Increased survival with invasive mechanical ventilation has come at the price of increased expense and complications in ventilation. Non-Invasive ventilation (NIV) is a realistic alternative for children who require moderate levels of respiratory support. We present a small cohort of patients who were treated with NIV in order to emphasize the widening application of this relatively low cost - low tech support.
Materials and Methods
This retrospective analysis over a period of 1 year showed that amongst 265 admissions in a PICU, 74 children (30%) required invasive ventilation whereas there were a total of 19 attempts of NIV in 11 children (4.1%).
The indications were acute hypoxemic respiratory failure (2 children) and as an adjunct to early extubation (7 children), post seizure hypoventilation (4 children) to provide positive pressure to overcome lung collapse (5 children) and neuromuscular disease in 1 child. BiPAP mode with an oro-nasal mask was used in 4 children and nasopharyngeal CPAP mode was used in 7 infants. Four attempts of NIV failed due to worsening of ongoing disease processes and these children had to be intubated. Among 19 attempts that were treated sequentially with invasive to noninvasive ventilation and vice versa, the total number of NIV days versus number of invasive ventilation days were 25 days versus 61 days. There were no complications due to NIV except facial ulceration seen in 1 child due to the mask and 1 child could not tolerate the NIV.
NIV holds an exciting promise to emerge as a modality that can be used increasingly as a low tech, low cost, low complication device for supporting a variety of conditions leading to moderate respiratory failure. It's relevance in the Indian scenario may be significant.
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