Modified hypoxic challenge testing in children needing nocturnal ventilation: An observational study.
Mollie Riley1, Stephanie Brotherston1, Paula Kelly2
1Lung Function Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Pediatric Pulmonology
|September 20, 2022
Summary
Children needing ventilatory support can travel by air. Evaluating their response to usual ventilation during a fitness-to-fly assessment aids decision-making, as ventilators can reduce or avoid supplemental oxygen needs.
Area of Science:
- Pediatric Pulmonology
- Aeromedical Physiology
- Respiratory Medicine
Background:
- Existing air travel guidelines for respiratory conditions primarily address primary lung pathologies.
- Limited evidence guides professionals advising children requiring ventilatory support due to neuromuscular or central hypoventilation.
- These children may face risks of hypoxia and hypercapnia if unable to adequately hyperventilate.
Purpose of the Study:
- To assess the response of children on ventilatory support to a modified hypoxic challenge test.
- To evaluate the utility of assessing patients' usual ventilation for "fitness-to-fly" decisions.
Main Methods:
- Twenty children (1.6-18 years) on nocturnal ventilatory support (10 neuromuscular weakness, 10 central hypoventilation) underwent a two-stage hypoxic challenge test.
- The test involved a conventional stage (oxygen titration by SpO2) and a new stage using routine ventilatory support with oxygen titration.
- Pulse oximetry, transcutaneous carbon dioxide, and patient interviews regarding testing and air travel experiences were recorded.
Main Results:
- Thirteen participants required supplemental oxygen in the conventional stage, compared to only two when using their ventilatory support.
- Transcutaneous carbon dioxide levels remained within the normal range for all participants, irrespective of ventilatory support.
- While some found the testing challenging, participants generally viewed both the assessment and air travel positively.
Conclusions:
- Assessing children's response to their usual ventilation during "fitness-to-fly" evaluations is crucial for informed decision-making.
- For some children requiring nocturnal ventilation, using their device during air travel can significantly reduce or eliminate the need for supplemental oxygen.
- This approach supports safer air travel for pediatric patients with complex respiratory needs.
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