Domiciliary noninvasive positive airway pressure therapy in children

Abstract

There has been a dramatic increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. Although PAP therapy was first prescribed for children with obstructive sleep apnea, the indications have rapidly widened to include treatment for central hypoventilation syndromes, neuromuscular and chest wall disorders as well as primary respiratory diseases. Given the rapidly expanding use of PAP therapy in children, pediatric pulmonologists need to be familiar with the indications, technical and safety considerations as well as potential complications and challenges that may arise when caring for children using PAP therapy. This review article covers the definition of PAP therapy, modes, interfaces, devices, indications, contraindications, suggested settings, complications as well as the factors influencing the adherence.

Use of non-invasive ventilation in cerebral palsy

“…NIV is indicated in three main scenarios25 : (i) airway obstruction can be improved by CPAP, which prevents airway collapse either during inspiration (in upper airway disorders) or expiration (in lower airway problems), as well as improving functional residual capacity and oxygenation; (ii) chronic respiratory failure resulting from muscle weakness (central cause or muscle fatigue due to increased respiratory load, eg, chronic lung disease), parenchymal lung disease (eg, recurrent aspiration) or chest wall disorders (eg, kyphoscoliosis) is more appropriately supported by BiPAP; (iii) reduced respiratory drive causing central apnoea/hypoventilation requires BiPAP with a back-up rate.…”

“…Nasal masks are the preferred choice for patients at risk of aspiration, who cannot remove the mask unaided 25 26. Uncontrolled upper airway secretion, despite medical and surgical therapies, can hinder the success of NIV25 as subsequent increased need for suctioning renders NIV less effective.…”

The Effect of Noninvasive Positive Pressure Ventilation on Pneumonia Hospitalizations in Children With Neurological Disease

“…In keeping with accepted practice definitions, adherence was defined as an estimated minimum of 4 hours of noninvasive positive pressure ventilation use for at least 50% of nights. 10 …”

A fine balance and a shared learning journey: Exploring healthcare engagement through the experiences of youth with Neuromuscular Disorders

“…Even though adolescents with chronic conditions can be knowledgeable about their health, their individual journeys of identity formation and developing autonomy influence their choices to take on and maintain health behaviors, particularly if these are perceived as counter to their desire to appear and feel 'normal' (Bucks et al, 2009). For adolescents with NMD the introduction of respiratory support such as NIV is crucial for survival and its uptake can be problematic (Amin, Al-Saleh, & Narang, 2016). Limited information sharing is one potential factor (Nierse, Abma, Horemans, & Van Engelen, 2013;van Huijzen & van Staa, 2013) but little is known about how these adolescents acquire an understanding of their condition and other factors that may influence their uptake and maintenance of life-sustaining health behaviors.…”