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Predictors of NIV-related adverse events in children using long-term noninvasive ventilation
Prabhjot K Bedi1,2, Kristie DeHaan3, Daniel Ofosu1
1Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Insights
Adverse events are common in children using long-term noninvasive ventilation (NIV). Younger age and certain conditions predict issues like air leaks and sleep disruption, highlighting the need for proactive management.
Area of Science:
- Pediatric Pulmonology
- Medical Technology Assessment
- Clinical Pediatrics
Background:
- Long-term noninvasive ventilation (NIV) use is increasing in children with diverse medical conditions.
- Understanding factors influencing adverse events is crucial for optimizing pediatric NIV care.
Purpose of the Study:
- To investigate demographic, clinical, and technology-related predictors of adverse events in a large cohort of children using long-term NIV.
- To identify specific complications and risk factors associated with pediatric NIV use.
Main Methods:
- Multicenter retrospective review of children initiating long-term NIV (≥3 months) in Alberta, Canada (2005-2014).
- Data collected on patient demographics, clinical conditions, technology used, and adverse events.
- Follow-up until December 2015.
Main Results:
- 93% of 507 children experienced at least one NIV-related adverse event.
- Common events included skin injury (20%) and unintentional air leaks (19%).
- Younger age and conditions like Down syndrome predicted air leaks and sleep disruption; obesity predicted nasal symptoms. Mask type was not significant.
Conclusions:
- NIV-related complications are frequent in pediatric patients.
- Early detection and proactive management, including proper mask fitting, are essential for reducing adverse events.
- Further research into specific interventions may improve outcomes.
Background And Objectives:
An increasing number of children with diverse medical conditions are using long-term noninvasive ventilation (NIV). This study examined the impact of demographic, clinical, and technology-related factors on long-term NIV adverse events in a large cohort of children using long-term NIV.
Methods:
This was a multicenter retrospective review of all children who initiated long-term NIV in the province of Alberta, Canada, from January 2005 to September 2014, and followed until December 2015. Inclusion criteria were children who had used NIV for 3 months or more and had at least one follow-up visit with the NIV programs.
Results:
We identified 507 children who initiated NIV at a median age of 7.5 (interquartile range: 8.6) years and 93% of them reported at least one NIV-related adverse event during the initial follow-up visit. Skin injury (20%) and unintentional air leaks (19%) were reported more frequently at the initial visit. Gastrointestinal symptoms, midface hypoplasia, increased drooling, aspiration and pneumothorax were rarely reported (<5%). Younger age and underlying conditions such as Down syndrome, achondroplasia, and Duchenne muscular dystrophy were early predictors of unintentional air leak. Younger age also predicted child sleep disruption in the short term and ongoing parental sleep disruption. Obesity was a risk factor for persistent nasal symptoms. Mask type was not a significant predictor for NIV-related short- or long-term complications.
Conclusions:
This study demonstrates that NIV-related complications are frequent. Appropriate mask-fitting and headgear adaptation, and a proactive approach to early detection may help to reduce adverse events.
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