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Recommendations for long-term home oxygen therapy in children and adolescents
Fabíola V Adde1, Alfonso E Alvarez, Beatriz N Barbisan
1Universidade de São Paulo Medical School (FMUSP), São Paulo, SP, Brazil. fabiola.adde@yahoo.com.br
Insights
Long-term home oxygen therapy is increasingly used in children for various lung conditions. This therapy offers benefits like improved growth and reduced hospitalizations, with specific pediatric guidelines differing from adult care.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Medical Therapy
Background:
- Long-term home oxygen therapy (LTOT) is a growing practice in pediatric care.
- Indications for LTOT in children are diverse and include chronic respiratory diseases.
Purpose of the Study:
- To provide guidance on the indications and characteristics of LTOT for pediatric patients.
- To inform healthcare professionals about the specific aspects of LTOT in children and adolescents.
Main Methods:
- Literature review of MEDLINE/PubMed (1990-2011) and reference lists.
- Recommendations supplemented by clinical experience due to limited consistent evidence.
Main Results:
- Key indications include bronchopulmonary dysplasia, cystic fibrosis, and pulmonary hypertension.
- Benefits encompass reduced hospitalizations, enhanced growth and development, and improved sleep and exercise tolerance.
- Pediatric oxygen saturation targets and therapy parameters differ from adult COPD guidelines; pulse oximetry is the primary monitoring tool.
Conclusions:
- LTOT is increasingly prevalent in pediatric practice with numerous indications.
- Pediatric LTOT requires specific considerations for indications, administration, and monitoring compared to adult therapy.
Objective:
To advise pediatricians, neonatologists, pulmonologists, pediatric pulmonologists, and other professionals in the area on the main indications and characteristics of long-term home oxygen therapy in children and adolescents.
Data Source:
A literature search was carried out in the MEDLINE/PubMed database (1990 to 2011). Additionally, references from selected studies were included. As consistent scientific evidence does not exist for many aspects, some of the recommendations were based on clinical experience.
Data Synthesis:
Long-term home oxygen therapy has been a growing practice in pediatric patients and is indicated in bronchopulmonary dysplasia, cystic fibrosis, bronchiolitis obliterans, interstitial lung diseases, and pulmonary hypertension, among others. The benefits are: decrease in hospitalizations, optimization of physical growth and neurological development, improvement of exercise tolerance and quality of sleep, and prevention of pulmonary hypertension/cor pulmonale. The levels of oxygen saturation indicative for oxygen therapy differ from those established for adults with chronic obstructive pulmonary disease, and vary according to age and disease. Pulse oximetry is used to evaluate oxygen saturation; arterial blood gas is unnecessary. There are three available sources of oxygen: gas cylinders, liquid oxygen, and oxygen concentrators. The flows used are usually smaller, as are the number of hours/day needed when compared to the use in adults. Some diseases show improvement and oxygen therapy discontinuation is possible.
Conclusions:
Long-term home oxygen therapy is increasingly common in pediatrics and has many indications. There are relevant particularities when compared to its use in adults, regarding indications, directions for use, and monitoring.
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