- Home oxygen therapy (HOT) is used to maintain health due to clinical benefits in children with chronic lung and pulmonary vascular diseases.
- Enabling a child to receive HOT also confers psychological advantages by allowing the child to remain within the family unit at home, reducing healthcare costs compared to hospitalization.
- Despite children having significantly different pulmonary physiology adults and additional requirements for optimal lung growth and development, indications for funding HOT as determined by the Centers for Medicare & Medicaid Services (CMS) are the same for pediatric and adult patients.
- These include:
- PaO2 <55 mmHg (<7.33 kPa), or
- SpO2 <88%, or
- PaO2 55–59 mmHg (7.33–7.87 kPa) or
- SpO2 89% accompanied by cor pulmonale, a hematocrit >55%, or a history of edema.
- These include:
- Recognizing the need for clinical guidance regarding HOT specifically for children, the American Thoracic Society (ATS) convened a task force of specialists in pediatric and neonatal medicine, respiratory therapy, nursing, and population health, along with parents to conduct systematic reviews and use available evidence to inform recommendations for the use of HOT in chronic lung and pulmonary vascular diseases of childhood.
Definition of Hypoxemia At or Near Sea Level (See Table 1):
- In children <1 year-old, hypoxemia was defined as spending 5% of the recording time with SpO2 ≤90%, or, if measurements are taken intermittently, obtaining three independent measurements of SpO2 ≤90%.
- In children ≥1 year-old, hypoxemia was defined as spending 5% of the time with SpO2 ≤93%, or, if measurements are taken intermittently, obtaining three independent measurements of SpO2 ≤93%. Additional conclusions from the panel included:
- Pulse oximetry is sufficient for diagnosing hypoxemia in children, as arterial blood analysis for PaO2 is not practical for routine monitoring due to technical difficulty in children and the pain associated with the arterial stick.
- On very rare occasions, an arterial blood gas for PaO2 may be required to assess for hypoxemia in a child, specifically when pulse oximetry may not accurately measure SpO2 including altered hemoglobin states (carboxyhemoglobin, methemoglobin, etc.) or in diseases affecting hemoglobin such as sickle cell disease.
- Intermittent pulse oximetry appears suitable with the different thresholds reflecting greater variability of SpO2 among healthy children <1 year-old, particularly the youngest children with this left at the discretion of the treating clinician according to the clinical scenario of the patient.
- In a child, three intermittent measurements, if abnormal, can diagnose hypoxemia but normal intermittent measurements cannot exclude it. This can be done only by continuous oximetry monitoring which includes a period of sleep. More advanced evaluation with polysomnography may be needed on a case-by-case basis at the discretion of the treating clinician.
- Averaging time for pulse oximetry measurements should take into account the age of the child, the underlying respiratory condition, and the current clinical scenario.
- A duration of two weeks defined chronicity of hypoxemia in a child.
- Hypoxemia in a child should account for anticipated SpO2 measurement alterations according to altitude.
Table 1. Normative Values
|Children <1 year old|
(97.9% to 99.8%)
|Not reported||86% (±1.5%)||85.5% (83% to 88%)|
|Children ≥1 year old|
|97.5% (97% to 98%)||97.8%|
|93% (91% to 94%)|