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

IF 4.3 3区 医学 Q1 PEDIATRICS Archives of Disease in Childhood Pub Date : 2024-10-18 DOI:10.1136/archdischild-2023-326782
Brigitte Fauroux, Jessica Taytard, Iulia Ioan, Marc Lubrano, Laurence Le Clainche, Plamen Bokov, Benjamin Dudoignon, Stephane Debelleix, Francois Galode, Laurianne Coutier, Elodie Sigur, Geraldine Labouret, Morgane Ollivier, Alexandra Binoche, Jean Bergougnioux, Blaise Mbieleu, Aben Essid, Eglantine Hullo, Audrey Barzic, Johan Moreau, Mikael Jokic, Sophie Denamur, Guillaume Aubertin, Cyril Schweitzer
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Abstract

Objective: Dyspnoea 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.

Methods: Cross-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.

Results: The 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%.

Conclusions: In 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.

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在儿科姑息治疗中,为病情复杂的儿童和年轻成人提供无创呼吸支持。
目的:呼吸困难和睡眠呼吸障碍(SDB)在患有生命垂危疾病的儿童中很常见,但有关无创通气(NIV)或持续气道正压(CPAP)治疗的研究却很少。本研究旨在描述在法国儿科姑息治疗项目中接受长期无创通气(NIV)/持续气道正压(CPAP)治疗的儿童的情况:方法:对在法国儿科 NIV 网络内接受长期 NIV/CPAP 治疗的患有复杂疾病的儿童和年轻成人进行横断面调查。对患者的特征进行了分析,并报告了与患者相关的 NIV/CPAP 收益结果:结果:分析了 50 名患者(68% 为男孩)的数据,中位年龄为 12(0.4-21)岁。23名患者(46%)患有中枢神经系统疾病,5名患者(10%)染色体异常。32名患者(64%)接受了 NIV 治疗,18 名患者(36%)接受了 CPAP 治疗。18(36%)名患者在呼吸暂停-低通气指数异常时开始使用 NIV/CPAP,28(56%)名患者仅在夜间气体交换异常时开始使用 NIV/CPAP,11(22%)名患者在急性呼吸衰竭后开始使用 NIV/CPAP。NIV/CPAP的平均客观坚持时间为9.3±3.7小时/夜。60%的患者通过使用 NIV/CPAP 减少了呼吸困难,60%的患者延长了睡眠时间,74%的患者提高了睡眠质量,40%的患者改善了父母的睡眠:结论:对于患有生命限制性疾病的儿童,长期使用 NIV/CPAP 可缓解呼吸困难、改善 SDB 和改善父母的睡眠。
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来源期刊
CiteScore
5.80
自引率
3.80%
发文量
291
审稿时长
3-6 weeks
期刊介绍: Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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