Non-invasive ventilation in children
What is non-invasive ventilation (NIV)?
Non-invasive ventilation means blowing air into the lungs with the help of a mask placed on the child’s face in order to improve their breathing. As breathing is less effective during sleep, NIV is preferentially and usually exclusively used during sleep (overnight and during naps in infants).This treatment is intended to be used at home, so that the child may lead as normal a life as possible.
The equipment for NIV is similar to that for CPAP and consists of an NIV machine, a circuit and a mask (see the CPAP information sheet). However, NIV machines need to be more powerful than CPAP machines. They allow more complex settings, they have a battery and oxygen can be added if required. Children who need NIV often need additional breathing equipment, such as oxygen, machines to help them cough (for children with a neuromuscular disease) or equipment for suctioning bronchial secretions.
When is this treatment needed?
Treatment by NIV is indicated when the child’s breathing is inadequate, which may be found if:
- The respiratory muscles are weak or paralysed, such as in neuromuscular diseases
- Breathing requires too much effort, such as in advanced cases of cystic fibrosis
- There is a failure of the brain’s respiratory drive, such as in certain compressions or tumours of the respiratory centres
So, the NIV machine either replaces (neuromuscular diseases) or assists (cystic fibrosis) the respiratory muscles, or replaces the brain’s respiratory control.
The decision to treat by NIV depends on a collection of criteria which may vary from one child to another and which include amongst others:
- the age of the child and the presence of any associated illness or pathology
- the symptoms associated with inadequate breathing: insufficient quantity or quality of sleep, daytime tiredness and drowsiness, headaches, worsening performance at school, increased severity of benign respiratory infections (colds, chest infections).
- the results of sleep studies and of the blood levels of oxygen and carbon dioxide during the night
In any event, the effectiveness and benefit of this treatment for your child will be regularly evaluated 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 NIV treatment is similar to that for CPAP (see the CPAP information sheet).