management effect of nippv in children may stabilize or even improve lung function in non-...
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Management Effect of NIPPV in children
May stabilize or even improve lung function in non-progressive, slowly progressive diseases [Barois et al 1992& 2005, Canani et al 1997]
May stabilize lung function in rapidly progressive diseases [Rideau et al 1995]
Mechanism Resting muscles Increased lung compliance Reduced sleep fragmentation [Barbe et al 1996] Resetting of chemoreceptors [Annane et al 1998]
Kirk et al 2000
Mellies et al 2004
Copyright ©2005 BMJ Publishing Group Ltd.
Ward, S et al. Thorax 2005;60:1019-1024
Figure 2 Difference between baseline values and those at 6, 12, 18 and 24 months in (A) peak nocturnal TcCO2, (B) mean nocturnal time TcCO2 >6.5 kPa, (C) mean nocturnal SaO2, and (D) mean minimum nocturnal SaO2; p values given at 6 and 24 months. Error bars represent SE.
Simonds, A. K. Chest 2006;130:1879-1886
Impact of NIV therapy on survival time in hypercapnic DMD patients
Management NIPPV in children
Two important factors [Panitch 2006] Patient-ventilator synchrony Interface fit and comfort
Complications: skin breakdown, sinus and ear pain, eye irritation,
gastric distention, excessive leak auto-trigger (nasal prongs) Flattening of facial structures [Li et al 2000, Villa et al
2002, Fauroux et al 2005]
Management Transition to adult care
Young adults who started mechanical support in childhood, cont their care in pediatric center
Pediatric program may no address adult issues Decision making, daily function, and quality of life
[Miller et al 1990, Bach et al 1991, Gibson 2001]
Management Medical-Ethical Decision
most difficult even when the prognosis is poor. Physicians underestimate the quality of life perceived by
ventilator-dependent NMD patients [Bach et al 1991] Negative perception contribute to failure to offer
mechanical ventilatory support option [Gibson 2001] Discussion about mechanical ventilation should occur well
before its need is apparent [ATS consensus 2004] End of life care