Noninvasive ventilation in children

Abstract

The use of noninvasive ventilation (NIV)/ventilatory assistance has in its modern form experienced a resurgence during the last two decades, primarily in the adult population.During the last few years, NIV, predominantly in the form of positive-pressure ventilation/ventilatory assistance, has also become an option in the paediatric population. Although the technique is increasingly being applied, data in this often very heterogeneous group of patients are still very limited, and are usually derived from case series and not randomised controlled studies.Available experience indicates that the technique is useful for children with a wide spectrum of hypercapnic and/or hypoxaemic respiratory disorders, in the acute as well as in the chronic setting. Results have shown improvements in survival and arterial blood gases, and have indicated better quality of life. Adverse effects are generally minor, although the impact on facial bony structures should be monitored closely during long-term ventilation.Considering the paucity of data, the area badly needs research, which preferentially should include: 1) short-and long-term effects and adverse effects in various conditions and age groups; 2) techniques, in particular interfaces and triggering mechanisms; 3) comprehensive plans for training of attendants, discharge and follow-up; and 4) quality of life measurements. As many of the conditions suited for noninvasive ventilation are very rare, much of the research would probably benefit from multicentre studies, or even studies on a European level.

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

“…However, leaks around the mask may cause discomfort and make it necessary to interrupt treatment. [12][13][14][15][16] A pediatric helmet has been used to deliver CPAP in neonates, infants, and preschool children with ARF. [17][18][19][20][21][22][23] In this population, CPAP by helmet was better tolerated than a facial mask, with no major complications and less need for sedation.…”

Uso precoz del BiPAP en el tratamiento de la insuficiencia respiratoria en un lactante con osteogénesis imperfecta: Case report

“…Se basa en la administración de un flujo de aire continuo a la vía aérea, entregada a dos niveles diferentes de presión, mediante una máscara facial. Permite disminuir el trabajo respiratorio, tratar la hipoventilación alveolar, aumentar la capacidad residual funcional y mantener una vía aérea permeable 8 , favoreciendo finalmente la ventilación alveolar minuto. Durante los períodos de sueño o durante una exacerbación, este sistema proporciona una respiración asistida para un correcto intercambio pulmonar 9,10 .…”

“…Los familiares mostraron satisfacción con los éxitos y objetivos alcanzados. Sin embargo, aún existe poca experiencia en el empleo de estos sistemas en niños pequeños y, al igual que otras condiciones, se requiere de algunos días para optimizar los parámetros correctos 4,8,9 . Inicialmente empleamos parámetros ventilatorios más altos que aquellos descritos por Fortenberry y cols 12 , a pesar de que nuestro paciente era de menor edad.…”

“…La mayoría de las publicaciones de VNI son en población adulta 5,6 , siendo la experiencia en niños aún reducida 7,8 . La administración de presión positiva a dos niveles (BiPAP) mediante una máscara nasal es una de las modalidades de VNI más empleadas 10,11 .…”

Long term negative pressure ventilation: Rescue for the failing fontan?

“…Overtime, positive pressure ventilators have completely replaced them as conventional modes of ventilation. As a result, there are very limited circumstances in contemporary medicine under which negative pressure ventilation negative pressure ventilation (NPV) is being considered [17,18] . An example would be patients with neuromuscular disorders for long term respiratory support [17] .…”