No longer limited to the ICU environment only, NIV can be used in children with acute respiratory distress, though treatment of ARDS (acute respiratory distress syndrome) needs some caution.
Abolfazl Najaf-Zadeh and Francis Leclerc provided an excellent review of NIV utilization in pediatric patients with ARF (acute respiratory failure). They located over 332 articles dealing with this topic. Their classifications for use of NIV in ARF highlighted respiratory causes; acute lower airway obstruction including conditions such as asthma, bronchiolitis; Acute upper airway obstruction, including studies on laryngeo or tracheo malacia and inspiratory stridor; parenchymal disease including pneumonia and ARDS. Non respiratory causes were covered in the category NPPV in special circumstances which included post operative ARF, facilitation of weaning or rescue of extubation failure, and immunocompromised patients. Much like NIV in adult patients vigilance is needed to detect NIV failure as early as possible.
Many articles in the recent years have been stressing the percentage of success in pediatric associated with ARF conditions to avoid endotracheal intubation (ETI) and in neuromuscular disease. Additionally, the use of NIV as first line treatment for pediatric patients is no longer limited to the ICU environment only.
The article by Abadesso et al. “Non-invasive ventilation in acute respiratory failure in children” proposes NIV as a first line treatment in children with acute respiratory distress. However, children with hypoxemic acute respiratory failure should start NIV with special attention, as evolution to ARDS is highly associated with failure in this group.¹
Other studies suggest caution towards pediatric patients with acute ARDS. In the article “Noninvasive positive pressure ventilation. Five years of experience in a pediatric intensive care unit” by Essouri & et al., 2006, NIV is suggested as a first line treatment in children with acute respiratory failure, except in those diagnosed with ARDS.²
More NIV studies for pediatric may still be required to gain a better insight. The ability to work closely with the pediatric patient as well as the age of the patient seem to be areas of interest in the years to come.³