Abstract
Noninvasive ventilation has been utilized successfully in the pre- and out-of-hospital settings for a variety of disorders, including respiratory distress syndrome in neonates, neurologic and pulmonary diseases in infants and children, and heart failure as well as chronic obstructive pulmonary disease in adults. A variety of interfaces as well as mechanical positive pressure devices have been used: simple continuous positive airway pressure devices are available which do not require sophisticated equipment, while a broad spectrum of ventilators have been used to provide bilevel positive airway pressure. Extensive training of transport teams may be important, particularly when utilizing bilevel positive airway pressure in infants and children.
Highlights
Ability to rapidly discontinue as needed) sugNoninvasive ventilation has been utilized gest a potential role for NIV in pre- and out-ofsuccessfully in the pre- and out-of-hospital set- hospital settings
Though not a true o mode of ventilation, continuous positive airN way pressure (CPAP) has proven quite these settings suggests there are differences in its utility depending in part on patient age, and reflecting the different spectrum of diseases common to different age groups
Acute cardiogenic pulmonary edema in adults responds well to NIV in the pre- or outof-hospital settings:[2,14,15,16,17,18,19] CPAP appears to be as or more effective than bilevel positive airway pressure (PAP) in these patients, though both are associated with decreased work of breathing and increased cardiac output.[20]
Summary
Interhospital transport of neonates, infants, and children presents a similar situation compared to the prehospital setting. Infants, or children require prompt referral to regional centers capable of providing more advanced therapies, and transport may be initiated in the clinic or the emergency or inpatient ward of a clinic or hospital. NIV may be initiated as a new therapy prior to such transport, or continued during transport as chronic therapy
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