Non-invasive respiratory support in children and young adults with complex medical conditions in pediatric palliative care

Author:

Fauroux BrigitteORCID,Taytard JessicaORCID,Ioan Iulia,Lubrano Marc,Le Clainche Laurence,Bokov Plamen,Dudoignon Benjamin,Debelleix Stephane,Galode Francois,Coutier Laurianne,Sigur Elodie,Labouret Geraldine,Ollivier Morgane,Binoche Alexandra,Bergougnioux Jean,Mbieleu Blaise,Essid Aben,Hullo Eglantine,Barzic Audrey,Moreau Johan,Jokic Mikael,Denamur Sophie,Aubertin Guillaume,Schweitzer Cyril

Abstract

ObjectiveDyspnoea and sleep-disordered breathing (SDB) are common in children with life-limiting conditions but studies on treatment with non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) are scarce. The aim of the study was to describe children treated with long-term NIV/CPAP within a paediatric palliative care programme in France.MethodsCross-sectional survey on children and young adults with complex medical conditions treated within the French paediatric NIV network with long-term NIV/CPAP. Characteristics of the patients were analysed and patient-related outcome measures of NIV/CPAP benefit were reported.ResultsThe data of 50 patients (68% boys), median age 12 (0.4–21) years were analysed. Twenty-three (46%) patients had a disorder of the central nervous system and 5 (10%) a chromosomal anomaly. Thirty-two (64%) patients were treated with NIV and 18 (36%) with CPAP. NIV/CPAP was initiated on an abnormal Apnoea-Hypopnoea Index in 18 (36%) of the patients, an abnormal nocturnal gas exchange alone in 28 (56%), and after an acute respiratory failure in 11 (22%) of the patients. Mean objective NIV/CPAP adherence was 9.3±3.7 hours/night. NIV/CPAP was associated with a decrease in dyspnoea in 60% of patients, an increase in sleep duration in 60% and in sleep quality in 74%, and an improvement in parents’ sleep in 40%.ConclusionsIn children with life-limiting conditions, long-term NIV/CPAP may be associated with relief of dyspnoea, an improvement of SDB and an improvement in parents’ sleep.

Publisher

BMJ

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