ventilatory support.
Main Methods:
- Retrospective review of 16 children receiving home ventilation between 1990 and 2000.
- Analysis of underlying conditions, ventilation methods (invasive vs. non-invasive), and timing of intervention.
Main Results:
- Neuromuscular diseases were the most common indication (10 children).
- Non-invasive ventilatory assistance was successful in most children (11/16), with only 5 requiring tracheotomy.
- Initiation was often reactive, following acute respiratory distress, though planned initiation occurred in some cases.
Conclusions:
- Home ventilation, particularly non-invasive, is a reliable long-term treatment for pediatric chronic alveolar hypoventilation.
- Further research is needed to establish optimal timing for initiating home ventilatory support to maximize benefits and prevent respiratory failure.
Abstract:
The concept of assisted ventilation in the home setting has greatly progressed as a routine practice. This technique was used from 1990 to 2000 in 16 children cared for at our center. Ten children had neuromuscular disease (infantile spinal amyotrophy 6, Duchenne myopathy 3, and mitochondrial myopathy 1) or other conditions including central hypoventilation (n = 2), traumatic tetraplegia (n = 2), encephalopathy with chronic bronchitis (n = 1) and bronchopulmonary dysplasia (n = 1). Only 5 children had a tracheotomy, the others were treated successfully with non-invasive ventilatory assistance. Initialization of non-invasive ventilatory assistance had been planned before development of respiratory failure in 4 of the 11 children, but generally was indicated after an episode of acute respiratory distress. Home ventilation, particularly with non-invasive assistance is a reliable method for long-term treatment of chronic alveolar hypoventilation in children. The appropriate time for initiating this therapy should be better defined.