Abstract:We observed that the implementation of an NIV management protocol that integrates initiation and discontinuation criteria for NIV is feasible. However, its use showed no advantages over a non-protocolized strategy.
“…The severity of acute respiratory failure in previous CNEP analyses (MWS score ≥ 5 10 ) was greater than that of the present patients. A previous study suggested that early intervention before the possible state of endotracheal intubation could avoid disease progression to severe clinical symptoms 16 . Our children with acute upper or lower respiratory disease had MWS scores of 3–4, which indicated mild respiratory symptoms without the requirement for immediate intubation therapy.…”
Background
Continuous negative extra‐thoracic pressure (CNEP) can prevent children with apnea developing severe respiratory infection with endotracheal intubation. Little is known about children with mild acute respiratory disease, especially with a focus on clinical respiratory symptoms.
Methods
We conducted a prospective, observational study between July 2014 and July 2017 to evaluate the safety of a modified setting of CNEP in hospitalized children with symptoms of chest‐wall retraction or nasal alar breathing without the requirement for immediate intubation therapy in a single center. A modified setting of CNEP was defined as 4 h of treatment comprising 3 consecutive hours of CNEP followed by 1 h of rest.
Results
We studied 19 hospitalized children with retraction or nasal breathing but no possible state of endotracheal intubation. The median age at admission was 0.9 years and the duration of CNEP was 6 days. No sedative drugs were used. The percentage of children with retraction or nasal breathing after 24 h from initiation of CNEP was significantly decreased compared with that just before CNEP (68% vs 100%, P = 0.02). Logistic regression showed no statistical evidence of contributing factors for pulmonary symptoms. No patients were transferred to receive intubation, but one boy reinitiated respiratory support within 6 months after discharge. No children had adverse events of upper airway obstruction, skin injury, interfering with access, hypothermia, discomfort from fitting a cuirass, and neck excoriation.
Conclusions
Our results suggest that a modified setting of CNEP management can be tolerated and continued without concern of adverse events.
“…The severity of acute respiratory failure in previous CNEP analyses (MWS score ≥ 5 10 ) was greater than that of the present patients. A previous study suggested that early intervention before the possible state of endotracheal intubation could avoid disease progression to severe clinical symptoms 16 . Our children with acute upper or lower respiratory disease had MWS scores of 3–4, which indicated mild respiratory symptoms without the requirement for immediate intubation therapy.…”
Background
Continuous negative extra‐thoracic pressure (CNEP) can prevent children with apnea developing severe respiratory infection with endotracheal intubation. Little is known about children with mild acute respiratory disease, especially with a focus on clinical respiratory symptoms.
Methods
We conducted a prospective, observational study between July 2014 and July 2017 to evaluate the safety of a modified setting of CNEP in hospitalized children with symptoms of chest‐wall retraction or nasal alar breathing without the requirement for immediate intubation therapy in a single center. A modified setting of CNEP was defined as 4 h of treatment comprising 3 consecutive hours of CNEP followed by 1 h of rest.
Results
We studied 19 hospitalized children with retraction or nasal breathing but no possible state of endotracheal intubation. The median age at admission was 0.9 years and the duration of CNEP was 6 days. No sedative drugs were used. The percentage of children with retraction or nasal breathing after 24 h from initiation of CNEP was significantly decreased compared with that just before CNEP (68% vs 100%, P = 0.02). Logistic regression showed no statistical evidence of contributing factors for pulmonary symptoms. No patients were transferred to receive intubation, but one boy reinitiated respiratory support within 6 months after discharge. No children had adverse events of upper airway obstruction, skin injury, interfering with access, hypothermia, discomfort from fitting a cuirass, and neck excoriation.
Conclusions
Our results suggest that a modified setting of CNEP management can be tolerated and continued without concern of adverse events.
“…Die nichtinvasive Beatmung zu Behandlung der ARI hat ihren festen Stellenwert in der Behandlung von Säuglingen und Kinder auf der pädiatrischen Intensivstation. Die Evidenz zum Nutzen der NIV kommt u. a. aus kleineren randomisierten Studien 499 500 501 502 503 504 505 506 507 508 , Cross-over-Studien 509 510 511 512 , prospektiven 90 94 101 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 und retrospektiven Kohortenstudien 91 93 95 97 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 . Trotz der vielen Studien ist aufgrund der meist kleinen Fallzahlen und Heterogenität der untersuchten Kohorten eine Überlegenheit von NIV im Vergleich zu Standardtherapie für viele Indikationen im Kindesalter außerhalb der Neugeborenen Periode unzureichend belegt.…”
Section: Ari Bei Kindern Und Jugendlichenunclassified
ZusammenfassungDie Leitlinienaktualisierung zeigt die Vorteile sowie die Grenzen der NIV bei der Behandlung von akutem Atemversagen im klinischen Alltag und bei unterschiedlichen Indikationen auf.Die nichtinvasive Beatmung (NIV) hat einen hohen Stellenwert bei der Therapie des hyperkapnischen akuten Atemversagens, da sie die Aufenthaltsdauer und den Krankenhausaufenthalt auf der Intensivstation sowie die Mortalität deutlich reduziert.Patienten mit kardiopulmonalem Ödem und akutem Atemversagen sollten zusätzlich zu notwendigen kardiologischen Eingriffen mit kontinuierlichem positivem Atemwegsdruck (CPAP) und Sauerstoff behandelt werden. Dies sollte bereits präklinisch und in der Notaufnahme erfolgen.Bei anderen Formen des akuten hypoxämischen Atemversagens mit nur leicht bis mäßig gestörtem Gasaustausch (PaO2/FiO2 > 150 mmHg) ergibt sich kein signifikanter Vor- oder Nachteil gegenüber nasaler Sauerstoff-High-Flow-Therapie (HFNO). Bei schweren Formen des ARDS ist die NIV mit einer hohen Rate an Behandlungsversagen und Mortalität verbunden, insbesondere in Fällen mit NIV-Versagen und verzögerter Intubation.Zur Präoxygenierung vor der Intubation sollte NIV verwendet werden. Bei Risikopatienten wird eine NIV empfohlen, um Extubationsversagen zu reduzieren. Im Entwöhnungsprozess von der invasiven Beatmung reduziert NIV das Risiko einer Reintubation bei hyperkapnischen Patienten wesentlich. NIV gilt in der Palliativversorgung als nützlich zur Reduzierung von Dyspnoe und zur Verbesserung der Lebensqualität, hier aber in Konkurrenz zur HFNO, das als komfortabler gilt. Mittlerweile wird die NIV auch im präklinischen Bereich empfohlen, insbesondere bei hyperkapnischem Atemversagen und beim Lungenödem.Bei entsprechender Überwachung auf einer Intensivstation kann NIV auch bei pädiatrischen Patienten mit akuter Ateminsuffizienz erfolgreich eingesetzt werden.
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