G397(P) Hypoxic challenge testing – which children are we assessing?

Abstract

Aim Hypoxic challenge testing (HCT) is the method used to assess whether a patient with stable respiratory disease requires in-flight oxygen. A national guideline, published by British Thoracic Society in 2011, makes recommendations on which children ought to undergo HCT prior to undertaking air travel. Identified are: infants under 1 year with neonatal history of chronic lung disease, children with CF/chronic lung disease old enough for spirometry whose FEV1 This audit aimed to define which patients had undergone hypoxic challenge tests and compared this against the patient groups identified in the BTS guideline. Methods A large tertiary children’s hospital in the UK conducted a retrospective audit of hypoxic challenge tests carried out between 2012 and 2014. Information was collected on age, diagnosis, when the patient last required long-term oxygen, lung function around the time of the test and the outcome of the test. Results 31 HCTs from 25 patients were audited. The average age was 6.3 years (6 months-16.5 years). Of the 22 patients who passed the HCT, three were recommended in the guideline to have HCT. Of the nine patients who did not pass HCT, two were within the recommendations. These five patients, who were within the recommendations, were three children with CF/chronic lung disease with FEV1 Of the nine children who did not pass the HCT, seven fell outside the recommended groups. Five were ex-preterm children older than one year had history of neonatal chronic lung disease, one had SMA Type 2, one had muscular dystrophy, one had severe kyphoscoliosis and one had severe restrictive lung disease following PNET. Conclusion Results show that clinicians are choosing to preform hypoxic challenge tests on patient outside of the recommendations. A larger proportion who failed the hypoxic challenge test were not defined within the BTS guidelines. With advancing technology the demographics of our respiratory paediatric patient population is evolving. It is therefore prudent to reconsider the paediatric recommendations.