A new clinical practice guideline published in the Annals of the American Thoracic Society outlines the recommendations for use of home oxygen therapy (HOT) in children.
Parent representatives as well as specialists in pediatric and neonatal medicine, respiratory therapy, nursing, and population health convened to develop recommendations for the use of HOT in children. A systematic review of available literature was performed by the panel.
In addition to defining hypoxemia in children, the panel provided an overview of HOT indications. Strong recommendations for HOT were made in children with cystic fibrosis complicated by severe chronic hypoxemia, bronchopulmonary dysplasia complicated by chronic hypoxemia, pulmonary hypertension without congenital heart disease complicated by chronic hypoxemia, and interstitial lung disease complicated by severe chronic hypoxemia.
The review also produced recommendations regarding the specific strategies necessary to delivery HOT in the home setting. The panel recommended the use of low-flow meters to deliver oxygen flows of 0.1 to 1 L/min in infants and young children. Young children and infants should not receive oxygen through pulse oxygen delivery systems. Long-term monitoring of HOT should be performed via an in-home pulse oximeter with pediatric-specific sensors.
Recommendations for weaning and/or discontinuing HOT in children who experience improvement in their underlying respiratory condition were also included. A reassuring medical exam as well as stable measures of oxygenation can help determine readiness for weaning and oxygen discontinuation, the panel stated. Gradually decreasing flow rates each week or removing HOT use at different times during the day can be used to wean the therapy. A pulse oximetry study on room air should be performed after discontinuation.
Although the recommendations set forth by the team of specialists and parent representatives may be considered useful clinical guidelines for pediatric HOT use, the panel concluded that “[m]ore research is needed to determine optimal oxygenation targets for growth and development, as well as to develop best practices for weaning and discontinuing HOT in children.”
Krivchenia K, Hawkins SM, Iyer NP, et al. 2019 clinical practice guideline summary for clinicians: home oxygen therapy for children [published online April 16, 2019]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201902-136CME