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Mastouri M, Amaddeo A, Griffon L, Frapin A, Touil S, Ramirez A, Khirani S, Fauroux B. Weaning from long term continuous positive airway pressure or noninvasive ventilation in children. Pediatr Pulmonol 2017; 52:1349-1354. [PMID: 28714612 DOI: 10.1002/ppul.23767] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES A significant number of children are able to discontinue long term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) but the underlying disorders, weaning criteria, and outcome of these children have not been studied. STUDY DESIGN Retrospective cohort follow up. SUBJECT SELECTION Consecutive children who were weaned from long term CPAP/NIV between October 2013 and January 2016. METHODOLOGY Underlying disorders, weaning criteria, and clinical outcome were analyzed. RESULTS Fifty eight (27%) of the 213 patients on long term CPAP/NIV could be weaned from CPAP/NIV with 50 patients being weaned from CPAP and 8 from NIV. Most patients were young children with upper airway anomalies, Prader Willi syndrome or bronchopulmonary dysplasia. CPAP/NIV was discontinued following spontaneous improvement of sleep-disordered breathing in 33 (57%) patients, upper airway surgery (n = 14, 24%), maxillofacial surgery (n = 6, 11%), neurosurgery (n = 1, 2%), upper airway and neurosurgery (n = 2, 3%), or switch to oxygen therapy (n = 2, 3%). CPAP/NIV was discontinued due to normal nocturnal gas exchange during spontaneous breathing in all patients, with an obstructive apnea-hypopnea index ≤6 events/h on a combined poly(somno)graphy in 27 patients. A relapse of obstructive sleep apnea was observed after a median delay of 2 years in six patients who resumed CPAP and in one patient who underwent midface distraction. CONCLUSIONS Weaning from CPAP/NIV is possible in children treated with long term CPAP/NIV but is highly dependent on the underlying disorder. Spontaneous improvement is possible but most children need specific surgery. Long term follow-up is necessary in children with underlying disorders.
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Affiliation(s)
- Meriem Mastouri
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Department of Pediatrics, CHR Citadelle, ULG University, Liege, Belgium
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Paris Descartes University, Paris, France.,Research Unit INSERM U 955, team 13, Créteil, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Annick Frapin
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Samira Touil
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Adriana Ramirez
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Air Liquide European Homecare Operations Services (ALEHOS), Gentilly, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Air Liquide European Homecare Operations Services (ALEHOS), Gentilly, France.,ASV Santé, Gennevilliers, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Paris Descartes University, Paris, France.,Research Unit INSERM U 955, team 13, Créteil, France
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Mortamet G, Amaddeo A, Essouri S, Renolleau S, Emeriaud G, Fauroux B. Interfaces for noninvasive ventilation in the acute setting in children. Paediatr Respir Rev 2017; 23:84-88. [PMID: 27887916 DOI: 10.1016/j.prrv.2016.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/14/2016] [Accepted: 09/28/2016] [Indexed: 01/30/2023]
Abstract
The use of noninvasive ventilation (NIV) is very specific in the acute setting as compared to its use in a chronic setting. In the Pediatric Intensive care Unit (PICU), NIV may be required around the clock and initiation has to be fast and easy. Despite the increasing use of non-invasive ventilation (NIV) and the larger choice of interfaces, data comparing the use of different interfaces for pediatric patients are scarce and recommendations for the most appropriate choice of interface are lacking. However, this choice in acute settings is crucial and a major contributor of the success of NIV. The aim of the present review was to describe the different types of interfaces available for children in the acute setting, their advantages and limitations, to highlight how to choose the optimal interface, and how to monitor the tolerance of the interface.
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Affiliation(s)
- Guillaume Mortamet
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Quebec, Canada; Université de Montréal, Montréal, Quebec, Canada; INSERM U 955, Equipe 13, Créteil, France.
| | - Alessandro Amaddeo
- INSERM U 955, Equipe 13, Créteil, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker, Paris, France.
| | - Sandrine Essouri
- Université de Montréal, Montréal, Quebec, Canada; Pediatric Department, CHU Sainte-Justine, Montreal, Quebec, Canada.
| | - Sylvain Renolleau
- Pediatric Intensive Care Unit, AP-HP, Hôpital Necker, Paris, France.
