Noninvasive Positive Pressure Ventilation In Children Research Articles

Noninvasive Positive Pressure Ventilation Use and In-Hospital Cardiac Arrest in Bronchiolitis.

A recent study showed an association between high hospital-level noninvasive positive pressure ventilation (NIPPV) use and in-hospital cardiac arrest (IHCA) in children with bronchiolitis. We aimed to determine if patient-level exposure to NIPPV in children with bronchiolitis was associated with IHCA. Retrospective cohort study at a single-center quaternary PICU in North America including children with International Classification of Diseases primary or secondary diagnoses of bronchiolitis in the Virtual Pediatric Systems database. The primary exposure was NIPPV and the primary outcome was IHCA. Of 4698 eligible ICU admissions with bronchiolitis diagnoses, IHCA occurred in 1.2% (57/4698). At IHCA onset, invasive mechanical ventilation (IMV) was the most frequent level of respiratory support (65%, 37/57), with 12% (7/57) receiving NIPPV. Patients with IHCA had higher Pediatric Risk of Mortality-III scores (3 [0-8] vs. 0 [0-2]; p < 0.001), more frequently had a complex chronic condition (94.7% vs. 46.2%; p < 0.001), and had higher mortality (21.1% vs. 1.0%; p < 0.001) compared with patients without IHCA. Return of spontaneous circulation (ROSC) was achieved in 93% (53/57) of IHCAs; 79% (45/57) survived to hospital discharge. All seven children without chronic medical conditions and with active bronchiolitis symptoms at the time of IHCA achieved ROSC, and 86% (6/7) survived to discharge. In multivariable analysis restricted to patients receiving NIPPV or IMV, NIPPV exposure was associated with lower odds of IHCA (adjusted odds ratio [aOR], 0.07; 95% CI, 0.03-0.18) compared with IMV. In secondary analysis evaluating categorical respiratory support in all patients, compared with IMV, NIPPV was associated with lower odds of IHCA (aOR, 0.35; 95% CI, 0.14-0.87), whereas no difference was found for minimal respiratory support (none/nasal cannula/humidified high-flow nasal cannula [aOR, 0.56; 95% CI, 0.23-1.36]). Cardiac arrest in children with bronchiolitis is uncommon, occurring in 1.2% of bronchiolitis ICU admissions. NIPPV use in children with bronchiolitis was associated with lower odds of IHCA.

Non-invasive positive-pressure ventilation in children in otolaryngology

Obstructive diseases of the upper airways are common in children and sometimes difficult to manage. Non-invasive positive-pressure ventilation (NPPV) consists of delivering continuous positive pressure during all or part of the respiratory cycle via a non-invasive interface (face mask or nasal mask, or nasal prongs). NPPV is the treatment of choice for severe obstructive sleep apnoea in children and should be considered prior to tracheotomy and is also indicated in the case of persistent sleep-disordered breathing following surgical treatment, a frequent situation in children with a malformation of the head and neck or upper airways. A simple ventilator, able to deliver continuous positive airway pressure, is sufficient is most cases in otolaryngology. The interface represents the major technical limitation of NPPV, especially in infants for whom no appropriate commercial interface is available. A sleep study before and after initiation of NPPV, followed by regular follow-up examinations, is essential to confirm correction of gas exchanges and sleep quality in response to NPPV. Finally, NPPV must be performed in a specialized paediatric centre with specific expertise in this field.

Assessment of sleep quality by pulse wave amplitude and actigraphy in children with sleep-disordered breathing: evaluation at diagnosis and under non-invasive ventilation

The aims of this study were to assess the interest of pulse wave amplitude (PWA) and actigraphy for characterizing sleep in children with sleep-disordered breathing and to evaluate PWA and actigraphy to assess the efficacy of non-invasive positive pressure ventilation (NPPV). We performed a retrospective analysis of children with sleep-disordered breathing. Patients were classified to upper airway obstructive disease (UAO) group or non-obstructive disease (non-UAO) group. Pulse oximetry (SpO2) and PWA were measured by photoplethysmography. Autonomic micro-arousals (AA) and AA related to SpO2 desaturations above 4 % (AA + DS4%) were quantified. The fragmentation index, sleep efficiency, sleep duration, and sleep latency were measured with actigraphy. Transcutaneous carbon dioxide (PtcCO2) was monitored. NPPV was started in case of severe OSA. AA + DS4% were more common in the UAO (n = 15) than the non-UAO group (n = 13) (p < 0.001). All nocturnal gas exchange parameters were worse in the UAO group. Eight children required NPPV. AA + DS4%, maximal PtcCO2, percent of time with PtcCO2 > 50 mmHg, and percent of time with SpO2 < 90 % decreased significantly after 1 month of NPPV. The analysis of AA + DS4% is very informative for the grading of the severity of OSA and for the efficacy of NPPV in children with sleep-disordered breathing.

