Failure of long term ventilatory support in children: definition via Delphi method, proportion and causes

Résumé fourni par la source

Background There is no consensual definition of home ventilatory support (VS) failure in adults nor children. Aims and objectives To define VS failure using the Delphi method and to test this definition in a cohort of children. Methods 31 experts took part in 6 DELPHI rounds. They defined failure of adherence, clinical failure and paraclinical failure. This 1st definition was retrospectively tested on children with VS in Lyon and Grenoble between November 2022 and December 2023. Results Failure of adherence if <4h/night and/or <3 nights/week, clinical failure if uncorrected obstructive sleep apnea (OSA) symptoms or respiratory decompensations hospitalized in intensive care unit/continuing care, paraclinical failure if persistent desaturation clusters and/or ≥5% of the time with SpO2 ≤90% ; mean TcPCO2 ≥50 mmHg and/or TcPCO2 ≥50 mmHg for ≥5% of the time and/or wake-up blood gas under machine with pCO2 ≥ 50 mmHg or bicarbonates ≥ 30 mmol/l ; poly(somnography) finding an obstructive apnea-hypopnea index remaining ≥10/h. Of the 209 patients included [median age(min-max) 11 years (4-15)], of whom 167 were still on VS, 65(39%) had a failure. Of these, 38(58%) had a failure of adherence, 15(23%) a clinical failure, 26(40%) a paraclinical failure. No factors associated with failure were significantly identified, and compared with failure recorded by the patient's referring physician, the definition had a positive predictive value of 66%. Following this population test, a 2nd definition was retained, with a more flexible definition of paraclinical failure. Conclusion A definition of home VS failure in pediatrics was validated, tested in a population of children and adapted.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.