Paediatric NonInvasive Ventilation

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Paediatric Non-Invasive Ventilation

• Sheffield Childrens NHS Foundation Trust
• PCCU

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Definition

• Non-Invasive Ventilation
• The provision of ventilatory support through the
  patients upper airway using a mask or similar
  device. Distinguished from those which bypass
  the upper airway with a tracheal tube, laryngeal
  mask, or tracheostomy.
• BTS (2002)

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Physiological Principles

• CPAP e.g. CPAP driver
• Increases oxygenation
• Maintains air in lungs at end of expiration
  splints open airways
• BIPAP what we call NIV
• Decreases effort of breathing
• Increases tidal volume
• Improves CO2 clearance

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Use in paediatrics

• Acute respiratory illness (with or without
  respiratory insufficiency)
• Increased O2 requirements
• Increased effort of breathing
• Focal CXR changes
• Weaning from ventilation (with or without
  respiratory insufficiency)
• electively or if fail extubation
• Palliation CF/oncology/neurodisability

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Exclusions

• Undrained pneumothorax
• Facial trauma/burns
• Inability to tolerate mask
• CVS instability
• Sepsis/Multisystem organ failure
• Abdominal distension/vomiting
• Decreased GCS
• FiO2 gt0.7?

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Set up

• Prepare equipment
• Mask fitting/headgear
• Persuasion and slow introduction if needed!
• Observe patient
• Chest movement/synchronisation
• Auscultation
• Gases
• CXR
• Supplementary Oxygen
• Humidification

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Masks we use
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Practical care

• Regular NP/oral suction
• Keep face and mask clean
• Pressure care
• Turn regularly lung drainage and comfort
• Hygiene care
• Hydration/nutrition abdo.distension (NG/gast)
• Fluid balance
• Drugs sedation if needed, antibiotics,
  diuretics
• Monitoring and recording
• Family

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Deterioration

• If child deteriorates may see
• Drop in SpO2
• Stop synchronising
• Increased work of breathing
• Drop in tidal volume
• Tachycardia and tachypnoea

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Pandemic flu ventilation

• May deteriorate too fast for NIV to be helpful
• But ......

• Could be used with other patients
• Could be used for weaning off ventilation
• Could be used for less-sick patients

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Questions
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Masks we use