Abstract
This review focuses on the delivery of non-invasive ventilation—i.e., intermittent positive-pressure ventilation—in children lasting more than 3 months. Several recent reviews have brought to light a dramatic escalation in the use of long-term non-invasive ventilation in children over the last 30 years. This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT-NIV equipment that can be used at home. While significant gaps in availability persist for smaller children and especially infants, home LT-NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care. While long-term NIV is usually delivered during sleep, it can also be delivered 24 h a day in selected patients. Close collaboration between the hospital complex-care team, the home LT-NIV program, and family caregivers is of the utmost importance for successful home LT-NIV. Long-term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation, with the aim to increase life expectancy and maximize quality of life. LT-NIV is considered for conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall anomalies). Relative contraindications for LT-NIV include the inability of the local medical infrastructure to support home LT-NIV and poor motivation or inability of the patient/caregivers to cooperate or understand recommendations. Anatomic abnormalities that interfere with interface fitting, inability to protect the lower airways due to excessive airway secretions and/or severely impaired swallowing, or failure of LT-NIV to support respiration can lead to considering invasive ventilation via tracheostomy. Of note, providing home LT-NIV during the COVID 19 pandemic has become more challenging. This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS-CoV-2 during NIV. Delay in initiating LT-NIV, decreased frequency of home visits by the home ventilation program, and decreased availability of polysomnography and oximetry/transcutaneous PCO2 monitoring are observed. Teleconsultations and telemonitoring are being developed to mitigate these challenges.
Highlights
Advances in perinatal and pediatric critical care have resulted in an increased number of children of all ages with complex medical conditions, including chronic respiratory insufficiency necessitating long-term respiratory support
This review focuses on Long-term noninvasive ventilation (LT-NIV), despite the much wider use of long-term non-invasive continuous positive-airway pressure (CPAP) at home in children
This becomes of the utmost importance in cases of suspected or confirmed COVID-19 infection, especially if another vulnerable person is present in the household
Summary
Advances in perinatal and pediatric critical care have resulted in an increased number of children of all ages with complex medical conditions, including chronic respiratory insufficiency necessitating long-term respiratory support. The latter includes continuous positive-airway pressure (CPAP) and long-term mechanical ventilation. The use of high-flow nasal cannulae has been recently reported for long-term respiratory support at home in children not amenable to CPAP or mechanical ventilation [1, 2]. This review focuses on LT-NIV, despite the much wider use of long-term non-invasive CPAP at home in children It describes the worldwide increase in LT-NIV in recent decades and compares the data from various programs around the globe.
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