Children with medical complexity (CMC) often have trouble breathing at night and need to use a breathing machine. This breathing machine is called noninvasive positive pressure ventilation (NiPPV). The use of NiPPV has been shown to improve quality of life and survival in children. Before it is used, NiPPV must first be tested to see what the correct 'machine settings' are for each child. This is usually done in the sleep laboratory at the hospital during a one-night stay. However, sleep studies in the hospital are disruptive and hard for CMC and their families because of the new environment and limited access to the equipment, supplies, comfort items and the routine their child has at home. Patients and families would prefer to start NiPPV at home but there needs to be more research on this to make sure it is possible and safe. This study will evaluate a new model of care to start NiPPV in the home. CMC aged 5-17 years old and starting NiPPV will be assigned at random, like a coin toss, to start NiPPV in the home or to start NiPPV in the sleep laboratory. The investigators will assess the feasibility and safety of the two ways to start NiPPV. This study will be the first step towards developing a study to evaluate if home NiPPV starts are effective. Starting NiPPV at home has the potential to improve the use of NiPPV (ie early adherence predicts long-term use) resulting in both medical benefits as well as improved quality of life for CMC and their families.
Age 5-17 years old
Newly prescribed NiPPV
Tolerated awake NiPPV trial
Provides informed consent
Cardiac disease at risk of hemodynamic instability with NiPPV initiation (eg cardiac dysfunction (ejection fraction <45%), pulmonary hypertension (mean pulmonary artery pressure ≥ 20 mmHg on right heart catheterization or suggestive echocardiogram findings in the opinion of a pediatric cardiologist), or single ventricle)
At high risk of complications with NiPPV in the opinion of the child's physician (eg pneumothorax and aspiration risk)
Severe sleep disordered breathing with peak CO2 ≥ 60mmHg or apnea-hypopnea index (AHI)≥ 30/hr (AHI measures the number of respiratory events per hour)
Participation in concurrent research study that may affect NiPPV adherence (proposed primary outcome of full study)
Parallel
Home Initiation of NiPPV
Other interventionInitiation of NiPPV in the home environment through the utilization of an awake NiPPV titration, oximetries, and telemonitoring.
Recruitment and retention rate
Feasibility outcome. The recruitment rate is the proportion of eligible people recruited to the trial. This is the number of people randomised divided by the number of people eligible. The retention rate is the proportion of randomised people who complete follow up at 3 months (end of trial).
Proportion of eligible patients randomized
Feasibility outcome. Proportion of eligible participants who are recruited to the study and randomized
Proportion of patients that crossover based on safety criteria
Safety outcome. Proportion of patients in the intervention arm who crossover to the control arm based on pre-specified monitoring criteria
Mean minutes of nightly NiPPV usage
Proposed trial outcome. Adherence will be determined adjectively using ventilator download data.
Proxy-reported Psychological Scale (percentage rank)
Proposed trial outcome. The proxy-reported Psychological Scale from the KIDSCREEN-52 questionnaire will be used. The percentage rank range is 0-100, with lower scores indicating a "dissatisfaction with life".
Proxy-reported Psychological Scale (percentage rank)
Proposed trial outcome. The proxy-reported Psychological Scale from the KIDSCREEN-52 questionnaire will be used. The percentage rank range is 0-100, with lower scores indicating a "dissatisfaction with life".
Proxy-reported Psychological Scale (T-value)
Proposed trial outcome. The proxy-reported Psychological Scale from the KIDSCREEN-52 questionnaire will be used. The T-values have a mean of 50 and standard deviation of 10. Higher T-values indicate a higher quality of life.
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