Abstract
Background:Nasal non-invasive-ventilation (Nasal NIV) is a mode of ventilatory support providing positive pressure to patients via a nasal interface. The RAM Cannula is an oxygen delivery device that can be used as an alternative approach to deliver positive pressure. Together they have been successfully used to provide respiratory support in neonatal in-patient settings.Objective:To describe the outpatient use of Nasal NIV/RAM Cannula as a feasible alternative for home respiratory support in children with chronic respiratory failure.Methods:We performed a retrospective case series of 18 children (4 months to 19 years old) using the Nasal NIV/RAM Cannula in the Pediatric Pulmonary Clinic at the McGovern Medical School, UTHealth (2014-16). Consideration for Nasal NIV/RAM Cannula utilization included: inability to wean-off in-patient respiratory support, comfort for dyspnea, intolerability of conventional mask interfaces and tracheostomy avoidance.Results:Average age was 7 years. 50% were Caucasian, 38% African-American and 11% Hispanics. Pulmonary disorders included: chest wall weakness (38%), central control abnormalities (33%), obstructive lung disease (16%) and restrictive lung disease (11%). Indications for Nasal NIV/RAM Cannula initiation included: CPAP/BPAP masks intolerability (11%), dyspnea secondary to chest wall weakness (38%) and tracheostomy avoidance (50%). Average length of use of Nasal NIV/RAM Cannula was 8.4 months. Successful implementation of Nasal NIV/Ram Cannula was 94%. One patient required a tracheostomy following the use of Nasal NIV/RAM Cannula. Significant decrease in arterial PaCO2 pre and post Nasal NIV/RAM cannula initiation was notable (p=0.001).Conclusion:Outpatient use of Nasal NIV/RAM Cannula may prove to be a feasible and save treatment alternative for children with chronic respiratory failure, chest wall weakness, dyspnea and traditional nasal/face mask intolerance to avoid tracheostomy.
Highlights
Nasal non-invasive ventilation (Nasal Non-invasive ventilation (NIV)) is a ventilatory support mode that provides positive pressure to patients1874-3064/17 2017 Bentham Open42 The Open Respiratory Medicine Journal, 2017, Volume 11 via a nasal cannula or mask
One patient required a tracheostomy following the use of Nasal NIV/RAM Cannula
Our goal is to describe and discuss the feasibility of Nasal NIV/RAM Cannula in children with chronic respiratory failure
Summary
Nasal non-invasive ventilation (Nasal NIV) is a ventilatory support mode that provides positive pressure to patients1874-3064/17 2017 Bentham Open42 The Open Respiratory Medicine Journal, 2017, Volume 11 via a nasal cannula or mask. Nasal non-invasive ventilation (Nasal NIV) is a ventilatory support mode that provides positive pressure to patients. NIV has been shown to be an effective means of providing respiratory support in the acute care setting to prevent endotracheal intubation [1]. Nasal NIV/ RAM Cannula may be a feasible and save long-term respiratory support for outpatient. Nasal non-invasive-ventilation (Nasal NIV) is a mode of ventilatory support providing positive pressure to patients via a nasal interface. The RAM Cannula is an oxygen delivery device that can be used as an alternative approach to deliver positive pressure. Together they have been successfully used to provide respiratory support in neonatal in-patient settings
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