Book of PDFs-Update in Non-invasive Ventilation

Update in Non-invasive Ventilation

Pdf Summary

This article provides an update on non-invasive ventilation (NiPPV) in children. The author discusses the increasing use of NiPPV in children and the indications for its use. The article also highlights important considerations when determining NiPPV settings in children. The number of children using home mechanical ventilation (HMV) has been increasing in the past decade, with a doubling in the Netherlands, tripling in parts of the USA, and a 6.5-fold increase in the UK. NiPPV is used in children with various conditions such as upper airway obstruction, lower airway disease, neuromuscular weakness, and cerebral palsy. The article emphasizes the importance of identifying the appropriate candidates for Bi-level PAP therapy, as not all children are suitable for this treatment at home. Factors to consider before initiating Bi-level PAP therapy include respiratory autonomy, support requirements, gas exchange control, and caregiver support. The article also discusses the safety of NiPPV in infants, with a review showing that mortality rates were higher in the NiPPV group compared to the invasive mechanical ventilation (IMV) group. The article concludes by discussing the different NiPPV devices available and their settings, including mode, inspiratory positive airway pressure (IPAP), expiratory positive airway pressure (EPAP), rate, and other considerations such as rise time and trigger/cycle sensitivity. The author emphasizes the need for more pediatric data on Volume Assured Pressure Support (VAPS) and encourages clinicians to consider individual patient physiology when determining the appropriate NiPPV settings.

Keywords

non-invasive ventilation

NiPPV

children

home mechanical ventilation

upper airway obstruction

lower airway disease

neuromuscular weakness

cerebral palsy

Bi-level PAP therapy

respiratory autonomy