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Home treatment for chronic respiratory failure in children: a prospective study
1Association Nationale pour le Traitement à Domicile del'Insuffisance Respiratoire chronique (ANTADIR), Paris, France.
Insights
Home treatment for pediatric chronic respiratory failure (CRF) is common. Causes are diverse, including obstructive and restrictive lung diseases, with treatments like oxygen therapy and mechanical ventilation widely used.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Home Healthcare
Background:
- Home treatment for pediatric chronic respiratory failure (CRF) is increasingly prevalent.
- Understanding the specific causes and home management strategies for CRF in children is crucial.
Purpose of the Study:
- To delineate the etiological landscape of CRF in the pediatric population.
- To characterize the home-based treatment modalities employed for pediatric CRF patients.
Main Methods:
- A survey was conducted among children initiating home treatment for CRF via the ANTADIR network in France.
- Data collection spanned from March 1992 to March 1993 for children aged 18 years or younger.
Main Results:
- 287 children initiated home CRF treatment; 111 had obstructive disease (e.g., bronchopulmonary dysplasia, cystic fibrosis) and 176 had restrictive disease (e.g., neuromuscular disorders).
- Oxygen therapy was administered to 113 patients (mean 17.7 h/day), primarily via concentrators (88%).
- Mechanical ventilation was provided to 158 children; treatment cessation occurred in 21 (9 deaths, 12 improvements).
Conclusions:
- The ANTADIR network demonstrates well-established home treatment infrastructure for pediatric CRF in France.
- Pediatric CRF presents with heterogeneous causes, yet a relatively favorable prognosis is suggested by treatment outcomes.
Abstract:
Home treatment for children with chronic respiratory failure (CRF) is increasing. However, the causes of CRF in children and the details of their home treatment are not well-known. The aim of this study was to describe the causes of CRF in the paediatric population and the treatments that the patients received at home. We surveyed all children (aged < or = 18 yrs) entering the Association Nationale pour le Traitement à Domicile de l'Insuffisance Respiratoire chronique (ANTADIR) for home treatment of CRF between March 1992 and March 1993. Two hundred and eighty seven children (178 boys, 62%) started home treatment for CRF during the year. One hundred and eleven patients had obstructive respiratory disease: cystic fibrosis (CF) (n = 24); bronchopulmonary dysplasia (BPD) (n = 79); other obstructive respiratory disease (n = 8). One hundred and seventy six patients had restrictive lung disease: neuromuscular disease (n = 87); kyphoscoliosis (n = 21); pulmonary fibrosis (n = 6); cardiac disease (n = 14); stomatological disease (n = 10); other restrictive respiratory disease (n = 9); and 29 miscellaneous causes. One hundred and thirteen patients received oxygen therapy, with a mean daily use of 17.7 h (20 h.day-1 for BPD patients and 12.3 h.day-1 for CF patients). Oxygen was delivered by a concentrator in 88% of cases. One hundred and fifty eight children received mechanical ventilation (MV). Five children received nasal continuous positive airway pressure ventilation for sleep apnoea, four had pneumatic belt ventilation, and 12 had a tracheostomy without MV. Treatment was stopped in 21 children, because of death in nine and improvement in the other 12. Home treatment for children with CRF is well developed in France via the ANTADIR network. Causes of CRF in children are heterogeneous, with a relatively good prognosis.