Skip to main content
Erschienen in: Intensive Care Medicine 4/2005

01.04.2005 | Neonatal and Pediatric Intensive Care

Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure

verfasst von: Sandrine Essouri, Frédéric Nicot, Annick Clément, Erea-Noel Garabedian, Gilles Roger, Frédéric Lofaso, Brigitte Fauroux

Erschienen in: Intensive Care Medicine | Ausgabe 4/2005

Einloggen, um Zugang zu erhalten

Abstract

Objective

This study evaluated the efficacy of noninvasive continuous positive pressure (CPAP) ventilation in infants with severe upper airway obstruction and compared CPAP to bilevel positive airway pressure (BIPAP) ventilation.

Design and setting

Prospective, randomized, controlled study in the pulmonary pediatric department of a university hospital.

Patients

Ten infants (median age 9.5 months, range 3—18) with laryngomalacia (n=5), tracheomalacia (n=3), tracheal hypoplasia (n=1), and Pierre Robin syndrome (n=1)

Interventions

Breathing pattern and respiratory effort were measured by esophageal and transdiaphragmatic pressure monitoring during spontaneous breathing, with or without CPAP and BIPAP ventilation.

Measurements and results

Median respiratory rate decreased from 45 breaths/min (range 24–84) during spontaneous breathing to 29 (range 18–60) during CPAP ventilation. All indices of respiratory effort decreased significantly during CPAP ventilation compared to unassisted spontaneous breathing (median, range): esophageal pressure swing from 28 to 10 cmH2O (13–76 to 7–28), esophageal pressure time product from 695 to 143 cmH2O/s per minute (264–1417 to 98–469), diaphragmatic pressure time product from 845 to 195 cmH2O/s per minute (264–1417 to 159–1183) During BIPAP ventilation a similar decrease in respiratory effort was observed but with patient-ventilator asynchrony in all patients.

