Weaning from long term continuous positive airway pressure or noninvasive ventilation in children

Abstract

Weaning from CPAP/NIV is possible in children treated with long term CPAP/NIV but is highly dependent on the underlying disorder. Spontaneous improvement is possible but most children need specific surgery. Long term follow-up is necessary in children with underlying disorders.

Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome

“…Their main reasons for initiating LTV were lower respiratory airways diseases (55% on NIV; 10% on IMV), and spinal cord injury (50% on IMV). Our results are similar to those of many studies performed especially in western, more developed and with high-income countries [8][9][10][11][12][13][14][16][17][18][19][20]. Differences between studies may vary depending on several factors such as the availability of local facilities and skills; differences of inclusion criteria in the main diagnostic categories considered, and collaborations with referral.…”

“…Previous studies report a discontinuation rate from ventilatory support ranging from 3.6 to 45% [15,16,18]. Children who discontinued respiratory support were those showing improvement of the underlying condition [8], such as chronic lung diseases, and upper airway abnormalities [9,10,14,16], or those ventilated < 24 h/day [10]. Conversely, children with NMDs were less likely to come off their ventilator compared to children with airway diseases [15].…”

“…Advances in the use of long-term NIV has progressively leaded to a reduction of the need for IMV through tracheostomy [1][2][3]. Information are growing about trends of clinical characteristics, technology used, longitudinal outcomes or discontinuation rates [8,9]. Furthermore, increasing knowledge is available on how often, when, and which patients with severe or progressive conditions transition from NIV to IMV due to worsening of their underlying condition [8][9][10].…”

Liberation and mortality outcomes in pediatric long‐term ventilation: A qualitative systematic review

“…Only 24 papers studied more than 100 patients. 2,4,5,20,29,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Of the 12 704 patients, 37% could be categorized as having ventilatory muscle weakness, 14% with chronic pulmonary disease, 10% with central hypoventilation, 9% with airway abnormalities, 6% with genetic/metabolic syndromes, 1% with cardiac/congenital heart disease, and 3% other/combined. Twenty percent of patients did not have a diagnosis reported.…”

Weaning long term non‐invasive ventilation (NIV) therapy in children

“…The mid‐face hypoplasia that has developed in young children with prolonged use of this life‐saving therapy is not to be overlooked . Consequently, the article about strategies for weaning CPAP and non‐invasive therapy by Mastouri et al in this issue of Pediatric Pulmonology provides a timely reminder of the need to reassess the need for ongoing treatment of respiratory failure …”