Home paediatric CPAP/NIV: the basics
Sonia Khirani, Alessandro Amaddeo, Lucie Griffon, Marine Dosso, Meryl Vedrenne‐Cloquet, Clément Poirault, Benjamin Dudoignon, Brigitte Fauroux
Abstract
The use of home continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) is constantly growing in children. CPAP comprises constant CPAP and auto CPAP (APAP), while NIV comprises several modes of ventilation, among which barometric modes are nowadays the most used. Initiation criteria, indications, initiation location and strategies, and CPAP/NIV settings will be reviewed for both CPAP and NIV. The equipment, comprising the devices, interfaces, circuits and humidifiers, has to be mastered, particularly in paediatrics, with the knowledge of their advantages and limits. A close follow-up is mandatory, and strategies exist to compensate for the lack of resources, such as the availability of hospital beds. Adherence to CPAP/NIV, and the management of unintentional leaks, residual respiratory events, and/or patient-ventilator asynchronies are the clues for treatment efficacy, and need to be addressed on a regular basis. • Home CPAP modes comprise constant CPAP and auto CPAP (APAP). • Barometric modes are the most used modes for home NIV in paediatrics. • CPAP/NIV initiation can be done during an overnight hospital or outpatient visit. • A close follow-up is mandatory, with different strategies depending on resources. • Weaning attempt constitutes an integral part of the follow-up strategy.