Interfaces for long-term noninvasive positive pressure ventilation in children

Abstract

Objective: The aim of the study was to report the type and tolerance of the interface chosen for long-term noninvasive positive pressure ventilation (NPPV) in children.

Methods: This was a descriptive study carried out in the clinical setting of a pediatric university hospital in which all children started on long-term NPPV over a 18-month period were included.

Results: NPPV was started in 97 children with neuromuscular disease or thoracic scoliosis (n = 35), obstructive sleep apnea with (n = 32) or without (n = 21) maxillofacial deformity, or lung disease (n = 9). All 25 children ≤ 2 years of age, as well as four older children, were fitted with custom-made nasal masks; all other children were fitted with an industrial nasal mask (50%), a facial mask (16%), or nasal prongs (2%). Industrial masks with and without manufactured leaks were used in 33 (34%) and 35 (36%) children, respectively. All patients with obstructive sleep apnea used interfaces with manufactured leaks, whereas all patients with neuromuscular disease or thoracic scoliosis used interfaces without manufactured leaks. Both types of interfaces were used in patients with lung disease. The interface had to be changed in 20 patients because of discomfort (n = 16), leaks (n = 4), facial growth (n = 3), skin injury (n = 2), or change of the ventilatory mode (n = 2). A second or third mask change was necessary in nine and four patients, respectively.

Conclusion: 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.