New Guidelines for Home Oxygen Therapy in Pediatric Patients

“Home oxygen is often needed for children with chronic lung and pulmonary vascular diseases,” says Don Hayes, Jr., MD, MS, MEd, medical director of the Advanced Lung Disease Program at Nationwide Children’s and co-chair of the working group organized by the ATS Assembly on Pediatrics and lead author on the document. “However, there is a striking lack of empirical evidence regarding its implementation, monitoring and discontinuation in children. These guidelines, developed by a panel of highly respected experts, offer an evidence-based approach to using home oxygen to benefit pediatric patients.” The multidisciplinary panel working on behalf of the ATS has released the following recommendations based on their confidence in the estimated effects, the balance of benefits and potential harms, patient values and preferences, and cost and feasibility. The report was published in American Journal of Respiratory and Critical Care Medicine.

The guidelines strongly suggest the use of home oxygen therapy for the following patient populations:

  • Children with cystic fibrosis complicated by severe chronic hypoxemia
  • Children with bronchopulmonary dysplasia complicated by chronic hypoxemia
  • Children with sleep-disordered breathing complicated by chronic hypoxemia who cannot tolerate treatment
  • Children with sickle cell anemia complicated by chronic hypoxemia
  • Children with pulmonary hypertension without congenital heart disease complicated by chronic hypoxemia
  • Children with interstitial lung disease complicated by severe chronic hypoxemia

Home oxygen therapy is conditionally recommended, or applicable in most situations, in the following cases:

  • Patients with cystic fibrosis and mild hypoxemia and dyspnea on exertion
  • Patients with sleep disordered breathing complicated by severe nocturnal hypoxemia who cannot tolerate positive airway pressure therapy or are awaiting surgical treatment of the sleep disordered breathing
  • Patients with sickle cell disease complicated by severe chronic hypoxemia
  • Patients with interstitial lung disease with mild chronic hypoxemia and either dyspnea on exertion or desaturation during sleep or exertion.

When implementing home oxygen therapy, providers should be aware that the following parameters are critical to achieving optimal benefit, according to the new guidelines. First, oxygen equipment used for children should be an appropriate size and function properly. Second, oxygen therapy should be titrated to maintain an oxygen saturation level greater than 90 percent at all times. Finally, providers should use pulse oximetry to titrate and monitor oxygen therapy.

“Future research is needed to further advance our understanding of and ability to utilize home oxygen therapy in children,” says Dr. Hayes, who is also medical director of the Lung and Heart-Lung Transplant Programs at Nationwide Children’s. “Specifically, research should address the relationship between oxygen saturation levels and growth and development as well as identifying best practices for weaning and discontinuing home oxygen therapy.”

References:
Hayes Jr D, Wilson KC, Krivchenia K, Hawkins SMM, Balfour-Lynn IM, Gozal D, Panitch HB, Splaingard ML, Rhein LM, Kurland G, Abman SH, Hoffman TM, Carroll CL, Cataletto ME, Tumin D, Oren E, Martin RJ, Baker J, Porta GR, Kaley D, Gettys A, Deterdine RR, American Thoracic Society Assembly on Pediatrics. Home oxygen therapy for children: An official ATS clinical practice guideline. American Journal of Respiratory Critical Care Medicine. 2018 Feb 1. [Epub ahead of print]