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01-12-2008 | Pediatric Original

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

Authors: Sandrine Essouri, Philippe Durand, Laurent Chevret, Vincent Haas, Claire Perot, Annick Clement, Denis Devictor, Brigitte Fauroux

Published in: Intensive Care Medicine | Issue 12/2008

Abstract

Introduction

A prospective physiological study was performed in 12 paediatric patients with acute moderate hypercapnic respiratory insufficiency to assess the ability of noninvasive positive pressure ventilation (NPPV) to unload the respiratory muscles and improve gas exchange.

Materials and methods

Breathing pattern, gas exchange, and inspiratory muscle effort were measured during spontaneous breathing and NPPV.

Results

NPPV was associated with a significant improvement in breathing pattern, gas exchange and respiratory muscle output. Tidal volume and minute ventilation increased by 33 and 17%, and oesophageal and diaphragmatic pressure time product decreased by 49 and 56%, respectively. This improvement in alveolar ventilation translated into a reduction in mean partial pressure in carbon dioxide from 48 to 40 mmHg (P = 0.01) and in respiratory rate from 48 to 41 breaths/min (P = 0.01). No difference between a clinical setting and a physiological setting of NPPV was observed. In conclusion, this study shows that NPPV is able to unload the respiratory muscles and improve clinical outcome in young patients admitted to the paediatric intensive care unit for acute moderate hypercapnic respiratory insufficiency.

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Bernet V, Hug MI, Frey B (2005) Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med 6:660–664PubMedCrossRef

Essouri S, Chevret L, Durand P, Haas V, Fauroux B, Devictor D (2006) Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med 7:329–334PubMedCrossRef

Fortenberry JD, Del Toro J, Jefferson LS, Evey L, Haase D (1995) Management of pediatric acute hypoxemic respiratory insufficiency with bilevel positive pressure (BiPAP) nasal mask ventilation. Chest 108:1059–1064PubMedCrossRef

Padman R, Lawless ST, Kettrick RG (1998) Noninvasive ventilation via bilevel positive airway pressure support in pediatric practice. Crit Care Med 26:169–173PubMedCrossRef

Teague WG (2003) Noninvasive ventilation in the pediatric intensive care unit for children with acute respiratory failure. Pediatr Pulmonol 35:418–426PubMedCrossRef

Essouri S, Nicot F, Clement A, Garabedian EN, Roger G, Lofaso F, Fauroux B (2005) Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure. Intensive Care Med 31:574–580PubMedCrossRef

Fauroux B, Lofaso F (2005) Non-invasive mechanical ventilation: when to start for what benefit? Thorax 60:979–980PubMedCrossRef

Fauroux B, Louis B, Hart N, Essouri S, Leroux K, Clement A, Polkey MI, Lofaso F (2004) The effect of back-up rate during non-invasive ventilation in young patients with cystic fibrosis. Intensive Care Med 30:673–681PubMedCrossRef

Fauroux B, Nicot F, Essouri S, Hart N, Clement A, Polkey MI, Lofaso F (2004) Setting of noninvasive pressure support in young patients with cystic fibrosis. Eur Respir J 24:624–630PubMedCrossRef

10.

Fauroux B, Pigeot J, Polkey MI, Isabey D, Clement A, Lofaso F (2001) In vivo physiologic comparison of two ventilators used for domiciliary ventilation in children with cystic fibrosis. Crit Care Med 29:2097–2105PubMedCrossRef

11.

GBaRA Goldstein B (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8CrossRef

12.

Baydur A, Behrakis PK, Zin WA, Jaeger M, Milic-Emili J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 126:788–791PubMed

13.

Barnard PA, Levine S (1986) Critique on application of diaphragmatic time-tension index to spontaneously breathing humans. J Appl Physiol 60:1067–1072PubMed

14.

Field S, Sanci S, Grassino A (1984) Respiratory muscle oxygen consumption estimated by the diaphragm pressure-time index. J Appl Physiol 57:44–51PubMed

15.

