Long-term non-invasive positive airway pressure ventilation in infants.
OBJECTIVE
To evaluate the clinical application of long-term non-invasive ventilation (NIV) in infants with life-threatening ventilatory failure with regard to: diagnosis, age at initiation, indication for and duration of treatment, clinical outcome and mortality and adverse effects.


METHODS
The medical records of 18 infants treated in a home setting during a 7-year period were reviewed. The criteria for ventilatory support were: (a) transcutaneous partial pressures of carbon dioxide (TcPCO(2)) >6.5 kPa and oxygen (TcPO(2)) < 8.5 kPa and (b) decreased cough ability and/or recurrent chest infections.


RESULTS
The median age at initiation was 4 months (range 1-12). NIV was initiated because of hypoventilation in 12 infants and because of reduced cough ability and/or recurrent infections in six infants. Tracheotomy was eventually needed in two infants. The median duration of treatment was 24 months (range 1-84). NIV produced significant improvements, with median TcPCO(2) falling from 9.9 to 6.1 kPa, and median TcPO(2) rising from 9.8 to 11.1 kPa.


CONCLUSIONS
NIV can be successfully and safely used in infants with prolonged life-threatening ventilatory failure, potentially avoiding intubation and tracheotomy.
Markström
Agneta
A
Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Div of Anaesthesiology and Intensive Care, Stockholm, Sweden. agneta.markstrom@ds.se
Sundell
Kerstin
K
Stenberg
Nader
N
Katz-Salamon
Miriam
M