Interfaces for long-term noninvasive positive pressure ventilation in children

The aim of the study was to report the type and tolerance of the interface chosen for long-term noninvasive positive pressure ventilation (NPPV) in children. This was a descriptive study carried out in the clinical setting of a pediatric university hospital in which all children started on long-term NPPV over a 18-month period were included. NPPV was started in 97 children with neuromuscular disease or thoracic scoliosis (n = 35), obstructive sleep apnea with (n = 32) or without (n = 21) maxillofacial deformity, or lung disease (n = 9). All 25 children ≤ 2 years of age, as well as four older children, were fitted with custom-made nasal masks; all other children were fitted with an industrial nasal mask (50%), a facial mask (16%), or nasal prongs (2%). Industrial masks with and without manufactured leaks were used in 33 (34%) and 35 (36%) children, respectively. All patients with obstructive sleep apnea used interfaces with manufactured leaks, whereas all patients with neuromuscular disease or thoracic scoliosis used interfaces without manufactured leaks. Both types of interfaces were used in patients with lung disease. The interface had to be changed in 20 patients because of discomfort (n = 16), leaks (n = 4), facial growth (n = 3), skin injury (n = 2), or change of the ventilatory mode (n = 2). A second or third mask change was necessary in nine and four patients, respectively. The choice of the interface for NPPV in children is determined by the patient's age and the underlying disease. Discomfort is the main reason for mask change.

U.S. attitudes and perceived practice for noninvasive ventilation in pediatric acute respiratory failure

Few pediatric studies exist regarding the use of noninvasive positive-pressure ventilation for acute respiratory failure; however, those that do suggest a role. This study seeks to describe attitudes and perceived practices of pediatric intensivists regarding the use of noninvasive positive-pressure ventilation in children with acute respiratory failure. Electronic survey. Medical institutions. Of the 932 physicians approached, 353 (38%) responded to the survey. Respondents included U.S. physicians practicing pediatric critical care (90%), pediatric anesthesia critical care (4%), pediatric pulmonary critical care (4%), and other disciplines (2%). Survey. The survey contained questions regarding 1) practitioner demographics, 2) patient characteristics, and 3) clinical cases designed to assess noninvasive positive-pressure ventilation use in certain patient scenarios. Noninvasive positive-pressure ventilation was used by 99% of the respondents, with 60% using noninvasive positive-pressure ventilation as initial support >10% of the time. Respondents reported use of noninvasive positive-pressure ventilation for acute respiratory failure in lower airway disease (70%), asthma (51%), acute lung injury/acute respiratory distress syndrome (43%), and upper airway obstruction (31%). In clinical scenarios, respondents reported that the factors associated with nonuse of noninvasive positive-pressure ventilation as initial support were disease process (31%), oxygenation (19%), ventilation severity (15%), expectation that the patient was likely to worsen (12%), and age or inability to cooperate (11%). Noninvasive positive-pressure ventilation is widely used and most frequently utilized in patients with acute lower airway disease. Factors such as severe defects in oxygenation and ventilation, disease progression, and patient tolerability decreased the likelihood of use. These findings may help direct further studies of noninvasive positive-pressure ventilation in children with acute respiratory failure.

Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review

Noninvasive positive pressure ventilation (NPPV) refers to the delivery of mechanical respiratory support without the use of endotracheal intubation (ETI). The present review focused on the effectiveness of NPPV in children > 1 month of age with acute respiratory failure (ARF) due to different conditions. ARF is the most common cause of cardiac arrest in children. Therefore, prompt recognition and treatment of pediatric patients with pending respiratory failure can be lifesaving. Mechanical respiratory support is a critical intervention in many cases of ARF. In recent years, NPPV has been proposed as a valuable alternative to invasive mechanical ventilation (IMV) in this acute setting. Recent physiological studies have demonstrated beneficial effects of NPPV in children with ARF. Several pediatric clinical studies, the majority of which were noncontrolled or case series and of small size, have suggested the effectiveness of NPPV in the treatment of ARF due to acute airway (upper or lower) obstruction or certain primary parenchymal lung disease, and in specific circumstances, such as postoperative or postextubation ARF, immunocompromised patients with ARF, or as a means to facilitate extubation. NPPV was well tolerated with rare major complications and was associated with improved gas exchange, decreased work of breathing, and ETI avoidance in 22-100% of patients. High FiO2 needs or high PaCO2 level on admission or within the first hours after starting NPPV appeared to be the best independent predictive factors for the NPPV failure in children with ARF. However, many important issues, such as the identification of the patient, the right time for NPPV application, and the appropriate setting, are still lacking. Further randomized, controlled trials that address these issues in children with ARF are recommended.

Non-invasive ventilation in children with upper airway obstruction

The aim of this paper is to highlight our experience with the use of non-invasive positive pressure ventilation (NIPPV) in children, neonates and pre-term infants with upper airway obstruction. This was a retrospective review of our recent experience in using NIPPV for the management of upper airway obstruction in paediatric patients. NIPPV was successful in preventing tracheostomy in patients with significant laryngo-tracheomalacia as well as being used to optimise the timing of surgery in subglottic stenosis. Furthermore, it proved beneficial in stabilising the airway after aryepiglottoplasty and also had a role in the management of obstructive sleep apnoea. The use of NIPPV in children with upper airway obstruction can be a safe and effective alternative to invasive mechanical ventilation. NIPPV can potentially be beneficial in avoiding prolonged invasive ventilation, avoiding tracheostomy, stabilizing the airway after extubation or decannulation, and management of obstructive sleep apnoea.

Performance of ventilators for noninvasive positive-pressure ventilation in children

The aim of the present study was to evaluate the performance characteristics of all the ventilators proposed for home noninvasive positive-pressure ventilation in children in France. The ventilators (one volume-targeted, 12 pressure-targeted and four dual) were evaluated on a bench which simulated six different paediatric ventilatory patterns. For each ventilator, the quality of the inspiratory and expiratory trigger and the ability to reach and maintain the preset pressures and volumes were evaluated with the six patient profiles. The performance of the ventilators showed great variability, and depended upon the type of trigger (flow or pressure), type of circuit and patient profile. Differences were observed between the preset and measured airway pressure and between the tidal volume measured by the ventilator and on the bench. Leaks were associated with an inability to detect the patient's inspiratory effort or autotriggering. No single ventilator was able to adequately ventilate the six paediatric profiles. Only a few ventilators were able to ventilate the profiles simulating the youngest patients. A systematic paediatric bench evaluation is recommended for every ventilator proposed for home ventilation, in order to detect any dysfunction and guide the choice of the appropriate ventilator for a specific patient.

L’assistance ventilatoire non invasive à domicile chez l’enfant

Non-invasive positive pressure ventilation (NPPV) represents a particularly interesting technique of ventilatory support in paediatrics. Indeed, a significant number of pathologies that may be responsible for chronic respiratory insufficiency in childhood, such as neuromuscular diseases, obstruction of the upper airways, disorders of chest wall and/or the lungs, and disorders of ventilatory control may all lead to alveolar hypoventilation that can be improved by ventilatory support.Few physiological studies have been performed on NPPV in children. The most appropriate modes and settings for each pathology have not been clearly defined, and the criteria for commencing NPPV are based essentially on consensus guidelines for the management of neuromuscular disorders.All the health care professionals managing these children should combine their efforts to evaluate more precisely the medium and long-term physiological effects of NPPV on the respiratory muscles, the development of the respiratory system, inspiratory activity, the indications for starting treatment and, above all, the benefits in terms of psycho-neurological development and quality of life.A better evaluation of the medium and long-term physiological and psychological benefits together with technical improvements in ventilators and associated equipment should allow a rapid expansion in the use of domiciliary NPPV in children.

