Continuous positive airway pressure ventilation in children
CPAP means the delivery of air pressure into the airways (nose, mouth, pharynx, larynx, trachea and bronchi) in order to keep them open during the entire breath (inspiration and expiration).
This treatment is indicated in obstructive sleep apnoea syndrome (OSAS) which is a condition characterised by the more or less complete closure of the airways during sleep. Therefore, in the vast majority of cases, this treatment is only used during sleep (overnight and during naps in infants). This treatment is intended to be performed at home, so that the child may live as normal a life as possible.
CPAP equipment is made up of:
- A CPAP machine which delivers air at a variable pressure, as determined by the doctor. This pressure may be constant or may fluctuate slightly depending on the degree of closure of the airways. Usually, the air coming out of the machine passes through a humidifier which warms and moistens the air for additional comfort.
- A circuit (tube) which delivers the air pressure from the machine to the child
- An interface (or mask) positioned on the child’s face and held in place by a harness.
The different types of interface are :
- The nasal mask which covers the nose
- The oronasal mask which covers the mouth and nose, and is used in children who breathe through their mouth whilst sleeping
- The nasal pillow mask (or nasal tubes) which covers the nostrils, used in older children
- The facial mask, which covers the whole face and is only used in exceptional circumstances in children.
The choice of mask depends on the age of the child, his way of breathing during the night (through the nose or mouth), the shape of the face and skull, and the comfort and preference of the child. The doctor will choose the most appropriate interface with you and your child because the comfort of the mask is an essential element for the acceptance and effectiveness of this treatment.
When is this treatment necessary?
Treatment by CPAP is indicated for a child presenting with OSAS persisting in spite of all other therapeutic options (ENT surgery with removal of the tonsils and/or adenoids, orthodontic treatment, maxillo-facial surgery or neurosurgery), or when these other treatments are not indicated. The decision to treat with CPAP depends on a collection of criteria which may vary from one child to another and which include amongst others:
- the child’s age and the existence of an associated condition or illness
- the symptoms associated with the OSAS (see table in paragraph X)
- the results of a sleep study and overnight measurement of blood oxygen and carbon dioxide
In any event, the effectiveness and benefit of this treatment for your child will be evaluated regularly in order to modify, continue or stop the treatment.
How will this happen in practice for my child at the Necker Hospital?
The initiation of CPAP treatment requires several nights in hospital (2-3 nights for older children, with the possibility of a longer stay being needed for a young infant). These days and nights are needed to:
- find the machine and mask most suited to your child
- determine the correct settings for the machine
- teach your child to sleep the entire night with the CPAP (at least 6 hours)
- teach your child (if he is old enough) and you how the machine works and how to connect and disconnect your child
- inform you of the main problems that can occur with the machine or the mask
A specialist team made up of doctors, a clinical teaching nurse specialised in CPAP, and technicians will be present to help you and to teach you and your child about this treatment.
On the first day, the CPAP treatment will be explained to you in detail. Your child will try on the CPAP several times during the day so that he can progressively get used to it. He will be asked to try to go to sleep wearing the CPAP at his usual bedtime. He will be monitored overnight. The next morning, the overnight report will be reviewed with the medical team and some adjustments may be performed: a change in the air pressure settings or in the interface. The instructions for the use of CPAP will be repeated. The domiciliary provider, who will take care of the CPAP treatment at your home, will meet you in the hospital in order to ensure continuity of care with the medical team and to optimise the arrangements for your return home with the CPAP.
On the following nights, your child will be asked to sleep the entire night with the CPAP. His sleep with the CPAP will be checked before he returns home. Your child will be able to leave hospital once he has good quality sleep for an entire night with the CPAP and you feel confident to administer this treatment to your child at home every night.
On the day of discharge, a home visit will be arranged by the domiciliary provider who will take care of the CPAP at home, to check the treatment with you. He will visit you in your home the following week to check the equipment, the effective duration of your child’s sleep with the CPAP and to answer your questions. The report on his visit will be sent to the hospital team.
The follow-up of your child’s CPAP will consist of regular checks in hospital of his sleep with the CPAP, with the frequency depending on your child’s age and state of health. Domiciliary checks by the provider who takes care of the CPAP at home, in communication with the hospital team, will also take place regularly. At all times, the hospital team and the domiciliary provider will be at your disposal to answer your questions or to help you in the event of a problem with the CPAP treatment.