Conclusions

This short-term study shows that noninvasive CPAP and BIPAP ventilation are associated with a significant and comparable decrease in respiratory effort in infants with upper airway obstruction. However, BIPAP ventilation was associated with patient-ventilator asynchrony.
Literatur
1.
Zurück zum Zitat Rupa V, Raman R (1991) Aetiological profile of paediatric laryngeal stridor in an Indian hospital. Ann Trop Paediatr 11:137–141 Rupa V, Raman R (1991) Aetiological profile of paediatric laryngeal stridor in an Indian hospital. Ann Trop Paediatr 11:137–141
2.
Zurück zum Zitat Altman KW, Wetmore RF, Marsch RR (1997) Congenital abnormalities requiring tracheotomy: a profile of 56 patients and their diagnosis over a 9 year period. Int J Pediatr Otorhinolaryngol 41:199–206 Altman KW, Wetmore RF, Marsch RR (1997) Congenital abnormalities requiring tracheotomy: a profile of 56 patients and their diagnosis over a 9 year period. Int J Pediatr Otorhinolaryngol 41:199–206
3.
Zurück zum Zitat Holinger LD (1980) Etiology of stridor in the neonate and child. Ann Otol Rhinol Laryngol 89:397–400 Holinger LD (1980) Etiology of stridor in the neonate and child. Ann Otol Rhinol Laryngol 89:397–400
4.
Zurück zum Zitat Lis G, Szczerbinski T, Cichocka-Jarosz E (1995) Congenital stridor. Pediatr Pulmonol 20:220–224 Lis G, Szczerbinski T, Cichocka-Jarosz E (1995) Congenital stridor. Pediatr Pulmonol 20:220–224
5.
Zurück zum Zitat Altman KW, Wetmore RF, Marsch RR (1999) Congenital airway abnormalities in patients requiring hospitalisation. Arch Otolaryngol Head Neck Surg 125:525–528 Altman KW, Wetmore RF, Marsch RR (1999) Congenital airway abnormalities in patients requiring hospitalisation. Arch Otolaryngol Head Neck Surg 125:525–528
6.
Zurück zum Zitat McSwiney PF, Cavanagh NP, Languth P (1977) Outcome in congenital stridor (laryngomalacia). Arch Dis Child 52:215–218 McSwiney PF, Cavanagh NP, Languth P (1977) Outcome in congenital stridor (laryngomalacia). Arch Dis Child 52:215–218
7.
Zurück zum Zitat Denoyelle F, Mondain M, Gresillon N, Roger G, Chaudré F, Garabédian EN (2003) Failures and complications of supraglottoplasty in children. Arch Otolaryngol Head Neck Surg 129:1077–1080 Denoyelle F, Mondain M, Gresillon N, Roger G, Chaudré F, Garabédian EN (2003) Failures and complications of supraglottoplasty in children. Arch Otolaryngol Head Neck Surg 129:1077–1080
8.
Zurück zum Zitat Guilleminault C, Pelayo R, Clerk A, Leger D, Boclan RC (1995) Home nasal continuous positive airway pressure in infants with sleep-disordered breathing. J Pediatr 127:905–912 Guilleminault C, Pelayo R, Clerk A, Leger D, Boclan RC (1995) Home nasal continuous positive airway pressure in infants with sleep-disordered breathing. J Pediatr 127:905–912
9.
Zurück zum Zitat Waters KA, Everett FM, Bruderer JW, Sullivan CE (1995) Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med 152:780–785 Waters KA, Everett FM, Bruderer JW, Sullivan CE (1995) Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med 152:780–785
10.
Zurück zum Zitat Fauroux B, Pigeot J, Polkey MI, Roger G, Boulé M, Clément A, Lofaso F (2001) Chronic stridor caused by laryngomalacia in children. Work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med 164:1874–1878 Fauroux B, Pigeot J, Polkey MI, Roger G, Boulé M, Clément A, Lofaso F (2001) Chronic stridor caused by laryngomalacia in children. Work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med 164:1874–1878
11.
Zurück zum Zitat Downey III R, Perkin RM, MacQuarrie J (2000) Nasal continuous positive airway pressure use in children with obstructive sleep apnea younger than 2 years of age. Chest 117:1608–1612 Downey III R, Perkin RM, MacQuarrie J (2000) Nasal continuous positive airway pressure use in children with obstructive sleep apnea younger than 2 years of age. Chest 117:1608–1612
12.
Zurück zum Zitat Sanders MH, Kern N (1990) Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Chest 98:317–324 Sanders MH, Kern N (1990) Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Chest 98:317–324
13.
Zurück zum Zitat Gaultier C, Boulé M, Allaire Y, Clément A, Burry A, Girard F (1978) Determination of capillary oxygen tension in infants and children: assessment of methodology and normal values during growth. Bull Euro Physiopathol Respir 14:287–294 Gaultier C, Boulé M, Allaire Y, Clément A, Burry A, Girard F (1978) Determination of capillary oxygen tension in infants and children: assessment of methodology and normal values during growth. Bull Euro Physiopathol Respir 14:287–294
14.
Zurück zum Zitat Stell IM, Tompkins S, Lovell AT, Goldstone JC, Moxham J (1999) An in vivo comparison of a catheter mounted pressure transducer system with conventional balloon catheters. Eur Respir J 13:1158–1163 Stell IM, Tompkins S, Lovell AT, Goldstone JC, Moxham J (1999) An in vivo comparison of a catheter mounted pressure transducer system with conventional balloon catheters. Eur Respir J 13:1158–1163
15.
Zurück zum Zitat Baydur A, Behrakis PK, Zin WA, Jaeger MJ, Milic-Emili J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 126:788–791PubMed Baydur A, Behrakis PK, Zin WA, Jaeger MJ, Milic-Emili J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 126:788–791PubMed
16.
Zurück zum Zitat Sassoon CSH, Light RW, Lodia R, Sieck GC, Mahutte CK (1991) Pressure-time product during continuous positive airway pressure, pressure support ventilation and T-piece during weaning from mechanical ventilation. Am Rev Respir Dis 143:459–475 Sassoon CSH, Light RW, Lodia R, Sieck GC, Mahutte CK (1991) Pressure-time product during continuous positive airway pressure, pressure support ventilation and T-piece during weaning from mechanical ventilation. Am Rev Respir Dis 143:459–475
