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Inspiratory Muscle Training as an Adjunct to the Treatment of Weaning Failure in Critically Ill Patients: A Practical Guide
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Weaning from long term continuous positive airway pressure or noninvasive ventilation in children

Meriem Mastouri1,2, Alessandro Amaddeo1,3,4, Lucie Griffon1

  • 1Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.

Pediatric Pulmonology
|July 18, 2017
PubMed

Insights

Many children can stop long-term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV). Weaning success depends on the underlying disorder, often requiring surgery, and necessitates long-term follow-up.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Respiratory Care

Background:

  • Long-term use of continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) is common in children.
  • Limited data exists on the ability of children to discontinue these therapies, including the factors influencing successful weaning and patient outcomes.

Purpose of the Study:

  • To investigate the underlying disorders, weaning criteria, and clinical outcomes of children who discontinue long-term CPAP or NIV.
  • To identify factors associated with successful weaning from respiratory support in pediatric patients.

Main Methods:

  • A retrospective cohort study was conducted.
  • Consecutive children weaned from long-term CPAP/NIV between October 2013 and January 2016 were analyzed.
  • Underlying conditions, weaning protocols, and clinical outcomes were systematically reviewed.

Main Results:

  • Of 213 children on long-term CPAP/NIV, 58 (27%) were successfully weaned.
  • Common underlying conditions included upper airway anomalies, Prader-Willi syndrome, and bronchopulmonary dysplasia.
  • Weaning occurred due to spontaneous improvement (57%), upper airway surgery (24%), or maxillofacial surgery (11%). Relapse of obstructive sleep apnea occurred in 7 patients after a median of 2 years.

Conclusions:

  • Discontinuation of long-term CPAP/NIV in children is feasible but highly dependent on the specific underlying disorder.
  • While spontaneous improvement can occur, surgical intervention is frequently required for successful weaning.
  • Long-term monitoring is crucial for children with underlying conditions requiring respiratory support.
Abstract

Keywords:
childrencontinuous positive airway pressurenocturnal gas exchangenoninvasive ventilationpolysomnographysleep apnea

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