Long term noninvasive ventilation in children: what’s new in 2015 ? Brigitte Fauroux, MD PhD Pediatric noninvasive ventilation and sleep unit Necker university hospital, Inserm U 955 Paris, France Inserm Institut national de la santé et de la recherche médicale
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Long term noninvasive ventilation in children: what’s new in 2015 ?
Brigitte Fauroux, MD PhDPediatric noninvasive ventilation and sleep unit
Necker university hospital, Inserm U 955Paris, France
InsermInstitut nationalde la santé et de la recherche médicale
Noninvasive ventilation in children: what’s new ?
• Epidemiology• Diseases that may require NIV• Interfaces• Compliance• CPAP monitoring• CPAP/NIV initiation
An italian experienceNumber of children treated with NIV since 1993 in a single centre
Pavone et al. Early Human Development 2013;89:S25
McDougall et al. Arch Dis Childh 2013;98:660
Incidence 1995-2009 Prevalence 1995-2009
15 year experience of a pediatric centre (Vancouver)
McDougall et al. Arch Dis Childh 2013;98:660
15 year experience of a pediatric centre (Vancouver)
McDougall et al. Arch Dis Childh 2013;98:66
McDougall et al. Arch Dis Childh 2013;98:660
Noninvasive ventilation in children: what’s new ?
• Epidemiology• Diseases that may require NIV• Interfaces• Compliance• CPAP monitoring• CPAP/NIV initiation
An italian experienceIndications for NIV in a single centre
Pavone et al. Early Human Development 2013;89:S25
Acute group
n=15
Subacute group
n=18
Chronic group
n=43
Age, years 1.2±3.4 6.4±7.2 5.9±7.1
Female/male 7/8 8/10 22/21
Diagnosis Pierre Robin syndromeLaryngomalaciaPolymalformative sdKabuki syndromeCystic fibrosisBPDNeuromuscular disorder
6321111
LaryngomalaciaPrader Willi syndromePierre Robin syndromeBDPCraniostenosisTreacher Collins s dVocal cord palsyDown syndromeMucopolysaccaridosisDuchenne MDLaryngeal massCraniofacial malform.Generalised dystonia AchondroplasiaTracheomalacia
• These patients were deficient in tests of • adaptive behavior• visual-motor integration• achievement
Noninvasive ventilation in children: what’s new ?
• Epidemiology• Diseases that may require NIV• Interfaces• Compliance• CPAP monitoring• NIV/CPAP initiation
PSG during CPAP/NIVNo description of eventsNo explanation on recommended CPAP/NIV changes
Number ofrespiratory events/polygraphy
Consequences of the respiratory events
Nocturnal gas exchange didnot predict PG results
Noninvasive ventilation in children: what’s new ?
• Epidemiology• Diseases that may require NIV• Interfaces• Compliance• CPAP monitoring• NIV/CPAP initiation
CPAP/NIV initiation
• No validated criteria to start CPAP/NIV due to the lack of markers of SDB end-organ morbidity
3 clinical scenario
AcuteImpossibility to
wean from NIV in the ICUN=15
SubacuteAbnormal
nocturnal gas exchange
N=18
ChronicAbnormal P(S)G
N=43
• Minimal SpO2 < 90%• Maximal PtcCO2 > 50 mmHg• % of time with a SpO2 < 90% ≥ 2%• % of time with a PtcCO2 > 50mmHg ≥ 2%• Oxygen desaturation index > 1.4/h
• AHI > 10/h
Number of criteria in the subacute and chronic group
Subacute groupChronic group
Acute group
n=15
Subacute group
n=18
Chronic group
n=43
Age, years 1.2±3.4 6.4±7.2 5.9±7.1
Female/male 7/8 8/10 22/21
Diagnosis Pierre Robin syndromeLaryngomalaciaPolymalformative sdKabuki syndromeCystic fibrosisBPDNeuromuscular disorder
6321111
LaryngomalaciaPrader Willi syndromePierre Robin syndromeBDPCraniostenosisTreacher Collins s dVocal cord palsyDown syndromeMucopolysaccaridosisDuchenne MDLaryngeal massCraniofacial malform.Generalised dystonia AchondroplasiaTracheomalacia
• Epidemiology: � use of NIV• Diseases that may require NIV: expanding• Interfaces: interfaces for infants• Compliance: value of specialised centers• CPAP monitoring: few events• NIV/CPAP initiation: future studies should
look for benefit of CPAP/NIV on end-organ morbidity