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in Pediatrics
Ira M. Cheifetz, MD, FCCM, FAARC
Professor of Pediatrics
Chief, Pediatric Critical Care
Medical Director, PICU and Peds Resp Care
Duke Children ’s Hospital
Children’s
Do you use noninvasive
ventilation for children in the
acute ICU setting?
♦ If yes, do you have convincing data to
support your practice?
Everyone
70
60
% intubated
50
40
30
20
10
0
Brochard Vitacca Brochard Kramer Wysocki Confalonieri
1990 1993 1995 1995 1995 1996
♦ Why?
– avoid intubation
– facilitate extubation
– ↓ length of ventilation
Real Life Situation
♦ 7 month old infant (5.9 kg)
– airway injury
– nosocomial pneumonia
Potential Applications
♦ Hypoxemic respiratory failure / ALI
– pneumonia, aspiration, any etiology
♦ Upper and lower airway obstruction
– subglottic stenosis; tracheolaryngomalacia
– asthma; bronchiolitis
♦ Neuromuscular weakness
– critical illness myopathy
– spinal muscular atrophy
♦ Application should be based on patho-
physiology; not necessarily on diagnosis
Potential Applications
♦ Special populations
– immunosuppressed patients;
s/p bone marrow transplantation
– chronic lung disease;
bronchopulmonary dysplasia
♦ Overall goals
– avoid intubation
– encourage prompt extubation
– ↓ length of ventilation
Pediatric NIV: Summary
♦ Technology (which is as good as the ‘adult’
products) does not currently exist for infants
and small children.
♦ Interfaces are probably the biggest challenge.
♦ Clinical need for technology does exist.
♦ Need more pediatric data, but the use of NIV
in pediatrics seems reasonable based on
extrapolation from the neonatal and adult
populations.
♦ Need consistent guidelines / protocols.
Pediatric NIV: Summary
♦ Use of NIV in the pediatric population is
growing at an increasing rate.
♦ Is it worth the effort?
– yes
– probably