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Quebec, Canada; Université de Montréal, Montréal, Quebec, Canada.
| | - Brigitte Fauroux
- INSERM U 955, Equipe 13, Créteil, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker, Paris, France.
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Dudoignon B, Amaddeo A, Frapin A, Thierry B, de Sanctis L, Arroyo JO, Khirani S, Fauroux B. Obstructive sleep apnea in Down syndrome: Benefits of surgery and noninvasive respiratory support. Am J Med Genet A 2017; 173:2074-2080. [DOI: 10.1002/ajmg.a.38283] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/14/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Benjamin Dudoignon
- AP-HP; Hôpital Necker-Enfants Malades; Pediatric Noninvasive Ventilation and Sleep Unit; Paris France
| | - Alessandro Amaddeo
- AP-HP; Hôpital Necker-Enfants Malades; Pediatric Noninvasive Ventilation and Sleep Unit; Paris France
- Paris Descartes University; Paris France
- Inserm U955; Team 13; Créteil France
| | - Annick Frapin
- AP-HP; Hôpital Necker-Enfants Malades; Pediatric Noninvasive Ventilation and Sleep Unit; Paris France
| | - Briac Thierry
- AP-HP, Hôpital Necker-Enfants Malades; Pediatric Head and Neck Surgery; Paris France
| | - Livio de Sanctis
- AP-HP; Hôpital Necker-Enfants Malades; Pediatric Noninvasive Ventilation and Sleep Unit; Paris France
| | - Jorge Olmo Arroyo
- AP-HP; Hôpital Necker-Enfants Malades; Pediatric Noninvasive Ventilation and Sleep Unit; Paris France
| | - Sonia Khirani
- AP-HP; Hôpital Necker-Enfants Malades; Pediatric Noninvasive Ventilation and Sleep Unit; Paris France
- ASV Santé; Gennevilliers France
| | - Brigitte Fauroux
- AP-HP; Hôpital Necker-Enfants Malades; Pediatric Noninvasive Ventilation and Sleep Unit; Paris France
- Paris Descartes University; Paris France
- Inserm U955; Team 13; Créteil France
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Boudewyns A, Abel F, Alexopoulos E, Evangelisti M, Kaditis A, Miano S, Villa MP, Verhulst SL. Adenotonsillectomy to treat obstructive sleep apnea: Is it enough? Pediatr Pulmonol 2017; 52:699-709. [PMID: 28052557 DOI: 10.1002/ppul.23641] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/07/2016] [Accepted: 11/03/2016] [Indexed: 01/01/2023]
Abstract
Although adenotonsillectomy is the first line treatment for children with obstructive sleep apnea syndrome (0SAS),1 improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease. Early recognition and treatment of children with persistent OSAS is required to prevent long-term morbidity. The management of these children is frequently complex and a multidisciplinary approach is required as most of them have additional risk factors for OSAS and comorbidities. In this paper, we first provide an overview of children at risk for persistent disease following adenotonsillectomy. Thereafter, we discuss different diagnostic modalities to evaluate the sites of persistent upper airway obstruction and the currently available treatment options. Pediatr Pulmonol. 2017;52:699-709. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- A Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - F Abel
- Department of Paediatric Respiratory and Sleep Medicine, Great Ormond Street Hospital for Children, London, United Kingdom
| | - E Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - M Evangelisti
- University of Rome "La Sapienza" School of Medicine, Rome, Italy.,Regional Sleep Disorders Center, Sant' Andrea Hospital, Rome, Italy
| | - A Kaditis
- First Department of Paediatrics, Pediatric Pulmonology Unit, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - S Miano
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - M P Villa
- University of Rome "La Sapienza" School of Medicine, Rome, Italy.,Regional Sleep Disorders Center, Sant' Andrea Hospital, Rome, Italy
| | - S L Verhulst
- Department of Pediatric Pulmonology, Antwerp University Hospital, University of Antwerp, Belgium
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