Interfaces for long-term noninvasive positive pressure ventilation in children

Ramirez, Adriana; Delord, Vincent; Khirani, Sonia; Leroux, Karl; Cassier, Sophie; Kadlub, Natacha; Aubertin, Guillaume; Picard, A.; Fauroux, Brigitte

doi:10.1007/s00134-012-2516-1

Cited by 69 publications

(60 citation statements)

References 16 publications

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“…In young infants, the oronasal interface is the first-line choice when administering NRS, but the need for tight-fitting interfaces may lead to higher failure rates due to intolerance and the greater need for sedation. 33,34 The helmet was reported to be efficient in delivering CPAP in a physiologic RCT in healthy adult volunteers: helmet CPAP was as effective as mask CPAP in increasing end expiratory lung volume and compensating for airway pressure oscillations without the need for a reservoir bag and without CO 2 rebreathing at high gas flow rates (.30 L/minute), regardless of the size of the helmet. [25][26][27] From a physiologic point of view, the more constant the pressure, the more pronounced the benefits on respiratory mechanics.…”

Section: Discussionmentioning

confidence: 99%

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

et al. 2015

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BACKGROUND: Noninvasive continuous positive airway pressure (CPAP) is usually applied with a nasal or facial mask to treat mild acute respiratory failure (ARF) in infants. A pediatric helmet has now been introduced in clinical practice to deliver CPAP. This study compared treatment failure rates during CPAP delivered by helmet or facial mask in infants with respiratory syncytial virus-induced ARF. METHODS:In this multicenter randomized controlled trial, 30 infants with respiratory syncytial virus-induced ARF were randomized to receive CPAP by helmet (n = 17) or facial mask (n = 13). The primary endpoint was treatment failure rate (defined as due to intolerance or need for intubation). Secondary outcomes were CPAP application time, number of patients requiring sedation, and complications with each interface.RESULTS: Compared with the facial mask, CPAP by helmet had a lower treatment failure rate due to intolerance (3/17 [17%] vs 7/13 [54%], P = .009), and fewer infants required sedation (6/17 [35%] vs 13/13 [100%], P = .023); the intubation rates were similar. In successfully treated patients, CPAP resulted in better gas exchange and breathing pattern with both interfaces. No major complications due to the interfaces occurred, but CPAP by mask had higher rates of cutaneous sores and leaks.CONCLUSIONS: These findings confirm that CPAP delivered by helmet is better tolerated than CPAP delivered by facial mask and requires less sedation. In addition, it is safe to use and free from adverse events, even in a prolonged clinical setting. WHAT'S KNOWN ON THIS SUBJECT:In a previous short-term physiologic randomized controlled trial, continuous positive airway pressure by helmet was feasible and efficient in improving gas exchange in pediatric acute respiratory failure due to bronchiolitis. WHAT THIS STUDY ADDS:Continuous positive airway pressure administered by helmet reduces the rate of noninvasive respiratory support failure and provides longer application time with less sedation than a facial mask. In addition, it is safe to use and free from adverse events.

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Section: Discussionmentioning

confidence: 99%

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

et al. 2015

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“…[36][37][38] Subjects with facial deformities were more difficult to fit, and subjects Յ2-y-old used a custom mask due to the unavailability of acceptable commercial devices. 18 Use of an oronasal mask was a significant risk factor for tissue injury among subjects Ͼ18 y old. 39 Our results suggest that oronasal masks would be a risk factor in younger patients as well.…”

Section: Discussionmentioning

confidence: 98%

“…17 Importantly, proper face mask fit may be difficult, particularly in the pediatric population. 18 Over 40% of pediatric patients with a face mask pressure ulcer had medical diagnoses associated with craniofacial anomalies. 4 Often acting synergistically, poor fit creates localized pressure areas and leaks.…”

