Noninvasive ventilation in infants and children

Noninvasive ventilation provides respiratory support without airway invasion. It is defined by interface between the ventilator and the patient rather than any specific technique. It has the advantage for allowing the patients a greater degree of autonomy, control and comfort in that they can talk, eat and drink while receiving ventilatory support. There is also a trend of less need for sedation. In addition, nosocomial ventilator associated infections may be diminished. Noninvasive ventilation has been used in the management of adults with acute respiratory failure for decades, however it is only in the last few years that the benefits in children had been recognized and accepted. Technical difficulties with noninvasive ventilation in children such as poor mask fitting, inadequate ventilation because of leaks, and eye irritation and nasal dryness due to high flow have been recognized and are being addressed to varying degrees. Recent attention to mask, helmet and strapping device designs, and proper positioning have improved patient compliance and acceptance. However even with these modifications, the use of noninvasive ventilation is limited in patients with congenital facial anomalies which preclude a tight fitting mask. It is also difficult to apply in conditions when there is a potential infection such as facial trauma or burns. In this manuscript, the authors discuss the role of noninvasive ventilation in infants and children.