Non Invasive Ventilation in Paediatric Intensive Care: Practical Aspects

Non invasive ventilation is increasingly used in the pediatric intensive care. However, its application still remains challenging. This is due to the unique anatomical and physiological respiratory features in children, and the fact that there is not much suitable material available for the pediatric population. Irrespective of application of either the continuous positive pressure mode or the bi-level positive pressure mode, three types of devices are available, each playing a specific function. The devices with fixed flow generate a pressure, which is regulated by non intentional leaks and is limited by the maximal flow that can be generated. These devices are indicated in children who weigh less than 4 kg. Turbine-driven devices maintain the desired pressure by compensating the unintentional leaks, which allows a gentle fixation of the mask on the face of the child. Nevertheless, the trigger system is highly influenced by many factors such as the presence of an anti-bacterial filter or the addition of oxygen flow. Conventional ventilators have a better trigger system but are less efficient in compensating leaks. Practitioners determine the choice of interface, settings and clinical monitoring according to the needs and to the situation.