Non-invasive positive pressure ventilation: current status in paediatric patients

Non-invasive positive pressure ventilation (NPPV) is a treatment for patients with respiratory dysfunction accomplished by an external interface and a positive pressure ventilator. The goals of NPPV therapy are to decrease the work of breathing and to improve respiratory gas exchange. Children with respiratory dysfunction are increasingly being treated with NPPV with the belief that it is a safe and effective alternative to invasive mechanical ventilation. Reports in support of NPPV are most promising in older children with chronic respiratory failure associated with restrictive pulmonary disorders and neuromuscular weakness. In children with advanced cystic fibrosis and nocturnal hypoxaemia, NPPV appears to be superior to treatment with supplemental oxygen alone in preventing hypoventilation. The role of NPPV in children with acute hypoxaemic respiratory failure is less well defined. Although early reports are encouraging, the question remains unanswered whether early application of NPPV as opposed to standard treatment reduces the likelihood or only delays the need for invasive mechanical ventilation. As young infants may not trigger the inspiratory pressure support feature of bi-level ventilators, application of NPPV with current devices is problematic in patients of this age. The horizon is promising for NPPV in the paediatric population and will likely include novel interfaces and responsive positive pressure devices better suited to the unique mechanical properties of the developing respiratory system.