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Paediatric Long-Term Home Respiratory Support: Recommendations of the Swiss Society of Paediatric Pulmonology
Regula Corbelli1, Miriam Giarrana2, Christian Bieli3
1Paediatric Pulmonary Unit, Division of Pediatric Specialties, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland, regula.corbelli@hug.ch.
Insights
Home respiratory support for children with complex conditions is increasing. This consensus statement offers guidelines for patient selection, care teams, and management to improve outcomes.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Practice Guidelines
Background:
- Rising number of pediatric patients requiring long-term home respiratory support.
- Clinical heterogeneity in patients with obstructive, restrictive, or central ventilatory disorders.
- Comorbidities like obesity, aspiration, and neuromuscular weakness complicate management.
Purpose of the Study:
- To provide comprehensive recommendations for home respiratory support in pediatric patients in Switzerland.
- To define indications, patient selection criteria, and optimal multidisciplinary care team composition.
- To outline equipment, safety, training, monitoring, and transition to adult care.
Main Methods:
- Development of a consensus statement by the Swiss Society of Paediatric Pulmonology's Special Interest Group.
- Review of current indications and best practices for home respiratory support.
- Inclusion of ethical considerations and transition strategies.
Main Results:
- Defined indications for non-invasive and invasive home respiratory support.
- Proposed criteria for patient selection and multidisciplinary team requirements.
- Specified equipment, safety, training, monitoring, and follow-up guidance.
Conclusions:
- Standardized care pathways are essential for improving clinical outcomes in pediatric home respiratory support.
- Comprehensive guidelines address all aspects of care, from initial assessment to transition to adult services.
- Multidisciplinary team approach and caregiver training are crucial for effective management.
Abstract:
The number of paediatric patients evaluated for long-term home respiratory support has risen sharply in recent years, reflecting both improved survival of children with complex chronic conditions and expanded therapeutic indications. This population is characterized by substantial clinical heterogeneity, encompassing obstructive, restrictive, or central ventilatory disorders. Contributing comorbidities - such as severe obesity, chronic aspiration with secondary lung disease, neuromuscular weakness, impaired central respiratory drive, and dynamic upper airway obstruction - further complicate diagnostic assessment and long-term management. This consensus statement, developed by the Special Interest Group of the Swiss Society of Paediatric Pulmonology, provides comprehensive recommendations for Switzerland. It defines current indications for non-invasive and invasive home respiratory support, proposes criteria for patient selection, and outlines key competencies and composition of an optimal multidisciplinary care team. The document also specifies requirements for equipment provision, safety measures, and training of caregivers, while offering structured guidance for monitoring strategies, long-term follow-up, and management of acute exacerbations. Ethical considerations and best practices for transitioning adolescents to adult respiratory care are additionally addressed, with the aim of standardizing care pathways and improving clinical outcomes.
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