Home continuous positive airway pressure therapy in infants: a single-center experience

Outpatient Utilization of the RAM Cannula for Nasal Noninvasive Ventilation in Children

“…In patients using home NIV via the RAM cannula, De Jesus Rojas et al reported a mean CPAP setting of 7 cm H 2 O and BPAP settings of IPAP 15 cm H 2 O, EPAP 6 cm H 2 O, and respiratory rate of 13 per minute. Although the median CPAP setting (8 cm H 2 O) in our study was similar to the CPAP settings reported by De Jesus Rojas et al, 10 they were higher than the CPAP settings used by Joshi et al 7 in infants using CPAP via conventional nasal masks possibly due to interface leaks. The BPAP settings in our study were higher than the settings used by De Jesus Rojas et al 10 This could be attributed to the age differences, interface leaks, inherent clinical features, and diagnoses of patients in these studies.…”

“…Similar to our study, patients had underlying diseases like Trisomy 21, RLDs, and craniofacial disorders and some children were weaned from CPAP therapy. In contrast to the study by Joshi et al 7 where nasal masks were the most used interfaces for CPAP therapy, patients in our study used the RAM cannula for NIV. Therefore, utilizing home NIV via the RAM cannula may permit time for airway and lung growth and potential improvement in OSA.…”

“…In this study, the indications for home NIV therapy during infancy and the utilization of the RAM cannula for outpatient NIV were similar to prior reports. 7,10 In our study, many patients who used NIV via the RAM cannula had genetic conditions such as Trisomy 18 and Trisomy 21 complicated by sleep-disordered breathing and chronic respiratory failure. Some patients require continuous ventilator support that may be challenging to use with conventional NIV interfaces that are generally meant for use during sleep.…”

“…Infants have a greater risk for airway obstruction and gas exchange abnormalities due to anatomical and physiological factors. 13 In a single-center study of 29 infants who received home CPAP therapy for a variety of etiologies, Joshi et al 7 reported that CPAP is an effective long-term therapy during infancy. Similar to our study, patients had underlying diseases like Trisomy 21, RLDs, and craniofacial disorders and some children were weaned from CPAP therapy.…”

“…5,6 Additionally, NIV is being increasingly used in infants and children for the outpatient management of sleep-disordered breathing, respiratory control disorders, neuromuscular diseases, and chronic respiratory failure. [1][2][3]7,8 The interfaces used for outpatient NIV include nasal, oro-nasal, nasal pillows, and total face masks. Despite the availability of several interfaces to provide CPAP and BPAP therapy to children, outpatient use of NIV is challenging due to limited interface sizes, poor interface fit, and lack of cooperation of the child.…”