Short-term Non-invasive Ventilation for Children with Palliative Care Needs

Area of Science:

• Pediatric Palliative Care
• Respiratory Medicine
• Critical Care

Background:

• Non-invasive ventilation (NIV), including CPAP and BiPAP, provides mechanical breaths without intubation.
• Short-term NIV (<21 days) is a potential management strategy for acute respiratory distress (ARD) in pediatric palliative patients with "Do Not Resuscitate or Intubate" (DNI) directives.
• Limited data exists on the utilization of short-term NIV in this specific patient population.

Purpose of the Study:

• To describe the usage patterns of short-term NIV in pediatric palliative patients.
• To evaluate the effectiveness and safety of short-term NIV in this cohort.
• To explore NIV as a modality for managing ARD and end-of-life comfort care.

Main Methods:

• A retrospective, observational study was conducted.
• Data was collected from pediatric palliative patients who received short-term NIV between March 2020 and May 2022.
• Patient demographics, indications for NIV, NIV modalities, duration, and outcomes were analyzed.

Main Results:

• Short-term NIV was used on 23 occasions for 20 children, primarily for potentially reversible ARD (69.6%) and comfort care (30.4%).
• BiPAP was the most common NIV modality (60.9%). Median duration of use was 4 days.
• NIV initiation led to significant improvements in heart rate, respiratory rate, and oxygen saturation within 6 hours. Most patients (87%) were weaned off NIV, with 17 discharged home.

Conclusions:

• Short-term NIV is a valuable tool in pediatric palliative care for managing distressing symptoms, including ARD and end-of-life breathlessness, especially when DNI directives are in place.
• The study demonstrates the benefit of NIV in both potentially reversible ARD and comfort care scenarios.
• Further rigorous research is needed to establish clear guidelines for optimizing NIV use to improve quality of life and death in children.