Intensive Care Medicine

, Volume 31, Issue 4, pp 574–580 | Cite as

Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure

  • Sandrine Essouri
  • Frédéric Nicot
  • Annick Clément
  • Erea-Noel Garabedian
  • Gilles Roger
  • Frédéric Lofaso
  • Brigitte FaurouxEmail author
Neonatal and Pediatric Intensive Care



This study evaluated the efficacy of noninvasive continuous positive pressure (CPAP) ventilation in infants with severe upper airway obstruction and compared CPAP to bilevel positive airway pressure (BIPAP) ventilation.

Design and setting

Prospective, randomized, controlled study in the pulmonary pediatric department of a university hospital.


Ten infants (median age 9.5 months, range 3—18) with laryngomalacia (n=5), tracheomalacia (n=3), tracheal hypoplasia (n=1), and Pierre Robin syndrome (n=1)


Breathing pattern and respiratory effort were measured by esophageal and transdiaphragmatic pressure monitoring during spontaneous breathing, with or without CPAP and BIPAP ventilation.

Measurements and results

Median respiratory rate decreased from 45 breaths/min (range 24–84) during spontaneous breathing to 29 (range 18–60) during CPAP ventilation. All indices of respiratory effort decreased significantly during CPAP ventilation compared to unassisted spontaneous breathing (median, range): esophageal pressure swing from 28 to 10 cmH2O (13–76 to 7–28), esophageal pressure time product from 695 to 143 cmH2O/s per minute (264–1417 to 98–469), diaphragmatic pressure time product from 845 to 195 cmH2O/s per minute (264–1417 to 159–1183) During BIPAP ventilation a similar decrease in respiratory effort was observed but with patient-ventilator asynchrony in all patients.


This short-term study shows that noninvasive CPAP and BIPAP ventilation are associated with a significant and comparable decrease in respiratory effort in infants with upper airway obstruction. However, BIPAP ventilation was associated with patient-ventilator asynchrony.


Continuous positive airway pressure ventilation Bilevel positive airway pressure ventilation Respiratory effort, upper airway obstruction Nasal ventilation Patient-ventilator asynchrony 


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Sandrine Essouri
    • 1
  • Frédéric Nicot
    • 2
  • Annick Clément
    • 2
  • Erea-Noel Garabedian
    • 3
  • Gilles Roger
    • 3
  • Frédéric Lofaso
    • 4
  • Brigitte Fauroux
    • 2
    Email author
  1. 1.Pediatric Intensive Care UnitKremlin-Bicetre Hospital, AP-HPParisFrance
  2. 2.Pediatric Pulmonary Department and INSERM U719Armand Trousseau Hospital, AP-HPParisFrance
  3. 3.Ear Nose and Throat DepartmentArmand Trousseau Hospital, AP-HPParisFrance
  4. 4.Physiology DepartmentRaymond Poincaré Hospital, AP-HPGarchesFrance

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