Review
Interfaces for noninvasive ventilation in the acute setting in children

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Summary

The use of noninvasive ventilation (NIV) is very specific in the acute setting as compared to its use in a chronic setting. In the Pediatric Intensive care Unit (PICU), NIV may be required around the clock and initiation has to be fast and easy. Despite the increasing use of non-invasive ventilation (NIV) and the larger choice of interfaces, data comparing the use of different interfaces for pediatric patients are scarce and recommendations for the most appropriate choice of interface are lacking. However, this choice in acute settings is crucial and a major contributor of the success of NIV. The aim of the present review was to describe the different types of interfaces available for children in the acute setting, their advantages and limitations, to highlight how to choose the optimal interface, and how to monitor the tolerance of the interface.

Introduction

Respiratory failure is the leading cause of hospital admissions in the pediatric intensive care unit (PICU) and nowadays noninvasive ventilation (NIV) represents the first-line treatment for acute respiratory failure [1], [2]. NIV is increasingly used in acute or chronic respiratory failure with various etiologies [3]. NIV in acute settings has been shown to be useful in critically ill children with bronchiolitis [2], [4], post extubation respiratory failure [5], pneumonia [6], acute chest syndrome [7], and status asthmaticus [8]. Moreover, findings regarding the benefits of NIV from clinical studies were confirmed by several physiological studies [9], [10].

The use of NIV is very specific in the acute setting as compared to its use in a chronic setting [11]. Indeed, in the PICU, NIV may be required around the clock and initiation has to be fast and easy. Different types of interfaces should be immediately available and the medical team should be experienced with the choice and the use of the different interfaces. Several types of interfaces are currently available: nasal mask, nasal prongs, oronasal mask, full face mask, and the helmet. Interfaces are characterized by different shapes, sizes, and materials. However, despite the increasing use of NIV and the larger choice of interfaces, data comparing the tolerance or efficacy of different interfaces for pediatric patients are scarce and recommendations for the most appropriate choice of interface are lacking [12], [13], [14], [15].

The aim of the present paper is to describe the different types of interfaces available for children in the acute setting, their advantages and limitations, to highlight how to choose the optimal interface, and how to monitor the tolerance of the interface.

Section snippets

Vented or non-vented ventilation?

Interfaces can be vented or non-vented, i.e with or without intentional leaks. In PICU, due to the performance and availability of ICU ventilators, most patients are supported by non-vented NIV with closed double-limb respiratory circuits [3]. On the other hand, most home ventilators and CPAP devices use a single limb circuit with vented interfaces. The appropriate selection of equipment, including an appropriate mask, circuit, device and device settings is essential for the success of NIV. The

Nasal interface

Nasal masks cover solely the nose and differ with regard to the presence or not of a forehead support, internal flap and type of fixation. Nasals masks are available for all ages, from the newborn to the adolescent. They are usually chosen as a first choice and are preferred to nasobuccal or full face masks due to the small static dead space, especially in the younger patients [16], [17]. Nasal masks are easy to apply and have the advantage of causing less anxiety, which may be a major issue in

The interface

The choice of the optimal interface for NIV in acute settings is challenging and of paramount importance for the success of NIV [47] (Table 2). In critically ill children, the ideal interface should be: (i) small, with minimal dead-space; (ii) causing minimal leaks; (iii) light-weight; (iv) easy to fit and remove; (v) nontraumatic; (vi) manufactured with nonallergenic material; (vii) cheap and (viii) having an appropriate and well-adapted headgear that confers stability preventing movement or

Conclusion

The choice of interface for NIV in the acute setting is crucial and a major contributor of the success of NIV. The availability of interfaces and headgears could certainly be improved and future pediatric studies are required to identify the best strategy to choose the interface, depending on the patient characteristics and condition.

Financial support

No financial support was required to perform this work.

Educational aims

The reader will come to appreciate that in critically ill children:

  • The ideal interface should be: small, inexpensive, comfortable, light-weight, easy to fit and remove.

  • The interface should manufactured with non-allergenic material and have appropriate and well-adapted headgear.

  • The choice of interface for NIV depends on patient's age, weight and clinical situation, facial anatomy the mode of ventilation and the type of circuit (vented or non-vented) and the risk of skin injury.

Directions for future research

  • The availability of interfaces and headgears could certainly be improved and future pediatric studies are required to identify the best strategy to choose the interface, depending on the patient characteristics and condition.

References (53)

  • E.P. Vichinsky et al.

    Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group

    N Engl J Med

    (2000)
  • J. Mayordomo-Colunga et al.

    Non-invasive ventilation in pediatric status asthmaticus: a prospective observational study

    Pediatr Pulmonol

    (2011)
  • S. Khirani et al.

    Continuous positive airway pressure titration in infants with severe upper airway obstruction or bronchopulmonary dysplasia

    Crit Care

    (2013)
  • S. Essouri et al.

    Physiological effects of noninvasive positive ventilation during acute moderate hypercapnic respiratory insufficiency in children

    Intensive Care Med

    (2008)
  • A. Amaddeo et al.

    Long-term non-invasive ventilation in children

    Lancet Respir Med

    (2016)
  • G. Conti et al.

    Mechanical ventilation for children

    Curr Opin Crit Care

    (2016)
  • C. Gregoretti et al.

    Non-invasive ventilation in pediatric intensive care

    Minerva Pediatr

    (2010)
  • A. Najaf-Zadeh et al.

    Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review

    Ann Intensive Care

    (2011)
  • J. Hull

    The value of non-invasive ventilation

    Arch Dis Child

    (2014)
  • B. Fauroux et al.

    Performance of ventilators for noninvasive positive-pressure ventilation in children

    Eur Respir J

    (2008)
  • W.B. de Carvalho et al.

    The fundamental role of interfaces in noninvasive positive pressure ventilation

    Pediatr Crit Care Med

    (2006)
  • L.J. Yanez et al.

    A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure

    Pediatr Crit Care Med

    (2008)
  • A. Najaf-Zadeh et al.

    Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review

    Ann Intensive Care

    (2011)
  • P. Navalesi et al.

    Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure

    Crit Care Med

    (2000)
  • C. Girault et al.

    Interface strategy during noninvasive positive pressure ventilation for hypercapnic acute respiratory failure

    Crit Care Med

    (2009)
  • A. Cuvelier et al.

    Cephalic versus oronasal mask for noninvasive ventilation in acute hypercapnic respiratory failure

    Intensive Care Med

    (2009)
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