Non-invasive positive pressure ventilation: current status in paediatric patients

Non-invasive positive pressure ventilation (NPPV) is a treatment for patients with respiratory dysfunction accomplished by an external interface and a positive pressure ventilator. The goals of NPPV therapy are to decrease the work of breathing and to improve respiratory gas exchange. Children with respiratory dysfunction are increasingly being treated with NPPV with the belief that it is a safe and effective alternative to invasive mechanical ventilation. Reports in support of NPPV are most promising in older children with chronic respiratory failure associated with restrictive pulmonary disorders and neuromuscular weakness. In children with advanced cystic fibrosis and nocturnal hypoxaemia, NPPV appears to be superior to treatment with supplemental oxygen alone in preventing hypoventilation. The role of NPPV in children with acute hypoxaemic respiratory failure is less well defined. Although early reports are encouraging, the question remains unanswered whether early application of NPPV as opposed to standard treatment reduces the likelihood or only delays the need for invasive mechanical ventilation. As young infants may not trigger the inspiratory pressure support feature of bi-level ventilators, application of NPPV with current devices is problematic in patients of this age. The horizon is promising for NPPV in the paediatric population and will likely include novel interfaces and responsive positive pressure devices better suited to the unique mechanical properties of the developing respiratory system.

Noninvasive Positive Pressure Ventilation Using a Face Mask for a Child with Spinal Muscular Atrophy: A case report

Respiratory complications are a major cause of morbidity and mortality in pediatric neuromuscular disease. In adults with acute or chronic respiratory failure, noninvasive positive pressure ventilation (NIPPV) is superior to standard therapy in terms of preventing intubation and reducing mortality. Moreover, domiciliary ventilation with NIPPV in children can prolong life and optimize the quality of life by allowing patients to eat, speak and sleep well. But the role of NIPPV in pediatric patients with respiratory failure is not well established. We report the case of a pediatric spinal muscular atrophy patient who was managed by using NIPPV for acute hypercapnic respiratory failure at a pediatric intensive care unit and by nocturnal hypoventilation later at home. In this case, NIPPV restored normal blood oxygenation, removed excess blood carbon dioxide, and normalized the work and pattern of breathing.

Noninvasive positive-pressure ventilation in pediatric status asthmaticus.

OBJECTIVE: To describe the use of noninvasive positive-pressure ventilation in children with status asthmaticus. DESIGN: Brief report. SETTING: Pediatric intensive care unit in two tertiary institutions. SUBJECTS: Children with severe acute asthma and hypercarbic respiratory failure. INTERVENTIONS: Noninvasive positive-pressure ventilation using a bilevel positive-pressure (BIPAP) device. MEASUREMENTS AND MAIN RESULTS: Three children, ages 9, 11, and 15 yrs, were treated for hypercarbic respiratory failure caused by status asthmaticus by using BIPAP. The duration of pediatric intensive care unit admission was 48 hrs, and the duration of therapy ranged from 12 to 17 hrs. Inspiratory positive airway pressure ranged from 10 to 14 cm H(2)O (0.98-1.37 kPa), with a mean of 12 cm H(2)O (1.18 kPa). Expiratory positive airway pressure ranged from 4 to 5 cm H(2)O (0.39-0.49 kPa), with a mean of 5 cm H(2)O (0.49 kPa). Pulse oximetry was monitored continuously until resolution of symptoms. The mean values for respiratory rate, pH, and CO(2) tension were compared at initiation, 3-4 hrs, and >12 hrs after beginning BIPAP. BIPAP treatment resulted in improved ventilatory status as shown by an increase in pH from a mean of 7.26 on admission to 7.38 after 3-4 hrs and after 12 hrs, respectively. However, respiratory rate showed a steady decrease from a mean of 31.7 breaths/min on admission to 24 breaths/min at 3-4 hrs and 19 breaths/min at >12 hrs of BIPAP therapy. CO(2) tension (Pco(2)) decreased from a mean value of 54.6 mm Hg (7.28 kPa) on admission to 36.4 mm Hg (4.85 kPa) at 3-4 hrs of treatment; the mean Pco(2) after >12 hrs of treatment was 39.8 mm Hg (5.31 kPa). CONCLUSION: In three children with status asthmaticus, BIPAP seemed to improve ventilation and gas exchange, culminating in resolution of hypercarbic respiratory failure. A prospective, randomized, and controlled study is required to determine its role in pediatric status asthmaticus.