Noninvasive pressure support ventilation for acute respiratory failure in children

Noninvasive ventilation is becoming widely accepted not only for treatment of chronic but also acute respiratory failure of various aetiology in children. However, thus far, there is only empirical evidence that this treatment is safe and effective in improving oxygenation and alveolar ventilation and in obviating endotracheal intubation in many cases. With this limited experience it is difficult to define the ideal candidate who will respond to a noninvasive ventilation trial. Infants and small children are at high risk of developing respiratory fatigue and, consecutively, respiratory failure due to structural and functional properties of their developing respiratory system. This may justify early noninvasive pressure support ventilation as soon as clinical signs of impending respiratory failure develop and before physiological evidence of acute respiratory failure with respiratory acidosis and/or hypoxaemia are present. For the success of noninvasive ventilation in the acute care setting, the correct choice and adaptation of the patient-machine interface and the delivery system are crucial. Furthermore, medical and nursing staff must be familiar with child-specific respiratory physiology and mechanics. Well controlled randomised prospective trials in children presenting with acute respiratory failure will be needed to evaluate the treatment's effectiveness and safety, and to better define the patient likely to benefit from this alternative method of respiratory support.