A comparison of invasive and noninvasive ventilation in children less than 1 year of age: A long‐term follow‐up study

Summary Background We report on the long‐term survival of children initiated on invasive and noninvasive positive pressure ventilation (NiPPV) before the age of 1 to assess the safety and efficacy of long‐term ventilation at home. Methods A chart review was performed of children initiated on long‐term home mechanical ventilation (LTHV) before the age of 1 year, at The Hospital for Sick Children (SickKids), Canada, between January 1991 and April 2014. Results We report on 51 children. Twenty‐five children (49%) received NiPPV and 26 (51%) received invasive mechanical ventilation via tracheostomy (IMV). There was one NiPPV initiation between 1991 and 2001, the rest were in subsequent years. Most children had a “musculoskeletal disorder” in the NiPPV cohort, n = 14 (56%) and a “central nervous system” disorder in the IMV cohort, n = 13 (50%). The pCO 2 improved with the initiation of NiPPV, P =  <0.0001. Of the 25 subjects initiated on NiPPV, eight (32%) are currently being followed as compared to 22 (84%) in the IMV cohort. Seven (28%) of the NiPPV group were weaned off ventilation as compared to three (11.5%) in the IMV cohort. There were two NiPPV treatment failures. There were more deaths in the NiPPV cohort: eight (32%) versus two (7.6%) in the IMV cohort. Four of the deaths in the NiPPV cohort were in children in whom a palliative approach was taken. None were due to NiPPV technical failure. Conclusions Based on this long‐term follow‐up study, NiPPV use in infants appears to be a viable long‐term ventilation strategy. Pediatr Pulmonol. 2016;51:189–195. © 2015 Wiley Periodicals, Inc.