Is there an optimal ventilatory mode for neuromuscular children ? Brigitte Fauroux & Alessandro Amaddeo Pediatric noninvasive ventilation and sleep unit Research unit INSERM U 955 Necker university Hospital, Paris, France Inserm Institut national de la santé et de la recherche médicale
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Is there an optimal ventilatory mode for · • Ventilatory modes • In practice • Conclusion. Heterogeneity of neuromuscular disorders in children Motoneuron - SMA. Peripheral
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Is there an optimal ventilatory mode for
neuromuscular children ?Brigitte Fauroux & Alessandro Amaddeo
Pediatric noninvasive ventilation and sleep unitResearch unit INSERM U 955
Necker university Hospital, Paris, France
InsermInstitut nationalde la santé et de la recherche médicale
Is there an optimal ventilatorymode for neuromuscular children ?
• Introduction• Ventilatory modes• In practice• Conclusion
Heterogeneity of neuromuscular
disorders in children
Motoneuron- SMA
Peripheral nerve- Metabolic- Hereditary
Neuromuscularjunction- Myasthenia
Muscle- DMD, myotonic D.- Cong. myopathies
Ramirez et al. Intensive Care Med 2012;38:655
97 children over an 18 months period
36%
McDougall et al. Arch Dis Childh 2013;98:660
NIV for children with NMD in Rome
Pavone et al. Early Human Development 2013;89:S25
34%
Is there an optimal ventilatorymode for neuromuscular children ?
• Introduction• Ventilatory modes
– principles– efficacy
• In practice• Conclusion
Volume targetedventilation
Pressure targetedventilation
Target volumewith variable
pressure supportTidalvolume
stable variable « guaranteed »
Pressure variable stable variable (withintargets)
Flow
Avantages known tidal volume known IPAPleakcompensation
control of IPAPleak compensation« guantanteed »tidal volume