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Long-term non-invasive positive airway pressure ventilation in infants

Authors

  • Agneta Markström,

    1. Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Div of Anaesthesiology and Intensive Care, Stockholm, Sweden
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  • Kerstin Sundell,

    1. Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Div of Anaesthesiology and Intensive Care, Stockholm, Sweden
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  • Nader Stenberg,

    1. Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Div of Anaesthesiology and Intensive Care, Stockholm, Sweden
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  • Miriam Katz-Salamon

    1. Neonatal Unit, Department of Women and Children's Health, Karolinska University Hospital, Stockholm, Sweden
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Correspondence
Agneta Markström, M.D., Ph.D., National Respiratory Centre, Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, SE-182 88 Stockholm, Sweden. Tel: +46-8-655 5107, +46-8-655 5373 | Fax: +46-8-755 6765 | Email: agneta.markstrom@ds.se

Abstract

Aim: To evaluate the clinical application of long-term non-invasive ventilation (NIV) in infants with life-threatening ventilatory failure with regard to: diagnosis, age at initiation, indication for and duration of treatment, clinical outcome and mortality and adverse effects.

Patients and methods: The medical records of 18 infants treated in a home setting during a 7-year period were reviewed. The criteria for ventilatory support were: (a) transcutaneous partial pressures of carbon dioxide (TcPCO2) >6.5 kPa and oxygen (TcPO2) < 8.5 kPa and (b) decreased cough ability and/or recurrent chest infections.

Results: The median age at initiation was 4 months (range 1–12). NIV was initiated because of hypoventilation in 12 infants and because of reduced cough ability and/or recurrent infections in six infants. Tracheotomy was eventually needed in two infants. The median duration of treatment was 24 months (range 1–84). NIV produced significant improvements, with median TcPCO2 falling from 9.9 to 6.1 kPa, and median TcPO2 rising from 9.8 to 11.1 kPa.

Conclusion: NIV can be successfully and safely used in infants with prolonged life-threatening ventilatory failure, potentially avoiding intubation and tracheotomy.

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