Non-invasive Ventilation for Pediatric Hypoxic Acute Respiratory Failure Using a Simple Anesthetic Mask With 3D Printed Adaptor: A Case Report.

Gerrit J Muller,Coen Dijkman,Renee Hovenier,Dick Markhorst,Jip Spijker,Rozalinde Klein-Blommert,Reinout A Bem,Monica Van Gestel

doi:10.3389/fped.2021.710829

Abstract

Non-invasive ventilation (NIV) is increasingly used in the supportive treatment of acute respiratory failure in children in the pediatric intensive care unit (PICU). However, finding an optimal fitting commercial available NIV face mask is one of the major challenges in daily practice, in particular for young children and those with specific facial features. Large air leaks and pressure-related skin injury due to suboptimal fit are important complications associated with NIV failure. Here, we describe a case of a 4-year old boy with cardiofaciocutaneous syndrome and rhinovirus-associated hypoxic acute respiratory failure who was successfully supported with NIV delivered by a simple anesthetic mask connected to a headgear by an in-house developed and 3D printed adaptor. This case is an example of the clinical challenge related to pediatric NIV masks in the PICU, but also shows the potential of alternative NIV interfaces e.g., by using a widely available and relatively cheap simple anesthetic mask. Further personalized strategies (e.g., by using 3D scanning and printing techniques) that optimize NIV mask fitting in children are warranted.

Highlights

In the past two decades, there has been an increase in the use of non-invasive ventilation (NIV) for acute respiratory failure (ARF) in critically-ill children [1,2,3,4,5]
We describe the successful application of pediatric NIV for hypoxic ARF using a simple anesthetic mask with in-house 3D printed quick-release adaptor in a 4-year old boy with cardiofaciocutaneous syndrome
This alternative NIV interface has been successfully used in our pediatric intensive care unit (PICU) in patients for which commercially available pediatric NIV masks were unavailable or were associated with an unacceptable air leakage, pressure-related skin injury, and/or patient discomfort

Summary

INTRODUCTION

In the past two decades, there has been an increase in the use of non-invasive ventilation (NIV) for acute respiratory failure (ARF) in critically-ill children [1,2,3,4,5]. During this period the patient received NIV at pressure control 14–16 cmH2O, PEEP 8–10 cmH2O, inspiratory time 0.7 s/ETS 10% at 30 times per minute and a variable FiO2 of 0.5–1.0. On day 35 after admission he was discharged to home without need for oxygen supplementation

DISCUSSION

Findings

ETHICS STATEMENT