Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure
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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.
KeywordsContinuous positive airway pressure ventilation Bilevel positive airway pressure ventilation Respiratory effort, upper airway obstruction Nasal ventilation Patient-ventilator asynchrony
- 1.Rupa V, Raman R (1991) Aetiological profile of paediatric laryngeal stridor in an Indian hospital. Ann Trop Paediatr 11:137–141Google Scholar
- 2.Altman KW, Wetmore RF, Marsch RR (1997) Congenital abnormalities requiring tracheotomy: a profile of 56 patients and their diagnosis over a 9 year period. Int J Pediatr Otorhinolaryngol 41:199–206Google Scholar
- 3.Holinger LD (1980) Etiology of stridor in the neonate and child. Ann Otol Rhinol Laryngol 89:397–400Google Scholar
- 4.Lis G, Szczerbinski T, Cichocka-Jarosz E (1995) Congenital stridor. Pediatr Pulmonol 20:220–224Google Scholar
- 5.Altman KW, Wetmore RF, Marsch RR (1999) Congenital airway abnormalities in patients requiring hospitalisation. Arch Otolaryngol Head Neck Surg 125:525–528Google Scholar
- 6.McSwiney PF, Cavanagh NP, Languth P (1977) Outcome in congenital stridor (laryngomalacia). Arch Dis Child 52:215–218Google Scholar
- 7.Denoyelle F, Mondain M, Gresillon N, Roger G, Chaudré F, Garabédian EN (2003) Failures and complications of supraglottoplasty in children. Arch Otolaryngol Head Neck Surg 129:1077–1080Google Scholar
- 8.Guilleminault C, Pelayo R, Clerk A, Leger D, Boclan RC (1995) Home nasal continuous positive airway pressure in infants with sleep-disordered breathing. J Pediatr 127:905–912Google Scholar
- 9.Waters KA, Everett FM, Bruderer JW, Sullivan CE (1995) Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med 152:780–785Google Scholar
- 10.Fauroux B, Pigeot J, Polkey MI, Roger G, Boulé M, Clément A, Lofaso F (2001) Chronic stridor caused by laryngomalacia in children. Work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med 164:1874–1878Google Scholar
- 11.Downey III R, Perkin RM, MacQuarrie J (2000) Nasal continuous positive airway pressure use in children with obstructive sleep apnea younger than 2 years of age. Chest 117:1608–1612Google Scholar
- 12.Sanders MH, Kern N (1990) Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Chest 98:317–324Google Scholar
- 13.Gaultier C, Boulé M, Allaire Y, Clément A, Burry A, Girard F (1978) Determination of capillary oxygen tension in infants and children: assessment of methodology and normal values during growth. Bull Euro Physiopathol Respir 14:287–294Google Scholar
- 14.Stell IM, Tompkins S, Lovell AT, Goldstone JC, Moxham J (1999) An in vivo comparison of a catheter mounted pressure transducer system with conventional balloon catheters. Eur Respir J 13:1158–1163Google Scholar
- 16.Sassoon CSH, Light RW, Lodia R, Sieck GC, Mahutte CK (1991) Pressure-time product during continuous positive airway pressure, pressure support ventilation and T-piece during weaning from mechanical ventilation. Am Rev Respir Dis 143:459–475Google Scholar
- 17.Field S, Sanci S, Grassino A (1984) Respiratory muscle oxygen consumption estimated by the diaphragm pressure-time index. J Appl Physiol 57:44–51Google Scholar
- 18.Barnard P, Levine S (1986) Critique on application of diaphragmatic time-tension index to spontaneously breathing humans. J Appl Physiol 60:1067–1072Google Scholar
- 19.Parthasarathy S, Jubran A, Tobin M (2000) Assessment of neural inspiratory time in ventilator-supported patients. Am J Respir Crit Care Med 162:546–552Google Scholar
- 20.Lofaso F, Brochard L, Hang T, Lorino H, Harf A, Isabey D (1996) Home versus intensive care pressure support devices. Experimental and clinical comparison. Am J Respir Crit Care Med 153:1591–1599Google Scholar
- 21.Parthasarathy S, Jubran A, Tobin MJ (1998) Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med 158:1471–1478Google Scholar
- 22.Vanpee D, El Khawand C, Rousseau L, Jamart J, Delaunois L (2002) Effects of nasal pressure support on ventilation and inspiratory work in normocapnic and hypercapnic patients with stable COPD. Chest 122:75–83Google Scholar
- 23.Vitacca M, Barbano L, D’Anna S, Porta R, Bianchi L, Ambrosino N (2002) Comparison of five bilevel pressure ventilators in patients with chronic ventilatory failure. Chest 122:2105–2114Google Scholar
- 24.Tassaux D, Strasser S, Fonseca S, Dalmas E, Jolliet P (2002) Comparative bench study of triggering, pressurization, and cycling between the home ventilator VPAP II and three ICU ventilators. Intensive Care Med 28:1254–1261Google Scholar
- 25.Calderini E, Confalonieri M, Puccio PG, Francavilla N, Stella L, Gregoretti C (1999) Patient-ventilator asynchrony during noninvasive ventilation: the role of the expiratory trigger. Intensive Care Med 25:622–667Google Scholar
- 26.Stell IM, Paul G, Lee KC, Ponte J, Moxham J (2001) Noninvasive ventilator triggering in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164:2092–2097Google Scholar
- 27.Sharshar T, Desmarais G, Louis B, Macadou G, Porcher R, Harf A, Raphael JC, Isabey D, Lofaso F (2003) Transdiaphragmatic pressure control of airway pressure support in healthy subjects. Am J Respir Crit Care Med 168:760–769Google Scholar
- 28.Teschler H, Stampa J, Ragette R, Konietzko N, Berthon-Jones M (1999) Effect of mouth leak on effectiveness of nasal bilevel ventilatory assistance and sleep architecture. Eur Respir J 14:1251–1257Google Scholar
- 29.Fauroux B, Lavis JF, Nicot F, Picard A, Clément A, Vazquez MP (2004) Tolerance of nasal masks used for positive pressure ventilation in children. Eur Respir J 24:474SGoogle Scholar