Postextubation Noninvasive Respiratory Support in Children

Abstract

Infants and children frequently require mechanical ventilation. Daily extubation readiness testing is currently recommended to minimize time on mechanical ventilation, which is associated with the development of morbidities. Re-intubation rates vary between patient populations and have been associated with significant adverse patient outcomes, including increased length of stay and mortality. Noninvasive respiratory support (NRS) is often used to help decrease the risk of re-intubation. NRS encompasses high-flow nasal cannula (HFNC), CPAP, noninvasive ventilation, and negative-pressure ventilation. This article will cover risk factors for re-intubation, assessing extubation readiness, rationale for NRS use, delivery systems for NRS, evidence for various NRS modalities, how to choose NRS modalities, practical considerations, and future research opportunities.

Keywords: CPAP noninvasive ventilation; bilevel; children; extubation failure; high-flow nasal cannula; infants; mechanical ventilation; negative pressure ventilation; noninvasive respiratory support; pediatrics; re-intubation; ventilator liberation.