Praud Jean-Paul
Division of Pediatric Pulmonology, University of Sherbrooke, Sherbrooke, QC, Canada.
Front Pediatr. 2020 Nov 5;8:584334. doi: 10.3389/fped.2020.584334. eCollection 2020.
This review focuses on the delivery of non-invasive ventilation-i.e., intermittent positive-pressure ventilation-in children lasting more than 3 months. Several recent reviews have brought to light a dramatic escalation in the use of long-term non-invasive ventilation in children over the last 30 years. This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT-NIV equipment that can be used at home. While significant gaps in availability persist for smaller children and especially infants, home LT-NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care. While long-term NIV is usually delivered during sleep, it can also be delivered 24 h a day in selected patients. Close collaboration between the hospital complex-care team, the home LT-NIV program, and family caregivers is of the utmost importance for successful home LT-NIV. Long-term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation, with the aim to increase life expectancy and maximize quality of life. LT-NIV is considered for conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall anomalies). Relative contraindications for LT-NIV include the inability of the local medical infrastructure to support home LT-NIV and poor motivation or inability of the patient/caregivers to cooperate or understand recommendations. Anatomic abnormalities that interfere with interface fitting, inability to protect the lower airways due to excessive airway secretions and/or severely impaired swallowing, or failure of LT-NIV to support respiration can lead to considering invasive ventilation via tracheostomy. Of note, providing home LT-NIV during the COVID 19 pandemic has become more challenging. This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS-CoV-2 during NIV. Delay in initiating LT-NIV, decreased frequency of home visits by the home ventilation program, and decreased availability of polysomnography and oximetry/transcutaneous PCO monitoring are observed. Teleconsultations and telemonitoring are being developed to mitigate these challenges.
本综述聚焦于为持续3个月以上的儿童提供无创通气，即间歇正压通气。最近的几项综述揭示，在过去30年里，儿童长期无创通气的使用急剧增加。这既是因为接受复杂和严重疾病护理且需要呼吸支持的儿童数量不断增加，也是因为有可在家中使用的长期无创通气设备。虽然较小儿童尤其是婴儿在设备可用性方面仍存在显著差距，但为慢性呼吸功能不全儿童提供家庭长期无创通气改善了他们的生活质量，并降低了总体护理成本。虽然长期无创通气通常在睡眠期间进行，但在特定患者中也可每天24小时进行。医院综合护理团队、家庭长期无创通气项目和家庭护理人员之间的密切合作对于成功开展家庭长期无创通气至关重要。长期无创通气适用于导致慢性肺泡通气不足的呼吸系统疾病，目的是延长预期寿命并最大限度提高生活质量。对于影响呼吸肌功能（中枢呼吸驱动或神经肌肉功能改变）和/或施加过度呼吸负荷（气道阻塞、肺部疾病或胸壁异常）的情况，可考虑采用长期无创通气。长期无创通气的相对禁忌证包括当地医疗基础设施无法支持家庭长期无创通气，以及患者/护理人员缺乏积极性或无法合作或理解建议。干扰接口适配的解剖异常、由于气道分泌物过多和/或吞咽严重受损而无法保护下呼吸道，或长期无创通气无法支持呼吸，可能导致考虑通过气管造口进行侵入性通气。值得注意的是，在新冠疫情期间提供家庭长期无创通气变得更具挑战性。这既是因为医疗系统中断，也是因为担心在无创通气期间，感染新冠病毒的患者产生的气溶胶会污染护理人员和家庭。观察到启动长期无创通气出现延迟、家庭通气项目的家访频率降低，以及多导睡眠图和血氧饱和度/经皮二氧化碳监测的可用性降低。正在开发远程会诊和远程监测以应对这些挑战。
