Use and outcomes of long-term noninvasive ventilation for infants

Bedi, Prabhjot K.; Castro‐Codesal, Maria L.; DeHaan, Kristie; MacLean, Joanna E.

doi:10.1080/24745332.2018.1465369

Cited by 4 publications

(16 citation statements)

References 38 publications

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“…A small number of these patients are likely double-counted, as investigators likely included some of them in other larger study cohorts. [13][14][15][16][17][18][19][20] Using the Newcastle-Ottawa Scale, the included papers were of low to moderate quality with 5 to 8 stars (out of a possible 9). No papers had a nonexposed cohort for comparison, and only 19 controlled for or explored associations between liberation and/or mortality and other clinically meaningful factors.…”

Section: Resultsmentioning

confidence: 99%

“…No papers had a nonexposed cohort for comparison, and only 19 controlled for or explored associations between liberation and/or mortality and other clinically meaningful factors. 2,4,5,15,17,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] The ratings of in- Table 1). Forty-two (32%) papers studied patients who were initiated solely on IV; 45 (35%) papers studied patients who were initiated solely on NIV.…”

Section: Resultsmentioning

confidence: 99%

“…Only 24 papers studied more than 100 patients. 2,4,5,20,29,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Of the 12 704 patients, 37% could be categorized as having ventilatory muscle weakness, 14% with chronic pulmonary disease, 10% with central hypoventilation, 9% with airway abnormalities, 6% with genetic/metabolic syndromes, 1% with cardiac/congenital heart disease, and 3% other/combined. Twenty percent of patients did not have a diagnosis reported.…”

Section: Resultsmentioning

confidence: 99%

“…17 Fourteen papers reported factors associated or not associated with liberation or mortality. 2,5,17,20,[22][23][24][29][30][31][32][89][90][91] Multiple papers found that patients with chronic pulmonary disease or airway abnormalities were more likely to be liberated than patients with other diseases. 2,23,80,90 One study found that younger age and CPAP use (compared to BPAP) were associated with liberation from NIV.…”

Section: Resultsmentioning

confidence: 99%

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Liberation and mortality outcomes in pediatric long‐term ventilation: A qualitative systematic review

Foy

Koncicki

Edwards

2020

Pediatric Pulmonology

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Objective: To provide a systematic review of liberation from positive pressure ventilation and mortality of children with chronic respiratory failure who used long-term invasive and noninvasive ventilation (LTV). Methods: Papers published from 1980 to 2018 were identified using Pubmed MEDLINE, Ovid MEDLINE, Embase, and Cochrane databases. Search results were limited to English-language papers with (a) patients less than 22 years at initiation, (b) patients who used invasive ventilation (IV) via tracheostomy or noninvasive ventilation (NIV), and (c) data on mortality or liberation from LTV. Data were presented using descriptive statistics; changes in outcomes over time were explored using linear regression. Follow-up variability, cohort heterogeneity, and insufficient data precluded combining data to estimate incidences or rates. Results: One hundred and thirty papers with 12 704 patients were included. The median number of patients was 37 (interquartile range [IQR] 17-74, range 6-3802). Twenty-five percent of patients were initiated on IV; 75% on NIV. The maximum follow-up ranged from 0.5 to 31.8 years (median 8.8 years). The median proportion of patients liberated in these papers was 3% (IQR 0%-21%). The median proportion of mortality was 18% (IQR 8%-27%). Proportions of liberation and mortality did not significantly change over time. Progression of underlying disease (44%), respiratory illness (19%), and LTV accident (11%) were the most common causes of death. Conclusions: These papers collectively show most patients survive for many years using LTV; in many subgroups, death is a more common outcome than liberation. However, the limitations of these papers preclude robust prognostication.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Liberation and mortality outcomes in pediatric long‐term ventilation: A qualitative systematic review

Foy

Koncicki

Edwards

2020

Pediatric Pulmonology

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“…Improvement in growth, leading to growth of the airway, is likely an important component of improving airway obstruction in infants with PRS and explains why more infants than older children will see improvement in their obstructive sleep apnea to the point that treatment can be stopped. 13 Airway obstruction compromises breathing and oral feeding, so progression to oral feeding is another marker of improvement in airway obstruction. Feeding difficulties result in longer length of stay, so early assessment of feeding is important.…”

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confidence: 99%

Understanding the Spectrum of Treatment Options for Infants With Pierre Robin Sequence and Airway Obstruction

