Noninvasive Mechanical Ventilation in Pediatric Practice
Noninvasive ventilation (NIV) use in pediatrics is now rapidly gaining acceptance. It refers to a technique that increases alveolar ventilation by supplying a transpulmonary pressure gradient through an oronasal or nasal mask. Avoiding any indwelling arti
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28
Benan Bayrakci
Keywords
Noninvasive ventilation • Pediatric • Acute respiratory failure
28.1
Introduction
Noninvasive ventilation (NIV) use in pediatrics is now rapidly gaining acceptance. It refers to a technique that increases alveolar ventilation by supplying a transpulmonary pressure gradient through an oronasal or nasal mask. Avoiding any indwelling artificial airways, such as endotracheal or tracheostomy tubes, and their complications constitutes its main advantage. Infant respiration is predominantly dependent on diaphragmatic function. NIV helps decrease the work of breathing by unloading the diaphragm. NIV also stabilizes the highly pliable chest wall and reduces retractions in young infants. Apnea and hypopnea frequency decrease by maintaining upper airway patency. NIV increases oxygenation and carbon dioxide washout by alveolar recruitment and improves cardiac output by decreasing left ventricular afterload [1, 2].
28.2
Indications for NIV
There are no well-defined clinical conditions for which NIV can be considered as standard therapy in the pediatric population. Standard NIV therapy protocols do not exist for high-risk pediatric infections. NIV should be initiated based on the
B. Bayrakci, MD Division of Pediatric Intensive Care, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ihsan Dogramaci Children’s Hospital, Sihhiye, Ankara 06100, Turkey e-mail: [email protected], [email protected] A.M. Esquinas (ed.), Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events, 251 DOI 10.1007/978-3-7091-1496-4_28, © Springer-Verlag Wien 2014
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B. Bayrakci
presence of dyspnea or tachypnea (respiratory rate > 75th percentile according to age), hypoxemia, or respiratory acidosis [2]. Favorable experiences in pediatric use of NIV are limited to cystic fibrosis, pneumonia, status asthmaticus, acute chest syndrome, pulmonary edema, postextubation acute respiratory failure (ARF), acute exacerbation of chronic respiratory failure, and hypoxemic ARF [1, 3]. NIV application seems to decrease the need for intubation in immunocompromised patients [4]. The most promising application of NIV in pediatrics is the treatment of respiratory failure in patients with neuromuscular disease and restrictive chest wall deformities [1]. NIV has a favorable influence on respiratory tract infections in children with neuromuscular disorders [5]. NIV combined with heliox have also been described as effective in infants with severe bronchiolitis [2]. Furthermore, tracheotomy weaning in children can be achieved with NIV support [6]. NIV was a preferred method for treating pediatric respiratory failure during the influenza (H1N1) pandemic in 2009, but the small numbers of patients do not let us to execute a protocol different from other NIV applications. None of the reports from various geographical parts of the world mentioned any additional risks due to NIV in H1N1-infected pediatric patients [7–12]. There are practically no data on how to initiate NIV in children. Face masks are appropr
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