Book of PDFs-Update in Non-invasive Ventilation Part II

Update in Non-invasive Ventilation Part II

Pdf Summary

This update provides an overview of non-invasive ventilation (NiPPV) in children. The number of children using home mechanical ventilation (HMV) has been increasing over the past decade, with significant growth in the Netherlands, parts of the USA, and the UK. Indications for NiPPV include upper and lower airway obstructions, neuromuscular weakness, cerebral palsy, and other respiratory abnormalities. NiPPV settings depend on the specific needs of the patient, including mode, inspiratory positive airway pressure (IPAP), expiratory positive airway pressure (EPAP), rate, and sensitivity. Certain considerations, such as the patient's respiratory autonomy, ability to tolerate therapy, caregiver support, and recent surgeries, should also be taken into account when determining candidacy for Bi-level PAP therapy. However, not all children are suitable candidates for this therapy at home. The safety of NiPPV for infants is still a matter of debate, with some studies showing increased risk of morbidity and mortality compared to invasive ventilation. The licensing of NiPPV devices for use in children under 5kg is limited, which affects flow triggering. Bi-level PAP settings, such as itime min and max, rise time, and trigger/cycle sensitivity, should be adjusted based on the patient's physiology. Finally, the use of volume assured pressure support (VAPS) algorithms, such as AVAPS and iVAPS, have shown promise in pediatric patients. Further research is needed to gather more data on the use of NiPPV in children.

Keywords

non-invasive ventilation

NiPPV

children

home mechanical ventilation

respiratory abnormalities

Bi-level PAP therapy

infants

morbidity

mortality

pediatric patients