Related Experiment Video
Updated: Jul 2, 2025
Ex Vivo Porcine Experimental Model for Studying and Teaching Lung Mechanics
Published on: April 19, 2024
Invasive versus non-invasive paediatric home mechanical ventilation: review of the international evolution over the
Michel Toussaint1, Olivier van Hove2, Dimitri Leduc2
1Department of Neurology, Centre de référence Neuromusculaire, Erasme Hospital, Bruxelles, Belgium michel.toussaint@hubruxelles.be.
Insights
Home mechanical ventilation (HMV) is crucial for chronic hypercapnic alveolar hypoventilation. Non-invasive ventilation (NIV) is increasingly used, especially for neuromuscular disorders, though invasive HMV remains vital for younger children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Medical Technology
Background:
- Home mechanical ventilation (HMV) treats chronic hypercapnic alveolar hypoventilation in children.
- Global data on the prevalence, evolution, and patient demographics for pediatric HMV are limited.
- Understanding trends in invasive (IMV) versus non-invasive (NIV) HMV is essential.
Purpose of the Study:
- To determine the global proportion and evolution of pediatric invasive (IMV) and non-invasive (NIV) HMV.
- To identify the primary disorders and age distribution of children requiring HMV.
- To analyze trends in HMV use over the past two decades.
Main Methods:
- Systematic search of Medline/PubMed for pediatric HMV surveys published between 2000 and 2023.
- Analysis of data from 32 international reports encompassing 8815 children.
- Statistical analysis of patient demographics, disorders, ventilation types, and age at initiation.
Main Results:
- Neuromuscular disorders (NMD) were the most common indication for HMV (37%), followed by cardiorespiratory and CNS disorders.
- Non-invasive ventilation (NIV) was used in 72% of children, significantly more than invasive HMV (28%).
- NIV was preferred for upper airway, genetic/congenital, thoracic, NMD, and cardiorespiratory conditions, while IMV was more common in younger children (mean age 3.3 years vs. 8.2 years for NIV).
- The overall estimated prevalence of pediatric HMV was 7.4 per 100,000 children.
- HMV use has grown, with a notable increase in NIV adoption in recent years (2020-2023).
Conclusions:
- Neuromuscular disorders are the leading reason for pediatric HMV.
- Non-invasive ventilation (NIV) is increasingly favored, but invasive HMV remains critical for young children, especially in regions with less NIV experience.
- The prevalence of HMV is estimated at 7.4/100,000 children, with a growing trend and increasing NIV utilization.
Background:
Home mechanical ventilation (HMV) is the treatment for chronic hypercapnic alveolar hypoventilation. The proportion and evolution of paediatric invasive (IMV) and non-invasive (NIV) HMV across the world is unknown, as well as the disorders and age of children using HMV.
Methods:
Search of Medline/PubMed for publications of paediatric surveys on HMV from 2000 to 2023.
Results:
Data from 32 international reports, representing 8815 children (59% boys) using HMV, were analysed. A substantial number of children had neuromuscular disorders (NMD; 37%), followed by cardiorespiratory (Cardio-Resp; 16%), central nervous system (CNS; 16%), upper airway (UA; 13%), other disorders (Others; 10%), central hypoventilation (4%), thoracic (3%) and genetic/congenital disorders (Gen/Cong; 1%). Mean age±SD (range) at HMV initiation was 6.7±3.7 (0.5-14.7) years. Age distribution was bimodal, with two peaks around 1-2 and 14-15 years. The number and proportion of children using NIV was significantly greater than that of children using IMV (n=6362 vs 2453, p=0.03; 72% vs 28%, p=0.048), with wide variations among countries, studies and disorders. NIV was used preferentially in the preponderance of children affected by UA, Gen/Cong, Thoracic, NMD and Cardio-Resp disorders. Children with NMD still receiving primary invasive HMV were mainly type I spinal muscular atrophy (SMA). Mean age±SD at initiation of IMV and NIV was 3.3±3.3 and 8.2±4.4 years (p<0.01), respectively. The rate of children receiving additional daytime HMV was higher with IMV as compared with NIV (69% vs 10%, p<0.001). The evolution of paediatric HMV over the last two decades consists of a growing number of children using HMV, in parallel to an increasing use of NIV in recent years (2020-2023). There is no clear trend in the profile of children over time (age at HMV). However, an increasing number of patients requiring HMV were observed in the Gen/Cong, CNS and Others groups. Finally, the estimated prevalence of paediatric HMV was calculated at 7.4/100 000 children.
Conclusions:
Patients with NMD represent the largest group of children using HMV. NIV is increasingly favoured in recent years, but IMV is still a prevalent intervention in young children, particularly in countries indicating less experience with NIV.
Related Concept Videos
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:29Mechanical Ventilation I: Indication and Settings
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:14Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation: