Non-invasive Ventilation for Pediatric Hypoxic Acute Respiratory Failure Using a Simple Anesthetic Mask With 3D Printed Adaptor: A Case Report

Abstract

Non-invasive ventilation (NIV) is increasingly used in the supportive treatment of acute respiratory failure in children in the pediatric intensive care unit (PICU). However, finding an optimal fitting commercial available NIV face mask is one of the major challenges in daily practice, in particular for young children and those with specific facial features. Large air leaks and pressure-related skin injury due to suboptimal fit are important complications associated with NIV failure. Here, we describe a case of a 4-year old boy with cardiofaciocutaneous syndrome and rhinovirus-associated hypoxic acute respiratory failure who was successfully supported with NIV delivered by a simple anesthetic mask connected to a headgear by an in-house developed and 3D printed adaptor. This case is an example of the clinical challenge related to pediatric NIV masks in the PICU, but also shows the potential of alternative NIV interfaces e.g., by using a widely available and relatively cheap simple anesthetic mask. Further personalized strategies (e.g., by using 3D scanning and printing techniques) that optimize NIV mask fitting in children are warranted.

Reduced Air Leakage During Non-Invasive Ventilation Using a Simple Anesthetic Mask With 3D-Printed Adaptor in an Anthropometric Based Pediatric Head–Lung Model

“… (A) The simple anesthetic mask (Ambu®King Mask, size 2) placed on the pediatric head model by a five-point headgear by our in-house 3D-printed quick release adaptor as previously described ( 22 ). (B) The PerforMax®, size XS, total face mask placed on the pediatric head model.…”

“…As we frequently observe quite large air leaks from such masks in daily clinical practice, we started to use an alternative interface: a simple, relatively cheap, anesthetic mask connected to a headgear via an in-house 3D-printed reusable quick-release adaptor. Recently, we described this interface as part of the successful NIV treatment in a 4-year-old boy with cardiofaciocutaneous syndrome and rhinovirus-associated hypoxic acute respiratory failure ( 22 ). Here, we used the pediatric head–lung model to more objectively investigate the extent of air leakage from this simple anesthetic mask during simulated pediatric NIV.…”

“…In this study, two masks were compared: (1) a simple anesthetic mask (nose–mouth full face mask from Ambu®King, size 2, Denmark), and (2) a total face mask (Respironics PerforMax®, size XS, Phillips, The Netherlands) covering the mouth, nose, and eyes. The simple anesthetic mask was connected to a five-point headgear (Respireo Soft Child Non Vented Masks, Air Liquide Healthcare, Paris, France) by our in-house 3D-printed quick release adaptor as described previously ( 22 ). The total face mask was used with the four-point headgear as supplied by the manufacturer.…”

“…Optimization of the interface fitting, including strategies that go so far as personalizing a mask by 3D scanning and printing techniques, holds a promising future to reduce air leakage, and hence, improve pediatric NIV effectiveness ( 16 , 17 , 21 ). Recently, we described the successful use of a simple anesthetic (nose–mouth) mask for NIV in a 4-year-old child with specific facial features admitted to the PICU for acute hypoxic respiratory failure ( 22 ). This anesthetic mask is connected to a 5-point headgear using an in-house developed, 3D-printed reusable quick-release adaptor, and may serve as an effective and relatively cheap alternative to commercially available NIV masks.…”

Adult‐size interface during non‐invasive ventilation for a child with pediatric acute respiratory distress syndrome: Maintaining principle on a different population

“…Muller et al reported a case of the effectiveness of using an invented 3D Printed Adaptor with a simple anesthetic mask applying the same concept of a properly sealed mask. 10 Putting children on NIV support sometimes ease the handling of the patient by the nursing staff. Also, the parents will be more comfortable when dealing with their NIV‐supported kids.…”