Positive airway pressure in pediatric obstructive sleep apnea

Parmar, Arpita; Baker, Adele; Narang, Indra

doi:10.1016/j.prrv.2019.04.006

Cited by 30 publications

(42 citation statements)

References 61 publications

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“…Data from noninvasive respiratory support devices are widely used in clinical practice as important improvements have been made on the built-in software of CPAP/NIV devices (34,35). Data such as adherence and effectiveness of ventilatory therapy are available, even though the type and number of available data vary according to the device (36). However, caution must be taken about interpretation of those data and technical specificities of the devices, as they are designed for adult patients and not for the pediatric population.…”

Section: Analysis Of Data Obtained From Built In Monitoring Devicesmentioning

confidence: 99%

“…Once again, no timing has been defined for the assessment of device data. However, the access to the respiratory support device data is becoming easier, as daily wireless transfer of data is now possible from many devices (36). This not only allows the patient to review their own therapy data, but also the homecare provider and healthcare staff to access remote monitoring of cloud-based data.…”

Section: Analysis Of Data Obtained From Built In Monitoring Devicesmentioning

confidence: 99%

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Follow-Up and Monitoring of Children Needing Long Term Home Ventilation

et al. 2020

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Once continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) is started in a child, and the child is discharged home, follow-up needs to be organized with regular visits in order to check the tolerance and efficacy of the treatment. But there is a lack of validated clinical guidelines, mainly because of the heterogeneity of the ventilator servicing, the costs and health care systems among countries. Therefore, visits timing and strategies to monitor CPAP/NIV are not clearly defined. Moreover, depending on various factors such as the underlying disorder, the medical stability, the age of the child, and socioeconomic factors, follow-up usually ranges between 1 month and 3-6 months, or even 1 year following treatment initiation, with an overnight hospital stay, an outpatient visit, a home visit, via telemonitoring or telemedicine, alone or in combination. Apart from clinical evaluation, nocturnal oximetry and capnography monitoring and/or poly(somno)graphy (P(S)G) are usually carried out during the follow-up visits to monitor the delivered pressure, leaks, residual respiratory events and synchrony between the patient and the ventilator. Built-in software data of CPAP/NIV devices can be used to assess the adherence of treatment, to monitor pressure efficiency, leaks, asynchronies, and to estimate the presence of residual respiratory events under CPAP/NIV if P(S)G is not available or in alternance with P(S)G. The possibility of CPAP/NIV weaning should be assessed on a regular basis, but no criteria for the timing and procedures have been validated. Weaning timing depends on the clinical condition that justified CPAP/NIV initiation, spontaneous improvement with growth, and the possibility and efficacy of various upper airway, maxillofacial and/or neurosurgical procedures. Weaning may be allowed in case of the disappearance of nocturnal and daytime symptoms of sleep-disordered breathing (SDB) after several nights without CPAP/NIV and the objective correction of SDB on a P(S)G. But no parameters are defined. In any case, a long term follow-up is necessary to ascertain the weaning success. Large prospective studies, together with international and national guidelines, are required in order to build evidence for standardizing practice for the follow-up and weaning of CPAP/NIV in children.

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Section: Analysis Of Data Obtained From Built In Monitoring Devicesmentioning

confidence: 99%

Section: Analysis Of Data Obtained From Built In Monitoring Devicesmentioning

confidence: 99%

Follow-Up and Monitoring of Children Needing Long Term Home Ventilation

et al. 2020

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“…Interfaces can cover the nose (nasal mask), the nose and the mouth (oronasal mask), the face (total face mask), and in certain particular situations, the mouth only (mouthpiece). Total facial masks, which covers the nose, mouth, and eyes, may be used in particular conditions such as complex craniofacial malformations but are rarely prescribed to home ventilation because of the increased risk of aspiration with emesis, in particular in younger children (10). Nasal pillows (or prongs or cannulas) are minimal contact interfaces, available for children older than 5-7 years.…”

Section: Interfacesmentioning

confidence: 99%

“…Finally, headgear should be considered as important as the mask. A well-fitted headgear maintains the mask in place with restraining straps made of soft material that allows sweating (10), and it is usually attached by adhesive strips, hooks, or magnetic pieces, which are easy to manipulate. Straps must be sufficiently tightened to prevent air leaks but with caution, in order to avoid pressure-related skin lesions and disturbed facial growth (23).…”

Section: Interfacesmentioning

confidence: 99%

Interfaces, Circuits and Humidifiers

Ferreira

2020

Front. Pediatr.

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Long-term non-invasive ventilation (LTNIV) has been increasingly used in children to manage chronic respiratory failure and airway obstruction. Interfaces are of paramount importance for non-invasive ventilation (NIV) effectiveness and patient compliance. However, historically, the choice of pediatric mask has been limited by the scarce availability of commercial interfaces. In recent years, an increasing number of different masks have been commercialized for children, allowing to increase the number of patients who could benefit from LTNIV. Factors such as the age of the child, disease, craniofacial conformation, type of ventilator and mode of ventilation, and children's and family's preferences should be taken into account when selecting the appropriate mask. Adverse events such as skin lesions, facial growth impairment, and leaks must be prevented and promptly corrected. Humidification is a controversial issue on NIV, but it may be useful in certain circumstances. Regular cleaning and disinfection of interfaces and equipment must be addressed. During follow-up, educational programs, close supervision, and continuous support to children and families are crucial to the success of LTNIV therapy.

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“…The population that may benefit from positive airway pressure are those that are not surgical candidates, have associated craniofacial syndromic features, obesity, residual SDB after surgery, or those that have failed prior surgical treatment. Based on patient needs, there are different variations of PAP that include fixed pressure and auto‐adjusting pressures . In recent years, there have been more masks available to fit the pediatric patient, thus increasing their efficacy and use in the community.…”

Section: Medical Management Of Osamentioning

confidence: 99%

New treatments for obstructive sleep apnea in children

Oguh

Elden

Swanson

et al. 2020

Pediatric Anesthesia

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Obstructive sleep apnea (OSA) has a prevalence of up to 5% in children and 50% in obese children. OSA is associated with various comorbidities in the general population and in the perioperative period. In this review, we will provide background of OSA and insights into the available treatment options both surgically and medically. Unlike adults, most pediatric OSA is treated with adenotonsillectomy. Continuous positive airway pressure therapy is the commonly used medical treatment. Management of pediatric OSA is multidisciplinary. We will discuss the surgical options and medical options of managing pediatric OSA.

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Positive airway pressure in pediatric obstructive sleep apnea

Cited by 30 publications

References 61 publications

Follow-Up and Monitoring of Children Needing Long Term Home Ventilation

Follow-Up and Monitoring of Children Needing Long Term Home Ventilation

Interfaces, Circuits and Humidifiers

New treatments for obstructive sleep apnea in children

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