MacLean

2019

Journal of Clinical Sleep Medicine

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Pierre Robin sequence (PRS), also referred to as Robin sequence, is defined by micrognathia, glossoptosis, and upper airway obstruction and results in varying degrees of airway compromise after birth. 1,2 Both evaluation and treatment of airway obstruction in infants with PRS varies between centers with considerable controversy around the role of polysomnography for the diagnosis of sleep-related breathing disorders and assessment of treatment response. 3,4 Disagreements about the role of polysomnography are undoubtedly influenced by access to polysomnographic testing as this is limited or unavailable in many areas. 5,6 On the treatment side, there are differences between centers with respect to available treatment options and how treatment success is evaluated. While there has been considerably more study of the surgical options compared to nonsurgical options, the field overall is hampered by a relative paucity of high quality evidence. 7 There is a relatively long list of options for management of airway obstruction in infants with PRS. Nonsurgical options include prone sleep position, 8 supplemental oxygen, use of an oral appliance with a velar extension, 9 oropharyngeal or nasopharyngeal tube, noninvasive ventilation (typically continuous positive airway pressure), and placement of an endotracheal tube. 3 Surgical options include tongue-lip adhesion (or glossopexy), mandibular distraction osteogenesis, subperiosteal release of the floor of the mouth, and tracheostomy-with additional surgical options used more selectively. 3 There are multiple algorithms from different centers to support treatment decisions but none incorporate all treatment options and all use different strategies for decision making. 3,10,11 With few studies comparing treatment modalities and even fewer randomized trials, there is little information on the characteristics of infants that will best respond to any given therapy. 7,11 The study by Ehsan and colleagues in this issue of the Journal of Clinical Sleep Medicine 12 adds another option, watchful waiting, to this list. The study reports on a cohort on infants with PRS who were treated with conservative (ie, nonsurgical) management. 12 The study design was a 14-year retrospective cohort study that included infants with PRS who underwent polysomnography COMMENTARY Understanding the Spectrum of Treatment Options for Infants With Pierre Robin Sequence and Airway Obstruction Commentary on Ehsan et al. Longitudinal sleep outcomes in neonates with Pierre Robin sequence treated conservatively.

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Predictors of longitudinal outcomes for children using long‐term noninvasive ventilation

Bedi

DeHaan

MacLean

et al. 2020

Pediatric Pulmonology

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Background Noninvasive ventilation (NIV) is a first‐line therapy for sleep‐related breathing disorders and chronic respiratory insufficiency. Evidence about predictors that may impact long‐term NIV outcomes, however, is scarce. The aim of this study is to determine demographic, clinical, and technology‐related predictors of long‐term NIV outcomes. Methods A 10‐year multicentred retrospective review of children started on long‐term continuous or bilevel positive airway pressure (CPAP or BPAP) in Alberta. Demographic, technology‐related, and longitudinal clinical data were collected. Long‐term outcomes examined included ongoing NIV use, discontinuation due to improvement in underlying conditions, switch to invasive mechanical ventilation (IMV) or death, patient/family therapy declination, transfer of services, and hospital admissions. Results A total of 622 children were included. Both younger age and CPAP use predicted higher likelihood for NIV discontinuation due to improvement in underlying conditions (p < .05 and p < .01). Children with upper airway disorders or bronchopulmonary dysplasia were less likely to continue NIV (p < .05), while presence of central nervous system disorders had a higher likelihood of hospitalizations (p < .01). The presence of obesity/metabolic syndrome and early NIV‐associated complications predicted higher risk for NIV declination (p < .05). Children with more comorbidities or use of additional therapies required more hospitalizations (p < .05 and p < .01) and the latter also predicted higher risk for being switched to IMV or death (p < .001). Conclusions Demographic, clinical data, and NIV type impact long‐term NIV outcomes and need to be considered during initial discussions about therapy expectations with families. Knowledge of factors that may impact long‐term NIV outcomes might help to better monitor at‐risk patients and minimize adverse outcomes.

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Use and outcomes of long-term noninvasive ventilation for infants

Abstract: Revue canadienne des soins respiratoires et critiques et de la médecine du sommeil

Cited by 4 publications

References 38 publications

Liberation and mortality outcomes in pediatric long‐term ventilation: A qualitative systematic review

Liberation and mortality outcomes in pediatric long‐term ventilation: A qualitative systematic review

Understanding the Spectrum of Treatment Options for Infants With Pierre Robin Sequence and Airway Obstruction

Predictors of longitudinal outcomes for children using long‐term noninvasive ventilation

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