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Noninvasive ventilation for acute and impending respiratory failure in children

Joshua Nagler, MD
Ira M Cheifetz, MD, FCCM, FAARC
Section Editor
Adrienne G Randolph, MD, MSc
Deputy Editor
James F Wiley, II, MD, MPH


This topic will focus on the use of noninvasive ventilation (NIV) for acute and impending respiratory failure, including benefits and risks, indications and contraindications, approach to initiation, predictors of NIV failure (need for tracheal intubation and invasive mechanical ventilation), and potential complications from use of NIV.

The use of NIV for apnea and respiratory distress syndrome in premature and term neonates, chronic respiratory failure from neuromuscular disease, post-extubation respiratory distress, and obstructive sleep apnea are discussed separately as follows:

(See "Prevention and treatment of respiratory distress syndrome in preterm infants" and "Noninvasive oxygen delivery and oxygen monitoring in the newborn", section on 'Nasal intermittent positive pressure ventilation' and "Prevention and treatment of respiratory distress syndrome in preterm infants", section on 'Assisted ventilation techniques'.)

(See "Respiratory muscle weakness due to neuromuscular disease: Management", section on 'Mechanical ventilation'.)

(See "Extubation management", section on 'Postextubation management'.)

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Literature review current through: Oct 2017. | This topic last updated: Jun 27, 2017.
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  1. Najaf-Zadeh A, Leclerc F. Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review. Ann Intensive Care 2011; 1:15.
  2. Bhatti A, Khan J, Murki S, et al. Nasal Jet-CPAP (variable flow) versus Bubble-CPAP in preterm infants with respiratory distress: an open label, randomized controlled trial. J Perinatol 2015; 35:935.
  3. Courtney SE, Kahn DJ, Singh R, Habib RH. Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange. J Perinatol 2011; 31:44.
  4. Martin S, Duke T, Davis P. Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review. Arch Dis Child Fetal Neonatal Ed 2014; 99:F495.
  5. Chisti MJ, Salam MA, Smith JH, et al. Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial. Lancet 2015; 386:1057.
  6. Akingbola OA, Hopkins RL. Pediatric noninvasive positive pressure ventilation. Pediatr Crit Care Med 2001; 2:164.
  7. Calderini E, Chidini G, Pelosi P. What are the current indications for noninvasive ventilation in children? Curr Opin Anaesthesiol 2010; 23:368.
  8. Deis JN, Abramo TJ, Crawley L. Noninvasive respiratory support. Pediatr Emerg Care 2008; 24:331.
  9. Teague WG. Noninvasive ventilation in the pediatric intensive care unit for children with acute respiratory failure. Pediatr Pulmonol 2003; 35:418.
  10. Antonelli M, Conti G, Rocco M, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 1998; 339:429.
  11. Smedsaas-Löfvenberg A, Nilsson K, Moa G, Axelsson I. Nebulization of drugs in a nasal CPAP system. Acta Paediatr 1999; 88:89.
  12. Mayordomo-Colunga J, Medina A, Rey C, et al. Non-invasive ventilation in pediatric status asthmaticus: a prospective observational study. Pediatr Pulmonol 2011; 46:949.
  13. Basnet S, Mander G, Andoh J, et al. Safety, efficacy, and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric patients admitted with status asthmaticus: a pilot study. Pediatr Crit Care Med 2012; 13:393.
  14. Abadesso C, Nunes P, Silvestre C, et al. Non-invasive ventilation in acute respiratory failure in children. Pediatr Rep 2012; 4:e16.
  15. Hostetler MA. Use of noninvasive positive-pressure ventilation in the emergency department. Emerg Med Clin North Am 2008; 26:929.
  16. Marohn K, Panisello JM. Noninvasive ventilation in pediatric intensive care. Curr Opin Pediatr 2013; 25:290.
  17. Fanning JJ, Lee KJ, Bragg DS, Gedeit RG. U.S. attitudes and perceived practice for noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med 2011; 12:e187.
