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Invasive versus non-invasive paediatric home mechanical ventilation: review of the international evolution over the past 24 years
  1. Michel Toussaint1,
  2. Olivier van Hove2,
  3. Dimitri Leduc2,
  4. Lise Ansay3,
  5. Nicolas Deconinck4,
  6. Brigitte Fauroux5,
  7. Sonia Khirani6,7
  1. 1 Department of Neurology, Centre de référence Neuromusculaire, Erasme Hospital, Bruxelles, Belgium
  2. 2 Department of Pulmonology, Erasme Hospital, Bruxelles, Belgium
  3. 3 Centre for Physiotherapy La Bulle Kiné, Nice, France
  4. 4 Department of Pediatric Neurology, HUDERF, Bruxelles, Belgium
  5. 5 Paediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
  6. 6 Necker-Enfants Malades Hospitals, Paris, France
  7. 7 ASV Santé, Gennevilliers, France
  1. Correspondence to Dr Michel Toussaint, Neurology, Centre de référence Neuromusculaire, Erasme Hospital, Bruxelles, Belgium; michel.toussaint{at}hubruxelles.be

Abstract

Background Home mechanical ventilation (HMV) is the treatment for chronic hypercapnic alveolar hypoventilation. The proportion and evolution of paediatric invasive (IMV) and non-invasive (NIV) HMV across the world is unknown, as well as the disorders and age of children using HMV.

Methods Search of Medline/PubMed for publications of paediatric surveys on HMV from 2000 to 2023.

Results Data from 32 international reports, representing 8815 children (59% boys) using HMV, were analysed. A substantial number of children had neuromuscular disorders (NMD; 37%), followed by cardiorespiratory (Cardio-Resp; 16%), central nervous system (CNS; 16%), upper airway (UA; 13%), other disorders (Others; 10%), central hypoventilation (4%), thoracic (3%) and genetic/congenital disorders (Gen/Cong; 1%). Mean age±SD (range) at HMV initiation was 6.7±3.7 (0.5–14.7) years. Age distribution was bimodal, with two peaks around 1–2 and 14–15 years. The number and proportion of children using NIV was significantly greater than that of children using IMV (n=6362 vs 2453, p=0.03; 72% vs 28%, p=0.048), with wide variations among countries, studies and disorders. NIV was used preferentially in the preponderance of children affected by UA, Gen/Cong, Thoracic, NMD and Cardio-Resp disorders. Children with NMD still receiving primary invasive HMV were mainly type I spinal muscular atrophy (SMA). Mean age±SD at initiation of IMV and NIV was 3.3±3.3 and 8.2±4.4 years (p<0.01), respectively. The rate of children receiving additional daytime HMV was higher with IMV as compared with NIV (69% vs 10%, p<0.001). The evolution of paediatric HMV over the last two decades consists of a growing number of children using HMV, in parallel to an increasing use of NIV in recent years (2020–2023). There is no clear trend in the profile of children over time (age at HMV). However, an increasing number of patients requiring HMV were observed in the Gen/Cong, CNS and Others groups. Finally, the estimated prevalence of paediatric HMV was calculated at 7.4/100 000 children.

Conclusions Patients with NMD represent the largest group of children using HMV. NIV is increasingly favoured in recent years, but IMV is still a prevalent intervention in young children, particularly in countries indicating less experience with NIV.

  • Assisted Ventilation
  • Child
  • Respiratory Muscles
  • Non invasive ventilation
  • Paediatric Lung Disease

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Footnotes

  • X @Ansay Lise

  • Contributors MT contributed to the design of the review and data acquisition, analysis and interpretation, performed the search of Medline/PubMed for HMV articles, drafted the review, approved the successive and final version of the review before submission to publication and agreed to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. OvH contributed to the interpretation of data for the review, revised the review critically, approved the different and final version of the review before submission to publication and agreed to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DL contributed to the interpretation of data for the review, revised the review critically, approved the different and final version of the review before submission to publication and agreed to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LA contributed to the design of the review and data acquisition, analysis and interpretation, performed the search of Medline/PubMed for HMV articles, drafted the review with MT, contributed to the interpretation of data for the review and approved the final version of the review before submission to publication. ND revised the review critically, approved the final version of the review before submission to publication and agreed to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BF revised the review critically, approved the final version of the review before submission to publication and agreed to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SK contributed to the design of the review and data analysis and interpretation, drafted and revised the review critically, approved the successive and final version of the review before submission to publication and agreed to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.