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.
Insights
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.
Background:
Guidelines for air passengers with respiratory disease focus on primary lung pathology. Little evidence exists to guide professionals advising children needing ventilatory support because of neuromuscular or central hypoventilation conditions; these children might risk hypoxia and hypercapnia if unable to mount an adequate hyperventilation response.
Objective:
This study assessed the response to low ambient oxygen using a modified hypoxic challenge test. In addition to measuring pulse oximetry and response to supplementary oxygen, we also measured transcutaneous carbon dioxide and response to ventilatory support.
Methods:
Twenty children on nocturnal ventilatory support aged 1.6-18 years were recruited in a pragmatic sample from outpatient clinics; 10 with neuromuscular weakness and 10 with central hypoventilation. Participants underwent a two-stage, modified hypoxic challenge test; a conventional stage, where oxygen alone was titrated according to SpO2, and a new stage, where participants used their routine ventilatory support with oxygen titrated if needed. Participants were interviewed to understand their experiences of testing and of air travel.
Results:
Thirteen participants needed supplemental oxygen during the conventional stage, but only two did when using ventilatory support. Transcutaneous carbon dioxide remained within normal range for all participants, on or off ventilatory support. Whilst some participants found testing challenging, participants generally reported both testing and air travel to be valuable.
Conclusions:
Evaluating response to patients' usual ventilation through "fitness-to-fly" assessment aids decision making when considering whether children who receive nocturnal ventilation can travel by air, since for some using a ventilator reduces or avoids the need for supplemental oxygen.
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