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Long term continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) in children: Initiation criteria in real life
Author(s) -
Amaddeo A.,
Moreau J.,
Frapin A.,
Khirani S.,
Felix O.,
FernandezBolanos M.,
Ramirez A.,
Fauroux B.
Publication year - 2016
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23416
Subject(s) - medicine , continuous positive airway pressure , noninvasive ventilation , term (time) , airway , positive pressure ventilation , intermittent positive pressure ventilation , anesthesia , intensive care medicine , ventilation (architecture) , positive pressure respiration , positive pressure , mechanical ventilation , respiratory failure , obstructive sleep apnea , mechanical engineering , engineering , physics , quantum mechanics
Summary Introduction Long term noninvasive continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are increasingly used in children but limited information is available on the criteria and conditions leading to the initiation of these treatments. The aim of the study is to describe the objective overnight respiratory parameters and clinical situations that led to the initiation of CPAP/NIV in a pediatric NIV unit. Material and Methods Retrospective analysis of the data of all the children discharged on home CPAP/NIV over a 1 year period. Results Seventy‐six patients were started on CPAP (n = 64) or NIV (n = 12). CPAP/NIV was initiated because of CPAP/NIV weaning failure ( Acute group ) in 15 patients. None of these patients had an overnight gas exchange or sleep study before CPAP/NIV initiation. In 18 patients, CPAP/NIV was initiated on abnormal nocturnal gas exchange alone ( Subacute group ). These patients had a median of three of the following five overnight gas exchange abnormalities: minimal pulse oximetry (SpO 2 ) <90%, maximal transcutaneous carbon dioxide (PtcCO 2 ) >50 mmHg, time spent with SpO 2 <90% or PtcCO 2 >50 mmHg ≥2% of recording time, oxygen desaturation index >1.4/hr. In the last 43 patients, CPAP/NIV was initiated after an abnormal sleep study ( Chronic group ) on a mean of four of the aforementioned criteria and an apnea‐hypopnea index >10/hr. Conclusion In clinical practice, CPAP/NIV was initiated in an acute, subacute and chronic setting with most patients having an association of several abnormal gas exchange or sleep study parameters. Future studies should evaluate the effectiveness and benefits of CPAP/NIV according to the clinical situation and initiation criteria. Pediatr Pulmonol. 2016; 51:968–974 . © 2016 Wiley Periodicals, Inc.