Noninvasive Ventilation: Past, Present, and Future: A Focus on Pediatric Applications

Abstract

Noninvasive ventilation (NIV) is a technique of augmenting alveolar ventilation without requiring an indwelling artificial airway. Use of negative pressure ventilation began in the 1830s and antedates the development of artificial airways by almost a century. It has had a long history of success in the treatment of chronic respiratory failure in patients with neuromuscular disease, thoracic dysplasia, or central hypoventilation. In the 1980s, the concept of body ventilation evolved to include negative pressure ventilation and positive pressure ventilation via nasal mask. Nasal mask positive pressure ventilation has several advantages compared with negative pressure ventilation. It is more portable, easier to use and to fit, causes less discomfort, and avoids upper airway obstruction. Many additional uses of nasal mask positive pressure ventilation have been explored in pediatric practice, including treatment of patients with acute and chronic respiratory failure. NIV has been successfully used in pediatric patients with end-stage cystic fibrosis and hypercapnic respiratory failure, as a bridge to lung transplant, as a bridge to liberation from invasive mechanical ventilation, in children with transient upper airway obstruction, in hypoxemic respiratory insufficiency associated with pneumonia, in acute chest syndrome in patients with sickle cell disease, and for exacerbation of reactive airway disease. It may be particularly useful in patients whose underlying conditions warrant avoidance of tracheal intubation, especially patients who are immune-compromised. As in a review of any technology, potential and reported complications of NIV are discussed, and pediatric indications and relative contraindications are outlined. Clin Pulm Med 2000;7(4):199-207