Sassoon CS, Light RW, Lodia R, Sieck GC, Mahutte CK (1991) Pressure-time product during continuous positive airway pressure, pressure support ventilation, and T-piece during weaning from mechanical ventilation. Am Rev Respir Dis 143:469–475PubMed

16.

Akingbola OA, Simakajornboon N, Hadley EF Jr, Hopkins RL (2002) Noninvasive positive-pressure ventilation in pediatric status asthmaticus. Pediatr Crit Care Med 3:181–184PubMedCrossRef

17.

Thill PJ, McGuire JK, Baden HP, Green TP, Checchia PA (2004) Noninvasive positive-pressure ventilation in children with lower airway obstruction. Pediatr Crit Care Med 5:337–342PubMedCrossRef

18.

Fauroux B, Boffa C, Desguerre I, Estournet B, Trang H (2003) Long-term noninvasive mechanical ventilation for children at home: a national survey. Pediatr Pulmonol 35:119–125PubMedCrossRef

19.

Fauroux B, Boule M, Lofaso F, Zerah F, Clement A, Harf A, Isabey D (1999) Chest physiotherapy in cystic fibrosis: improved tolerance with nasal pressure support ventilation. Pediatrics 103:E32PubMedCrossRef

20.

Fauroux B, Pigeot J, Polkey MI, Roger G, Boule M, Clement A, Lofaso F (2001) Chronic stridor caused by laryngomalacia in children: work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med 164:1874–1878PubMed

21.

L’Her E, Deye N, Lellouche F, Taille S, Demoule A, Fraticelli A, Mancebo J, Brochard L (2005) Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med 172:1112–1118PubMedCrossRef

22.

Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Umberto Meduri G (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 160:1585–1591PubMed

23.

Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A (2003) Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:1438–1444PubMedCrossRef

24.

Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487PubMedCrossRef

25.

Georgopoulos D, Prinianakis G, Kondili E (2006) Bedside waveforms interpretation as a tool to identify patient-ventilator asynchronies. Intensive Care Med 32:34–47PubMedCrossRef

26.

Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32:1515–1522PubMedCrossRef

27.

Imanaka H, Nishimura M, Takeuchi M, Kimball WR, Yahagi N, Kumon K (2000) Autotriggering caused by cardiogenic oscillation during flow-triggered mechanical ventilation. Crit Care Med 28:402–407PubMedCrossRef

28.

Deye N, Lellouche F, Maggiore S, Taille S, Lefrançais F, Pignataro C, Fartoukh M, Harf A, Brochard L (2002) Influene of body posture on the effort to breathe in mechanically ventilated patients. Am J Respir Crit Care Med 165

29.

Giannouli E, Webster K, Roberts D, Younes M (1999) Response of ventilator-dependent patients to different levels of pressure support and proportional assist. Am J Respir Crit Care Med 159:1716–1725PubMed

30.

Piastra M, Antonelli M, Chiaretti A, Polidori G, Polidori L, Conti G (2004) Treatment of acute respiratory failure by helmet-delivered non-invasive pressure support ventilation in children with acute leukemia: a pilot study. Intensive Care Med 30:472–476PubMedCrossRef

31.

Teague WG (2005) Non-invasive positive pressure ventilation: current status in paediatric patients. Paediatr Respir Rev 6:52–60PubMedCrossRef

32.

Al-Majed SI, Thompson JE, Watson KF, Randolph AG (2004) Effect of lung compliance and endotracheal tube leakage on measurement of tidal volume. Crit Care 8:R398–402PubMedCrossRef

Title: Physiological effects of noninvasive positive ventilation during acute moderate hypercapnic respiratory insufficiency in children
Authors: Sandrine Essouri
Philippe Durand
Laurent Chevret
Vincent Haas
Claire Perot
Annick Clement
Denis Devictor
Brigitte Fauroux
Publication date: 01-12-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 12/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1202-9

At a glance: The STEP trials

Springer Medicine

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

Abstract

Introduction

Materials and methods

Results

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

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