Long-term Non-Invasive Ventilation in Infants: A Systematic Review and Meta-Analysis

Abstract

BackgroundThe use of long-term non-invasive ventilation (NIV) to treat sleep and breathing disorders in children has increased substantially in the last decade; however, less data exist about its use in infants. Given that infants have distinct sleep and breathing patterns when compared to older children, the outcomes of infants on long-term NIV may differ as well. The aim of this study is to systematically review the use and outcomes of long-term NIV in infants.MethodsOvid Medline, Ovid Embase, CINAHL (via EbscoHOST), PubMed, and Wiley Cochrane Library were systematically searched from January 1990 to July 2017. Studies on infants using long-term NIV outside of an acute care setting were included. Data were extracted on study design, population characteristics, and NIV outcomes.ResultsA total of 327 studies were full-text reviewed, with final inclusion of 60. Studies were distributed across airway (40%), neuromuscular (28%), central nervous system (10%), cardio-respiratory (2%), and multiple (20%) disease categories. Of the 18 airway studies reporting on NIV outcomes, 13 (72%) reported improvements in respiratory parameters. Of the 12 neuromuscular studies exclusively on spinal muscular atrophy type 1 (SMA1), six (50%) reported decreased hospitalizations and nine (75%) reported on mortality outcomes. Risk of bias was moderate to serious, and quality of the evidence was low to very low for all studies. Most studies had an observational design with no control group, limiting the potential for a meta-analysis.ConclusionThe outcomes reported in studies differed by the disease category being studied. Studies on airway conditions showed improvements in respiratory parameters for infants using NIV. Studies on neuromuscular disorder, which were almost exclusively on SMA1, reported decreased hospitalizations and prolonged survival. Overall, it appears that NIV is an effective long-term therapy for infants. However, the high risk of bias and low quality of the available evidence limited strong conclusions.

Management and current status of spinal muscular atrophy: a retrospective multicentre claims database analysis

“…Nonetheless, procedures aimed to resolve respiratory problems made up for the majority of measures. Oxygen enrichment and mechanical ventilation are crucial when patients present respiratory muscle weakness and still are the preferred treatment in such cases [19,20]. Other repeated procedures are designed to reduce motor impairment, as the fixation or reconstruction of pelvic bones, an expected outcome given the recommendation for intervention in these patients to diminish the consequences of scoliosis, surgery that appears in the highest percentages in the youngest patients to lose ambulation capacity [4,21].…”

Use and outcomes of long-term noninvasive ventilation for infants

“…These results are similar to those described in other infant studies reporting on improvement in PSG parameters with NIV for infants with obstructive sleep apnea and support benefit for NIV in other airway disorders. 38 With limited information on the impact of NIV on sleep and respiratory parameters outside upper airway disorders, additional work is needed to understand the relationship between improvements in sleep and respiratory parameters and subsequent health outcomes in other underlying disease categories for both infants and older children.…”

Vaikų lėtinio kvėpavimo nepakankamumo priežastys ir gydymas

“…Svabu įvertinti taikytą kvėpavimo nepakankamumo ir gretutinių ligų gydymą bei skiriamo koncentruoto deguonies srauto kiekį ir jo vartojimo trukmę. Pacientą prižiūri pirminės grandies gydytojai, slaugytojai bei suaugusieji, besirūpinantys vaiku, taip pat kiti specialistai pagal poreikį skubių arba planinių konsultacijų metu [8,10].…”

“…Tėvai privalo žinoti, kokios priemonės bus reikalingos namuose, kaip jomis naudotis, taip pat kaip vertinti vaiko būklę ir atpažinti pablogėjusios sveikatos požymius. Būtinas nuolatinis jų mokymas bei žinių tikrinimas [7,10].…”

“…Ligoninėje gali būti naudojamos ir kitos priemonės: kaukės su rezervuaru, šalmai, gaubtai, kaukės su Venturi tipo vožtuvu ir kt. Tiekiant deguonį per tracheostomą arba didesniu srautu per kaukę, reikalingas įkvepiamo oro drėkinimas [10].…”