Abstract
Noninvasive ventilation (NIV) and high-flow nasal cannulae therapy (HFNCT) are first-line methods of treatment for children presenting with acute respiratory distress, with paediatric intensive care units (PICUs) providing an ideal environment for subsequent treatment monitoring. However, the availability of step-down units, where NIV and HFNCT can be safely utilised, has reduced the need for such patients to be admitted to PICUs, thereby leading to the better overall utilisation of critical care resources. In addition, NIV and HFNCT can also be used during transport instead of invasive ventilation, thus avoiding the complications associated with the latter approach. This review article examines the safety and applicability of these respiratory support approaches outside of paediatric intensive care as well as various factors associated with treatment success or failure.
Highlights
Safety and Efficacy in Respiratory DiseasesVariable success rates have been reported in different paediatric diseases following Noninvasive ventilation (NIV)
Noninvasive ventilation (NIV) and high-flow nasal cannulae therapy (HFNCT) are first-line methods of treatment for children presenting with acute respiratory distress, with paediatric intensive care units (PICUs) providing an ideal environment for subsequent treatment monitoring
The availability of step-down units, where NIV and HFNCT can be safely utilised, has reduced the need for such patients to be admitted to PICUs, thereby leading to the better overall utilisation of critical care resources
Summary
Variable success rates have been reported in different paediatric diseases following NIV. Favourable results have been observed with primary respiratory diseases including bronchiolitis, asthma and pneumonia.[4,5]. NIV has resulted in lower success rates among children diagnosed with acute respiratory distress syndrome (ARDS).[5]. HFNCT is widely used to treat infants and children presenting with acute respiratory distress and has been successful for various respiratory diseases including pneumonia, asthma and obstructive sleep apnoea.[8,11]. Other research has shown a decrease in intubation rates following HFNCT among infants with severe bronchiolitis (5–9%).[12–14]. A randomised controlled trial (RCT) comparing HFNCT to nasal CPAP demonstrated that the latter method required less escalation of respiratory support and was associated with earlier improvement in respiratory distress among a cohort of young infants with acute viral bronchiolitis.[14] Other research has shown a decrease in intubation rates following HFNCT among infants with severe bronchiolitis (5–9%).[12–14] a randomised controlled trial (RCT) comparing HFNCT to nasal CPAP demonstrated that the latter method required less escalation of respiratory support and was associated with earlier improvement in respiratory distress among a cohort of young infants with acute viral bronchiolitis.[14]
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