Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline

Hayes, Don; Wilson, Kevin C.; Krivchenia, Katelyn; Hawkins, S.J.; Balfour‐Lynn, Ian M.; Gozal, David; Panitch, Howard B.; Splaingard, Mark; Rhein, Lawrence; Kurland, Geoffrey; Abman, Steven H.; Hoffman, Timothy M.; Carroll, Christopher L.; Cataletto, Mary; Tumin, Dmitry; Oren, Eyal; Martin, Richard J.; Baker, Joyce; Porta, Gregory R.; Kaley, Deborah; Gettys, Ann; Deterding, Robin R.

doi:10.1164/rccm.201812-2276st

Cited by 105 publications

(81 citation statements)

References 141 publications

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“…ATS, American Thoracic Society guidelines 2019; BTS, British Thoracic Society guidelines 2009; N, unsatisfactory study; SpO2, peripheral capillary oxygen saturation; TSANZ, Thoracic Society of Australia and New Zealand position statement 2008; Y, satisfactory study. [Correction added on 13 September 2019, after first online publication: In Table 1, ‘TSANZ/BTS (mean SpO 2 < 93–95%)’ was amended to ‘TSANZ/BTS (mean SpO 2 > 93–95%)’ and ‘McGrath Morrow et al .’ was replaced with ‘BTS’].…”

Section: Resultsmentioning

confidence: 99%

“…Ideas and suggestions were deliberated, including criteria for establishing home oxygen, weaning regimes and performing polysomnography. All 25 quiz questions were also scored against criteria for abnormal overnight oximetry studies published by the TSANZ (mean SpO 2 < 93–95%), the BTS (mean SpO 2 < 93%), the ATS (≥ 5% of study time with SpO 2 ≤ 93%) and BTS (≥ 5% of study time with SpO 2 ≤ 90%) . Using the consensus answers as a gold standard, sensitivity and specificity were calculated using each criterion.…”

Section: Methodsmentioning

confidence: 99%

“…The literature defining acceptable overnight oximetry parameters in infants with CNLD is limited to a few position statements and best practice guidelines from the Thoracic Society of Australia and New Zealand (TSANZ), British Thoracic Society (BTS) and American Thoracic Society (ATS) and recommend the following: At least 6 h of evaluation by polysomnography (PSG) or overnight oximetry. The evaluation period should include sleeping and feeding – the two most vulnerable infant daily activities. Chronic hypoxaemia should be avoided in CNLD and is suggested by: An overnight oximetry with mean SpO 2 < 93–95% or SpO 2 < 93% An overnight oximetry with ≥ 5% of the study time ≤ SpO 2 93% At least three intermittently measured SpO 2 ≤ 93% …”

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confidence: 99%

“…Previous clinical practice surveys of oxygen weaning in CNLD do not mention use of overnight continuous pulse oximetry and available publications on interpreting oximetry data relate to other conditions such as paediatric obstructive sleep apnoea (OSA), adults with chronic obstructive pulmonary disease or adult sleep disordered breathing . Current recommendations are based on low‐level evidence and consensus clinician experience …”

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confidence: 99%

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Using continuous overnight pulse oximetry to guide home oxygen therapy in chronic neonatal lung disease

Wong

Chung

Chawla

2019

J Paediatrics Child Health

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Aim The aims of this study are: (i) to survey the knowledge of paediatric clinicians using overnight continuous pulse oximetry data to guide management of infants with chronic neonatal lung disease (CNLD); (ii) to assess the ability of paediatric clinicians to interpret overnight continuous pulse oximetry data; and (iii) to describe the overnight oximetry interpretation practices of paediatric respiratory specialists. Methods Paediatric clinicians from three tertiary teaching hospitals completed an anonymous survey regarding overnight continuous pulse oximetry in chronic neonatal lung disease. Using a modified Delphi technique, paediatric respiratory specialists participated in a concordance exercise and discussions to establish consensus interpretations for 25 oximetry studies. Paediatric clinicians were invited to complete the same exercise as a comparison. Results Self‐rated knowledge from 74 surveyed clinicians was proportional to clinical experience. Twenty paediatric clinicians and nine paediatric respiratory specialists completed the oximetry exercise with scores of 64% (κ = 0.25) and 80% (κ = 0.45), respectively. Individual parameters like a mean peripheral arterial haemoglobin saturation (SpO2) below 93% and percentage time spent below SpO2 93% correlated poorly with the consensus interpretations. Paediatric respiratory specialists instead relied on visual analysis of SpO2 waveforms, utilising the frequency and depth of desaturations to guide management. Conclusion Interpretation of overnight oximetry data is variable amongst both paediatric clinicians and respiratory specialists. This likely reflects inadequate evidence defining clinically significant intermittent hypoxaemia, whether in terms of desaturation duration, frequency or nadir.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Using continuous overnight pulse oximetry to guide home oxygen therapy in chronic neonatal lung disease

Wong

Chung

Chawla

2019

J Paediatrics Child Health

View full text Add to dashboard Cite

show abstract

“…A recently published clinical practice guideline from the American Thoracic Society (ATS) established standards and provided recommendations for home oxygen therapy (HOT) for children in the United States (US) . With no previous benchmark for HOT in pediatric patients with respiratory conditions in the US, the expert panel developed a document highlighting important differences between adults and children.…”

mentioning

confidence: 99%