  18. Yañez LJ, Yunge M, Emilfork M, et al. A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med 2008; 9:484.
  19. Thia LP, McKenzie SA, Blyth TP, et al. Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis. Arch Dis Child 2008; 93:45.
  20. Bernet V, Hug MI, Frey B. Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med 2005; 6:660.
  21. Chidini G, Calderini E, Cesana BM, et al. Noninvasive continuous positive airway pressure in acute respiratory failure: helmet versus facial mask. Pediatrics 2010; 126:e330.
  22. Codazzi D, Nacoti M, Passoni M, et al. Continuous positive airway pressure with modified helmet for treatment of hypoxemic acute respiratory failure in infants and a preschool population: a feasibility study. Pediatr Crit Care Med 2006; 7:455.
  23. Cavari Y, Sofer S, Rozovski U, Lazar I. Non invasive positive pressure ventilation in infants with respiratory failure. Pediatr Pulmonol 2012; 47:1019.
  24. Essouri S, Chevret L, Durand P, et al. Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med 2006; 7:329.
  25. Javouhey E, Barats A, Richard N, et al. Non-invasive ventilation as primary ventilatory support for infants with severe bronchiolitis. Intensive Care Med 2008; 34:1608.
  26. Padman R, Lawless ST, Kettrick RG. Noninvasive ventilation via bilevel positive airway pressure support in pediatric practice. Crit Care Med 1998; 26:169.
  27. Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med 2007; 8:115.
  28. Lazner MR, Basu AP, Klonin H. Non-invasive ventilation for severe bronchiolitis: analysis and evidence. Pediatr Pulmonol 2012; 47:909.
  29. Dohna-Schwake C, Stehling F, Tschiedel E, et al. Non-invasive ventilation on a pediatric intensive care unit: feasibility, efficacy, and predictors of success. Pediatr Pulmonol 2011; 46:1114.
  30. Fortenberry JD, Del Toro J, Jefferson LS, et al. Management of pediatric acute hypoxemic respiratory insufficiency with bilevel positive pressure (BiPAP) nasal mask ventilation. Chest 1995; 108:1059.
  31. Storre JH, Steurer B, Kabitz HJ, et al. Transcutaneous PCO2 monitoring during initiation of noninvasive ventilation. Chest 2007; 132:1810.
  32. Tobias JD. Transcutaneous carbon dioxide monitoring in infants and children. Paediatr Anaesth 2009; 19:434.
  33. van Oppen JD, Daniel PS, Sovani MP. What is the potential role of transcutaneous carbon dioxide in guiding acute noninvasive ventilation? Respir Care 2015; 60:484.
  34. Mayordomo-Colunga J, Medina A, Rey C, et al. Predictive factors of non invasive ventilation failure in critically ill children: a prospective epidemiological study. Intensive Care Med 2009; 35:527.
  35. Muñoz-Bonet JI, Flor-Macián EM, Brines J, et al. Predictive factors for the outcome of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med 2010; 11:675.
  36. Padman R, Henry M. The use of bilevel positive airway pressure for the treatment of acute chest syndrome of sickle cell disease. Del Med J 2004; 76:199.
  37. James CS, Hallewell CP, James DP, et al. Predicting the success of non-invasive ventilation in preventing intubation and re-intubation in the paediatric intensive care unit. Intensive Care Med 2011; 37:1994.
  38. Ganu SS, Gautam A, Wilkins B, Egan J. Increase in use of non-invasive ventilation for infants with severe bronchiolitis is associated with decline in intubation rates over a decade. Intensive Care Med 2012; 38:1177.
  39. Morris JV, Ramnarayan P, Parslow RC, Fleming SJ. Outcomes for Children Receiving Noninvasive Ventilation as the First-Line Mode of Mechanical Ventilation at Intensive Care Admission: A Propensity Score-Matched Cohort Study. Crit Care Med 2017; 45:1045.
  40. Teague WG. Non-invasive positive pressure ventilation: current status in paediatric patients. Paediatr Respir Rev 2005; 6:52.
  41. Carroll CL, Zucker AR. Barotrauma not related to type of positive pressure ventilation during severe asthma exacerbations in children. J Asthma 2008; 45:421.