Interfaces, Circuits and Humidifiers

Abstract

Long-term non-invasive ventilation (LTNIV) has been increasingly used in children to manage chronic respiratory failure and airway obstruction. Interfaces are of paramount importance for non-invasive ventilation (NIV) effectiveness and patient compliance. However, historically, the choice of pediatric mask has been limited by the scarce availability of commercial interfaces. In recent years, an increasing number of different masks have been commercialized for children, allowing to increase the number of patients who could benefit from LTNIV. Factors such as the age of the child, disease, craniofacial conformation, type of ventilator and mode of ventilation, and children's and family's preferences should be taken into account when selecting the appropriate mask. Adverse events such as skin lesions, facial growth impairment, and leaks must be prevented and promptly corrected. Humidification is a controversial issue on NIV, but it may be useful in certain circumstances. Regular cleaning and disinfection of interfaces and equipment must be addressed. During follow-up, educational programs, close supervision, and continuous support to children and families are crucial to the success of LTNIV therapy.

Respiratory effort during noninvasive positive pressure ventilation and continuous positive airway pressure in severe acute viral bronchiolitis

“…Air leaks are common with a nasal interface and may decrease NIPPV efficiency by means of PVA. 26 Unfortunately, we…”

“…In the present study, all infants except one used a nasal interface. Air leaks are common with a nasal interface and may decrease NIPPV efficiency by means of PVA 26 . Unfortunately, we were not able to adequately detect and quantify PVA, since we were not able to record patient's airflow.…”

Mask interfaces and devices for home noninvasive ventilation in children

“…Total face masks are rarely prescribed for home NIV, and should be reserved to very particular cases, such as patients with severe facial deformities or bilateral cleft lips with no possibility to adapt other types of interfaces, or because of severe skin injuries. 6,15,16 Three manufacturers propose total face masks for toddlers and older children (Figure 2). The same limitations of oronasal masks may apply for total face masks.…”

“…[17][18][19] Some recent reviews have summarized the characteristics, advantages, and disadvantages of the different types of masks, except for the mouth-only masks and the new "under-the-nose" nasal and oronasal masks. 6,12,15,16 Castro-Codesal et al 6 have also reviewed the comparative performances between the different types of masks. Data in children comparing performance among interfaces are scarce.…”

“…There are 3 types of circuits: the single-limb circuit, the single-limb circuit with an active exhalation valve, and the double-limb circuit. 16,21 The double-limb circuit exists as a "classical" double tubing or a co-axial tubing which is mainly used for anesthesia or in ICU, but is available for home NIV. [60][61][62] A careful check of the integrity of the co-axial circuit must be always done to prevent potential malfunctioning.…”