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Pediatric outpatient non-invasive ventilation program: Reflections on the first experience from the Middle East
Long-term noninvasive ventilation (NIV) is being progressively used in children. The current guidelines recommend NIV initiation in the hospital during overnight polysomnography (PSG) titration study. Due to the logistic, socioeconomic, and financial difficulties including bed availability, an outpa...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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HBKU Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9810482/ https://www.ncbi.nlm.nih.gov/pubmed/36605540 http://dx.doi.org/10.5339/qmj.2023.5 |
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author | AlNaimi, Amal Hamad, Sara G. Arar, Rania Mandanas, Ricardo Abu-Hassan, Mutasim |
author_facet | AlNaimi, Amal Hamad, Sara G. Arar, Rania Mandanas, Ricardo Abu-Hassan, Mutasim |
author_sort | AlNaimi, Amal |
collection | PubMed |
description | Long-term noninvasive ventilation (NIV) is being progressively used in children. The current guidelines recommend NIV initiation in the hospital during overnight polysomnography (PSG) titration study. Due to the logistic, socioeconomic, and financial difficulties including bed availability, an outpatient program for NIV initiation and patients/parents counseling to prevent delay and provide cost-effective care has been commissioned. Hence, this study reports on the clinical outcome of our program as it represents the first reported experience from the middle east. A retrospective review of electronic medical charts was conducted for all patients with PSG-confirmed sleep-related breathing disorders (SRBD) who were evaluated and treated in the NIV clinic in the pediatric pulmonary clinic at Sidra Medicine from January 2020 to November 2021. Patients’ data included demographics, PSG results, and NIV clinic records. The results show that twenty-eight patients (17 male, 11 female) were included during the study period. The patients’ median age at NIV initiation was 11 ± 5.17 years. The median BMI was 32.72 ± 15.91 kg/m( 2 ). The most common diagnosis was morbid obesity in 9 (32%) of the patients. The identified SRBD based on the diagnostic PSG were obstructive sleep apnea in 21 patients, hypoventilation in 3 patients, mixed apnea in 3 patients, and central apnea in 1 patient. The median total Apnea-Hypopnea Index (AHI) was 12.7 (0.7-153.9) events per hour. The main reason for the initial NIV clinic visit was NIV initiation in 19 patients. Upon follow-up, six patients were successfully weaned off NIV support by the treating pulmonologist. Five patients refused to use NIV at home. Fifteen out of the remaining seventeen patients used NIV ≥ 4 hours per night (subjective adherence: 88%). Twelve patients used the NIV for ≥ 24 nights per month (70.6%). All parents reported that the clinic experience was beneficial and helped them to be more comfortable with applying the NIV machine at home. In conclusion, pediatric NIV outpatient programs are achievable and beneficial, especially in developing countries. Pediatric NIV clinics managed by a specialized and experienced team play important role in the initiation and follow-up of NIV support. They provide alternative pathways for the care of pediatric patients, education, and support of their families, and decrease the load on intensive care and sleep laboratory units. Studies about cost-effectiveness are needed to evaluate the impact of implementing outpatient NIV programs on sleep laboratories and hospital admission rates. |
format | Online Article Text |
id | pubmed-9810482 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | HBKU Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-98104822023-01-04 Pediatric outpatient non-invasive ventilation program: Reflections on the first experience from the Middle East AlNaimi, Amal Hamad, Sara G. Arar, Rania Mandanas, Ricardo Abu-Hassan, Mutasim Qatar Med J Research Paper Long-term noninvasive ventilation (NIV) is being progressively used in children. The current guidelines recommend NIV initiation in the hospital during overnight polysomnography (PSG) titration study. Due to the logistic, socioeconomic, and financial difficulties including bed availability, an outpatient program for NIV initiation and patients/parents counseling to prevent delay and provide cost-effective care has been commissioned. Hence, this study reports on the clinical outcome of our program as it represents the first reported experience from the middle east. A retrospective review of electronic medical charts was conducted for all patients with PSG-confirmed sleep-related breathing disorders (SRBD) who were evaluated and treated in the NIV clinic in the pediatric pulmonary clinic at Sidra Medicine from January 2020 to November 2021. Patients’ data included demographics, PSG results, and NIV clinic records. The results show that twenty-eight patients (17 male, 11 female) were included during the study period. The patients’ median age at NIV initiation was 11 ± 5.17 years. The median BMI was 32.72 ± 15.91 kg/m( 2 ). The most common diagnosis was morbid obesity in 9 (32%) of the patients. The identified SRBD based on the diagnostic PSG were obstructive sleep apnea in 21 patients, hypoventilation in 3 patients, mixed apnea in 3 patients, and central apnea in 1 patient. The median total Apnea-Hypopnea Index (AHI) was 12.7 (0.7-153.9) events per hour. The main reason for the initial NIV clinic visit was NIV initiation in 19 patients. Upon follow-up, six patients were successfully weaned off NIV support by the treating pulmonologist. Five patients refused to use NIV at home. Fifteen out of the remaining seventeen patients used NIV ≥ 4 hours per night (subjective adherence: 88%). Twelve patients used the NIV for ≥ 24 nights per month (70.6%). All parents reported that the clinic experience was beneficial and helped them to be more comfortable with applying the NIV machine at home. In conclusion, pediatric NIV outpatient programs are achievable and beneficial, especially in developing countries. Pediatric NIV clinics managed by a specialized and experienced team play important role in the initiation and follow-up of NIV support. They provide alternative pathways for the care of pediatric patients, education, and support of their families, and decrease the load on intensive care and sleep laboratory units. Studies about cost-effectiveness are needed to evaluate the impact of implementing outpatient NIV programs on sleep laboratories and hospital admission rates. HBKU Press 2022-12-30 /pmc/articles/PMC9810482/ /pubmed/36605540 http://dx.doi.org/10.5339/qmj.2023.5 Text en © 2023 AlNaimi, Hamad, Arar, Mandanas, Abu-Hassan, licensee HBKU Press. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Paper AlNaimi, Amal Hamad, Sara G. Arar, Rania Mandanas, Ricardo Abu-Hassan, Mutasim Pediatric outpatient non-invasive ventilation program: Reflections on the first experience from the Middle East |
title | Pediatric outpatient non-invasive ventilation program: Reflections on the first experience from the Middle East |
title_full | Pediatric outpatient non-invasive ventilation program: Reflections on the first experience from the Middle East |
title_fullStr | Pediatric outpatient non-invasive ventilation program: Reflections on the first experience from the Middle East |
title_full_unstemmed | Pediatric outpatient non-invasive ventilation program: Reflections on the first experience from the Middle East |
title_short | Pediatric outpatient non-invasive ventilation program: Reflections on the first experience from the Middle East |
title_sort | pediatric outpatient non-invasive ventilation program: reflections on the first experience from the middle east |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9810482/ https://www.ncbi.nlm.nih.gov/pubmed/36605540 http://dx.doi.org/10.5339/qmj.2023.5 |
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