Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi. Correspondence to: Dr Rakesh Lodha, Professor, Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, New Delhi,110 029.
Indian Pediatr. 2021 Nov 15;58(11):1077-1084. doi: 10.1007/s13312-021-2377-1. Epub 2021 May 3.
Non-Invasive respiratory support can be viewed as mechanical respiratory support without endotracheal intubation and it includes continuous positive airway pressure, bi-level positive airway pressure, high flow nasal cannula, and non-invasive positive pressure ventilation. Over past few years, non-invasive respiratory support is getting more popular across pediatric intensive care units for acute respiratory failure as well as for long-term ventilation support at home. It reduces the need for invasive mechanical ventilation, decreases the risk of nosocomial pneumonia as well as mortality in selected pediatric and adult population. Unfortunately, majority of available studies on non-invasive respiratory support have been conducted in high-income countries, which are different from low- and middle-income countries (LMICs) in terms of resources, manpower, and the disease profile. Hence, we need to consider disease profile, severity at hospital presentation, availability of age-appropriate equipment, ability of healthcare professionals to manage patients on non-invasive respiratory support, and cost-benefit ratio. In view of the relatively high cost of equipment, there is a need to innovate to develop indigenous kits/ devices with available resources in LMICs to reduce the cost and potentially benefit health system. In this review, we highlight the role of non-invasive respiratory support in different clinical conditions, practical problems encountered in LMICs setting, and few indigenous techniques to provide non-invasive respiratory support.
无创呼吸支持可被视为无需气管插管的机械性呼吸支持，包括持续气道正压通气、双水平气道正压通气、高流量鼻导管和无创正压通气。在过去几年中，无创呼吸支持在儿科重症监护病房（PICU）急性呼吸衰竭以及家庭长期通气支持中越来越受欢迎。它降低了有创机械通气的需求，降低了选定儿科和成人人群中医院获得性肺炎和死亡率的风险。不幸的是，大多数关于无创呼吸支持的现有研究都是在高收入国家进行的，这些国家在资源、人力和疾病谱方面与中低收入国家（LMICs）不同。因此，我们需要考虑疾病谱、入院时的严重程度、是否有适合年龄的设备、医护人员管理无创呼吸支持患者的能力以及成本效益比。鉴于设备成本相对较高，需要创新，利用 LMICs 中的现有资源开发本土套件/设备，以降低成本并可能使卫生系统受益。在本文中，我们强调了无创呼吸支持在不同临床情况下的作用、在 LMICs 环境中遇到的实际问题以及提供无创呼吸支持的一些本土技术。
