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Positive end-expiratory pressure in chronic care of children with obstructive sleep apnoea

Brigitte Fauroux1, Meryl Vedrenne-Cloquet2

  • 1Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, AP-HP, Paris, France; Université de Paris, EA 7330 VIFASOM, F-75004 Paris, France.

Paediatric Respiratory Reviews
|January 26, 2023
PubMed

Insights

Positive end-expiratory pressure (PEEP) helps keep airways open in children with severe obstructive sleep apnea. While expert guidelines exist, validated criteria for its chronic use are still needed, requiring multidisciplinary pediatric care.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Respiratory Care

Background:

  • Positive end-expiratory pressure (PEEP) maintains airway patency using noninvasive interfaces.
  • It is increasingly used for chronic management of pediatric obstructive sleep apnea (OSA) in children with upper airway abnormalities.
  • Improvements in equipment allow PEEP use across all age groups.

Purpose of the Study:

  • To review the current use of PEEP in pediatric chronic care.
  • To highlight the need for validated criteria in PEEP management.
  • To emphasize the importance of expert multidisciplinary team management for PEEP therapy.

Main Methods:

  • Review of current literature and expert guidelines on PEEP use in children.
  • Analysis of indications, settings, monitoring, and weaning of PEEP.
  • Discussion of challenges and future directions in pediatric PEEP therapy.

Main Results:

  • International experts have established criteria for PEEP initiation, settings, follow-up, and weaning.
  • Validated criteria for chronic PEEP use in children are currently lacking.
  • PEEP is effective for severe persistent OSA when other treatments fail.

Conclusions:

  • Chronic PEEP is a specialized treatment for pediatric obstructive sleep apnea.
  • Management requires an expert pediatric multidisciplinary team.
  • Further research is needed to establish validated criteria for PEEP therapy.

Keywords:
ChildContinuous positive airway pressure (CPAP)Home carePositive end-expiratory pressure (PEEP)

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