Noninvasive ventilation in pediatric emergency care: a literature review and description of our experience

Abstract

Noninvasive ventilation (NIV) refers to a kind of mechanical respiratory support used in order to avoid the progression of respiratory failure to endotracheal intubation. Even though if this method is widely known in patients affected by chronic diseases and in children admitted in pediatric and neonatal intensive care units, few data are actually available on its use in intermediate care units. The present review focuses on the efficiency of NIV performed in children with acute respiratory failure due to different conditions. Moreover, the authors have described their experience with NIV in pediatric patients admitted to their acute and emergency room where NIV was started, well tolerated and led to an improvement of gas exchanges, decreasing the muscular respiratory work and endotracheal intubation avoidance in most of the patients.

Keywords::

• emergency intermediate care
• noninvasive ventilation
• pediatrics

Acknowledgments

The authors thank the SIMEUP (Italian Society for Paediatric Acute and Emergency Medicine) for the critical review of the manuscript and help in writing the draft.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Currently, the standard treatment for chronic respiratory failure in children could be referred to noninvasive ventilation (NIV). The technique has been demonstrated to improve blood gases and prolongs survival in diseases such as congenital central hypoventilation syndrome or neuromuscular disorders.

• • The real goal is to be sure that NIV modality has a value in the prevention of the progressive respiratory failure in the early period after the admission in the emergency room. We have had experience on the use of NIV in a complex pediatric operative and not directly in the pediatric intensive care unit, just to avoid the progression to endotracheal intubation (ETI) and hence the transport of the child to the nearest pediatric intensive care unit.

• • NIV is used to avoid ETI when pH is between 7.25 and 7.30 and/or PaO₂/FiO₂ is between 200 and 250. It is right in these cases that NIV should be used as a prevention of ARF, avoiding the progression toward ETI.

• • Breathing difficulties are common in children and a frequent reason for their access in the emergency departments.

• • The best-documented application of NIV in pediatric patients is in chronic patients in the home setting. NIV has proven to improve or reverse nocturnal hypoventilation in infants and children with various causes of chronic respiratory failure, such as neuromuscular diseases, severe upper airway obstruction and cystic fibrosis.

• • During the past 10 years, NIV has been increasingly used in children with acute respiratory distress.

• • NIV has been demonstrated to be efficient in children affected by ARF due to acute lower and upper airway obstruction, parenchymal lung disease, PRF and immunocompromised children.

• • Our experience comes from acute cases treated with NIV in our pediatric acute and emergency department, and in our experience NIV was always efficient in resolving ARF.