Aggiornamento
Assistenza ventilatoria non invasiva: dalla teoria alla pratica
Noninvasive respiratory assistance: from theory to practice
Veronica Grigoletto1, Marta Cognigni1, Laura Badina2, Sergio Ghirardo2, Massimo Maschio2, Laura Mazzari2, Alessandro Amaddeo2
1Università di Trieste
2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Ottobre 2024 - pagg. 490 -498 | DOI: 10.53126/MEB43490
Abstract
Noninvasive respiratory assistance strategies are becoming part of everyday life for paediatricians, both in hospitals and territorial settings. In the acute condition, a timely and correct use of noninvasive respiratory support can improve the outcome of acute respiratory failure, decreasing the need for invasive mechanical ventilation. An increasing number of chronic patients can benefit from appropriate treatment with home ventilators. Respiratory assistance may be performed using High Flow Nasal Cannula (HFNC), Continuous Positive Airway Pressure (CPAP) or NonInvasive Ventilation (NIV), depending on the primary cause of respiratory failure. Understanding the working mechanisms of the different techniques and the golden rules to use them is crucial for a satisfying outcome.
Riassunto
L’utilizzo delle tecniche di assistenza respiratoria non invasive sta gradualmente diventando parte della quotidianità del pediatra, sia ospedaliero che territoriale. Dopo una breve introduzione sugli aspetti teorici dell’insufficienza respiratoria, questo articolo intende analizzare le diverse modalità di assistenza respiratoria (ossigenoterapia ad alti flussi, CPAP, NIV) e spiegarne il loro utilizzo in acuto e in cronico, con l’obiettivo di fornire al Pediatra gli strumenti per approcciarsi con maggiore consapevolezza ai pazienti che potrebbero beneficiare del loro utilizzo.
Parole chiave
Classificazione MeSH
Contenuto riservato
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Bibliografia
1. Racca F, Bonati M, Del Sorbo L, et al. Invasive and non-invasive long-term mechanical ventilation in Italian children. Minerva Anestesiol 2011;77(9):892-901.
2. Khemani RG, Smith L, Lopez-Fernandez YM, et al. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med 2019;7(2):115-28. doi: 10.1016/S2213-2600(18)30344-8.
3. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307 (23):2526-33. doi: 10.1001/jama.2012.5669.
4. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015;16(5):428-39. doi: 10.1097/ PCC.0000000000000350.
5. Emeriaud G, López-Fernández YM, Iyer NP, et al. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med 2023;24(2):143-68. doi: 10.1097/PCC.0000000000003147.
6. Thomas NJ, Shaffer ML, Willson DF, Shih MC, Curley MA. Defining acute lung disease in children with the oxygenation saturation index. Pediatr Crit Care Med 2010;11(1):12-7. doi: 10.1097/PCC.0b013e3181b0653d.
7. Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB. Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS. Chest 2007;132(2):410-7. doi: 10.1378/chest.07-0617.
8. Ray S, Rogers L, Pagel C, Raman S, Peters MJ, Ramnarayan P. PaO2/FIO22 Ratio Derived From the SpO2/FIO2 Ratio to Improve Mortality Prediction Using the Pediatric Index of Mortality-3 Score in Transported Intensive Care Admissions. Pediatr Crit Care Med 2017;18(3):e131-e136. doi: 10.1097/ PCC.0000000000001075.
9. Primhak RA, Hicks B, Shaw NJ, Donaldson GC, Balfour-Lynn IM. Use of home oxygen for children in England and Wales. Arch Dis Child 2011;96(4):389-92. doi: 10.1136/ adc.2009.180653.
10. Gregoretti C, Ottonello G, Chiarini Testa MB, Mastella C, Ravà L, Bignamini E, Veljkovic A, Cutrera R. Survival of patients with spinal muscular atrophy type 1. Pediatrics 2013;131(5):e1509-14. doi: 10.1542/peds. 2012-2278.
11. Chatwin M, Tan HL, Bush A, Rosenthal M, Simonds AK. Long term non-invasive ventilation in children: impact on survival and transition to adult care. PLoS One 2015;10 (5):e0125839. doi: 10.1371/journal.pone. 0125839.
12. Amaddeo A, Fauroux B. Oxygen and carbon dioxide monitoring during sleep. Paediatr Respir Rev 2016;20:42-44. doi: 10.1016/ j.prrv.2015.11.009.