Section: See the Related Editorial On Page 1708mentioning

confidence: 99%

Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers

et al. 2015

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BACKGROUND: Pressure ulcers (stages III and IV) are serious safety events (ie, never events).Healthcare institutions are no longer reimbursed for costs to care for affected patients. Medical devices are the leading cause of pediatric pressure ulcers. Face masks for noninvasive ventilation were associated with a high percentage of pressure ulcers at our institution. METHODS: A prospective cohort study investigated factors contributing to pressure ulcer development in 50 subjects using face masks for noninvasive ventilation. Color imaging, 3-dimensional surface imaging, and skin hydration measurements were used to identify early skin compromise and evaluate 3 interventions to reduce trauma: (1) a silicone foam dressing, (2) a water/polyethylene oxide hydrogel dressing, and (3) a flexible cloth mask. A novel mask fit technique was used to examine the impact of fit on the potential for skin compromise. RESULTS: Fifty subjects age 10.4 ؎ 9.1 y participated with color images for 22, hydration for 34, and mask fit analysis for 16. Of these, 69% had diagnoses associated with craniofacial anomalies. Stage I pressure ulcers were the most common injury. Skin hydration difference was 317 ؎ 29 for sites with erythema versus 75 ؎ 28 for sites without erythema (P < .05) and smallest for the cloth mask (P < .05). Fit distance metrics differed for the nasal, oronasal, and face shield interfaces, with threshold distances being higher for the oronasal mask than the others (P < .05). Areas of high contact were associated with skin erythema and pressure ulcers. CONCLUSIONS: This fit method is currently being utilized to select best-fit masks from available options, to identify the potential areas of increased tissue pressure, and to prevent skin injuries and their complications. Improvement of mask fit is an important priority for improving respiratory outcomes. Strategies to maintain normal skin hydration are important for protecting tissue integrity.

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“…Many of the devices used to provide NIV have not been approved for use in patients under 20 kg, and the improvements in the design of interfaces for pediatric patients have not been as forthcoming, often necessitating the use of custom fitted masks, cannulae, and other types of patient ventilator interfaces. In addition, NIV is often poorly tolerated by small children [1]. However, despite the dearth of effective interfaces, some success has been realized in applying NIV to children with acute and chronic respiratory failure.…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

“…However, pediatric application of NIV has been limited by the lack of availability of these interfaces. This has led to the need for custom fitted masks [1], nonconventional interfaces such as helmets [2,3], or failure of this approach to ventilatory support when such masks are unavailable. These issues are compounded by the fact that because of the more diverse population, infrequent mortality, and shorter duration of mechanical ventilation, fewer randomized controlled trials (RCTs) are available in pediatric patients than adults [4].…”

Section: Introductionmentioning

confidence: 99%

Advances in Ventilatory Support of Critically Ill Children

Chipman

Kacmarek

2012

Curr Pediatr Rep

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Advances in pediatric medical practices often lag behind the progress made in adult patients, primarily because of the limited number of randomized, controlled, clinical trials. Recent advances in mechanical ventilation derived from successful application in adults include neurally adjusted ventilatory assist, noninvasive ventilation, and protective lung strategies. NAVA improves patient/ ventilator synchrony and reduces the work of breathing, which allows for a decreased use of sedation. This should decrease the length of time patients are intubated and mechanically ventilated. The use of noninvasive ventilation eliminates the need for endotracheal tubes and complications associated with them including tracheal injury, pressure ulcers, issues with oral hygiene and ventilator associated pneumonia. Application of lung protective strategies to pediatric patients with acute lung injury and/or ARDS results in increased oxygenation, less lung injury, and improvements in morbidity and mortality.

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Interfaces for long-term noninvasive positive pressure ventilation in children

Abstract: The choice of the interface for NPPV in children is determined by the patient's age and the underlying disease. Discomfort is the main reason for mask change.

Cited by 69 publications

References 16 publications

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers

Advances in Ventilatory Support of Critically Ill Children

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