17.
Zurück zum Zitat Field S, Sanci S, Grassino A (1984) Respiratory muscle oxygen consumption estimated by the diaphragm pressure-time index. J Appl Physiol 57:44–51 Field S, Sanci S, Grassino A (1984) Respiratory muscle oxygen consumption estimated by the diaphragm pressure-time index. J Appl Physiol 57:44–51
18.
Zurück zum Zitat Barnard P, Levine S (1986) Critique on application of diaphragmatic time-tension index to spontaneously breathing humans. J Appl Physiol 60:1067–1072 Barnard P, Levine S (1986) Critique on application of diaphragmatic time-tension index to spontaneously breathing humans. J Appl Physiol 60:1067–1072
19.
Zurück zum Zitat Parthasarathy S, Jubran A, Tobin M (2000) Assessment of neural inspiratory time in ventilator-supported patients. Am J Respir Crit Care Med 162:546–552 Parthasarathy S, Jubran A, Tobin M (2000) Assessment of neural inspiratory time in ventilator-supported patients. Am J Respir Crit Care Med 162:546–552
20.
Zurück zum Zitat Lofaso F, Brochard L, Hang T, Lorino H, Harf A, Isabey D (1996) Home versus intensive care pressure support devices. Experimental and clinical comparison. Am J Respir Crit Care Med 153:1591–1599 Lofaso F, Brochard L, Hang T, Lorino H, Harf A, Isabey D (1996) Home versus intensive care pressure support devices. Experimental and clinical comparison. Am J Respir Crit Care Med 153:1591–1599
21.
Zurück zum Zitat Parthasarathy S, Jubran A, Tobin MJ (1998) Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med 158:1471–1478 Parthasarathy S, Jubran A, Tobin MJ (1998) Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med 158:1471–1478
22.
Zurück zum Zitat Vanpee D, El Khawand C, Rousseau L, Jamart J, Delaunois L (2002) Effects of nasal pressure support on ventilation and inspiratory work in normocapnic and hypercapnic patients with stable COPD. Chest 122:75–83 Vanpee D, El Khawand C, Rousseau L, Jamart J, Delaunois L (2002) Effects of nasal pressure support on ventilation and inspiratory work in normocapnic and hypercapnic patients with stable COPD. Chest 122:75–83
23.
Zurück zum Zitat Vitacca M, Barbano L, D’Anna S, Porta R, Bianchi L, Ambrosino N (2002) Comparison of five bilevel pressure ventilators in patients with chronic ventilatory failure. Chest 122:2105–2114 Vitacca M, Barbano L, D’Anna S, Porta R, Bianchi L, Ambrosino N (2002) Comparison of five bilevel pressure ventilators in patients with chronic ventilatory failure. Chest 122:2105–2114
24.
Zurück zum Zitat Tassaux D, Strasser S, Fonseca S, Dalmas E, Jolliet P (2002) Comparative bench study of triggering, pressurization, and cycling between the home ventilator VPAP II and three ICU ventilators. Intensive Care Med 28:1254–1261 Tassaux D, Strasser S, Fonseca S, Dalmas E, Jolliet P (2002) Comparative bench study of triggering, pressurization, and cycling between the home ventilator VPAP II and three ICU ventilators. Intensive Care Med 28:1254–1261
25.
Zurück zum Zitat Calderini E, Confalonieri M, Puccio PG, Francavilla N, Stella L, Gregoretti C (1999) Patient-ventilator asynchrony during noninvasive ventilation: the role of the expiratory trigger. Intensive Care Med 25:622–667 Calderini E, Confalonieri M, Puccio PG, Francavilla N, Stella L, Gregoretti C (1999) Patient-ventilator asynchrony during noninvasive ventilation: the role of the expiratory trigger. Intensive Care Med 25:622–667
26.
Zurück zum Zitat Stell IM, Paul G, Lee KC, Ponte J, Moxham J (2001) Noninvasive ventilator triggering in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164:2092–2097 Stell IM, Paul G, Lee KC, Ponte J, Moxham J (2001) Noninvasive ventilator triggering in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164:2092–2097
27.
Zurück zum Zitat Sharshar T, Desmarais G, Louis B, Macadou G, Porcher R, Harf A, Raphael JC, Isabey D, Lofaso F (2003) Transdiaphragmatic pressure control of airway pressure support in healthy subjects. Am J Respir Crit Care Med 168:760–769 Sharshar T, Desmarais G, Louis B, Macadou G, Porcher R, Harf A, Raphael JC, Isabey D, Lofaso F (2003) Transdiaphragmatic pressure control of airway pressure support in healthy subjects. Am J Respir Crit Care Med 168:760–769
28.
Zurück zum Zitat Teschler H, Stampa J, Ragette R, Konietzko N, Berthon-Jones M (1999) Effect of mouth leak on effectiveness of nasal bilevel ventilatory assistance and sleep architecture. Eur Respir J 14:1251–1257 Teschler H, Stampa J, Ragette R, Konietzko N, Berthon-Jones M (1999) Effect of mouth leak on effectiveness of nasal bilevel ventilatory assistance and sleep architecture. Eur Respir J 14:1251–1257
29.
Zurück zum Zitat Fauroux B, Lavis JF, Nicot F, Picard A, Clément A, Vazquez MP (2004) Tolerance of nasal masks used for positive pressure ventilation in children. Eur Respir J 24:474S Fauroux B, Lavis JF, Nicot F, Picard A, Clément A, Vazquez MP (2004) Tolerance of nasal masks used for positive pressure ventilation in children. Eur Respir J 24:474S
Metadaten
Titel
Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure
verfasst von
Sandrine Essouri
Frédéric Nicot
Annick Clément
Erea-Noel Garabedian
Gilles Roger
Frédéric Lofaso
Brigitte Fauroux
Publikationsdatum
01.04.2005
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 4/2005
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-2568-6

Weitere Artikel der Ausgabe 4/2005

Intensive Care Medicine 4/2005 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.