13. Hime NJ, Zurynski Y, Fitzgerald D, et al. Childhood interstitial lung disease: A systematic review. Pediatr Pulmonol 2015;50(12): 1383-92. doi: 10.1002/ppul.23183.
14. Traunero A, Lorenzon B, Amaddeo A, Barbi E. L’ossigenoterapia. Medico e Bambino 2023;42(2):85-95 doi: 10.53126/ MEB42085.
15. Milési C, Requirand A, Douillard A, et al. Assessment of Peak Inspiratory Flow in Young Infants with Acute Viral Bronchiolitis: Physiological Basis for Initial Flow Setting in Patients Supported with High-Flow Nasal Cannula. J Pediatr 2021;231:239-245.e1. doi: 10.1016/j.jpeds.2020.12.020.
16. Arora B, Mahajan P, Zidan MA, Sethuraman U. Nasopharyngeal airway pressures in bronchiolitis patients treated with high-flow nasal cannula oxygen therapy. Pediatr Emerg Care 2012;28(11):1179-84. doi: 10.1097/PEC.0b013e318271a671.
17. Milési C, Boubal M, Jacquot A, et al. High-flow nasal cannula: recommendations for daily practice in pediatrics. Ann Intensive Care 2014;4:29. doi: 10.1186/s13613-014-0029-5.
18. Ehrlich S, Golan Tripto I, Lavie M, et al. High flow nasal cannula therapy in the pediatric home setting. Pediatr Pulmonol 2023;58 (3):941-8. doi: 10.1002/ppul.26282.
19. Steindor M, Wagner CE, Kavvalou A, Bock C, Olivier M, Stehling F. Indications and outcome of home high-flow nasal therapy in children, a single-center experience. Pediatr Pulmonol 2022;57(9):2048-52. doi: 10.1002/ppul.25974.
20. Essouri S, Durand P, Chevret L, et al. Optimal level of nasal continuous positive airway pressure in severe viral bronchiolitis. Intensive Care Med 2011;37(12):2002-7. doi: 10.1007/s00134-011-2372-4.
21. Milési C, Essouri S, Pouyau R, et al. High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med 2017;43 (2):209-16. doi: 10.1007/s00134-016-4617-8.
22. Vitaliti G, Vitaliti MC, Finocchiaro MC, et al. Randomized Comparison of Helmet CPAP Versus High-Flow Nasal Cannula Oxygen in Pediatric Respiratory Distress. Respir Care 2017;62(8):1036-42. doi: 10.4187/respcare.05384.
23. Fauroux B, Abel F, Amaddeo A, et al. ERS statement on paediatric long-term noninvasive respiratory support. Eur Respir J 2022;59(6):2101404. doi: 10.1183/13993003. 01404-2021.
24. Essouri S, Chevret L, Durand P, Haas V, Fauroux B, Devictor D. Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med 2006;7(4):329-34. doi: 10.1097/ 01.PCC.0000225089.21176.0B.
25. ERS Practical Handbook of Noninvasive Ventilation. Edited by Anita K. Simonds. Published in 2015. doi: 10.1183/ 9781849840767. eph01.
26. Paiva R, Krivec U, Aubertin G, Cohen E, Clément A, Fauroux B. Carbon dioxide monitoring during long-term noninvasive respiratory support in children. Intensive Care Med 2009;35(6):1068-74. doi: 10.1007/s00134-009-1408-5.
27. Gregoretti C, Ottonello G, Chiarini Testa MB, Mastella C, Ravà L, Bignamini E, Veljkovic A, Cutrera R. Survival of patients with spinal muscular atrophy type 1. Pediatrics 2013; 131(5):e1509-14. doi: 10.1542/peds.2012-2278.
28. Villanova M, Brancalion B, Mehta AD. Duchenne muscular dystrophy: life prolongation by noninvasive ventilatory support. Am J Phys Med Rehabil 2014;93(7):595-9. doi: 10.1097/PHM.0000000000000074.
29. Fauroux B, Khirani S, Griffon L, Teng T, Lanzeray A, Amaddeo A. Non-invasive Ventilation in Children With Neuromuscular Disease. Front Pediatr 2020;8:482. doi: 10.3389/ fped.2020.00482.
30. Caring for the Ventilator Dependent Child. Edited by Humana press. Published in 2016.
31. Nørregaard O. Noninvasive ventilation in children. Eur Respir J 2002;20:1332-42. doi: 10.1183/09031936.02.00404802.
Corrispondenza: veronica.grigoletto@gmail.com