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Noninvasive Ventilation and Mechanical Insufflator-Exsufflator for Acute Respiratory Failure in Children With

Tai-Heng Chen1,2,3, Jong-Hau Hsu1,4

  • 1Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Frontiers in Pediatrics
|November 16, 2020
PubMed

Insights

Children with neuromuscular disorders (NMD) often face respiratory failure. Noninvasive ventilation (NIV) combined with mechanical insufflator-exsufflator (MI-E) shows promise for treating acute respiratory failure in these pediatric patients.

Area of Science:

  • Pediatric Pulmonology
  • Neuromuscular Disorders
  • Critical Care Medicine

Background:

  • Children with neuromuscular disorders (NMD) frequently experience pulmonary complications, including respiratory muscle weakness and impaired airway secretion clearance.
  • These vulnerabilities increase the risk of acute respiratory failure (ARF) when community-acquired pneumonia occurs, contributing to mortality in NMD.
  • Noninvasive ventilation (NIV) is increasingly recognized for its role in managing chronic hypoventilation and acute respiratory failure in NMD.

Purpose of the Study:

  • To review the feasibility and effectiveness of combined noninvasive ventilation (NIV) and mechanical insufflator-exsufflator (MI-E) for treating acute respiratory failure (ARF) in pediatric patients with neuromuscular disorders (NMD).
  • To explore predictors of outcome and novel applications for this combined therapy in managing acute neuromuscular respiratory failure.

Main Methods:

  • Review of recent studies and clinical evidence on the use of NIV and MI-E in pediatric NMD patients with ARF.
  • Analysis of factors influencing NIV failure, particularly secretion clearance challenges.
  • Examination of existing research gaps, including the limited number of randomized controlled trials.

Main Results:

  • Combined NIV and MI-E has demonstrated feasibility and effectiveness in acute care settings for pediatric NMD patients with ARF.
  • This combination therapy offers benefits such as avoiding invasive ventilation, reducing hospital stays, and improving survival.
  • Difficulty in clearing secretions is a key risk factor for NIV failure, highlighting the importance of MI-E.

Conclusions:

  • Combined NIV and MI-E represents a valuable treatment strategy for acute respiratory failure in children with NMD.
  • Further research, particularly randomized controlled trials, is needed to establish evidence-based guidelines for this combined approach.
  • Understanding predictors of outcome and exploring novel applications will optimize the management of these vulnerable patients.

Keywords:
acute respiratory failuremechanically assisted coughingneuromuscular disordernoninvasive ventilationrisk factors

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