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Pavone M, Misseri G, Ippolito M, Gregoretti C, Cutrera R. New noninvasive modalities in long-term pediatric ventilation: a scoping review. Monaldi Arch Chest Dis 2024. [PMID: 39058015 DOI: 10.4081/monaldi.2024.2841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 05/06/2024] [Indexed: 07/28/2024] Open
Abstract
Long-term noninvasive ventilation modalities for the pediatric population have undergone a continuous evolution. Hybrid noninvasive ventilation modalities have been recently introduced in clinical practice. Combining the advantages of conventional ventilation, hybrid modes use algorithms that automatically adjust the ventilator's settings to achieve a predefined ventilation target. Most of the recommendations on the use and settings of hybrid noninvasive ventilation modalities in children are derived from adult experience. Therefore, there is a lack of evidence on its implementation in pediatric chronic respiratory diseases. This scoping review aims to map the existing information regarding the use of hybrid ventilation modalities in the pediatric population and identify knowledge or research gaps. We performed a literature search using MEDLINE and Pubmed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We included 13 studies (ten studies on average volume-assured pressure-support ventilation; two studies on intelligent volume-assured pressure-support ventilation; and one study on adaptive servoventilation). The use of new noninvasive ventilation modes in the pediatric population has been applied for the treatment of neuromuscular and hypoventilation syndromes as an alternative therapeutic option in the case of the failure of conventional noninvasive ventilation. Their widespread use has been hampered by the limited evidence available. Longitudinal studies on a larger number of patients are needed to confirm their effectiveness and evaluate their long-term clinical and functional outcomes.
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Affiliation(s)
- Martino Pavone
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Pediatric Hospital "Bambino Gesù" Research Institute, Rome.
| | | | | | - Cesare Gregoretti
- Fondazione Istituto "G. Giglio", Cefalù, Palermo; Department of Surgical, Oncological and Oral Science, University of Palermo.
| | - Renato Cutrera
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Pediatric Hospital "Bambino Gesù" Research Institute, Rome.
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2
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Saddi V, O'Connor A, Thambipillay G, Teng A. Delivery of average assured pressure support (AVAPS) through tracheostomy in paediatric patients. Respirol Case Rep 2024; 12:e01269. [PMID: 38074920 PMCID: PMC10709993 DOI: 10.1002/rcr2.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/28/2023] [Indexed: 10/16/2024] Open
Abstract
Average volume-assured pressure support (AVAPS) mode has been available since 2009 and allows the ventilator to deliver a constant pre-set tidal volume by automatically adjusting the inspiratory pressures within a set range. Data in AVAPS mode use is limited in both paediatric populations, and in patients who are ventilated through a tracheostomy. This case series reports on the successful use of AVAPS mode in four paediatric patients with tracheostomy ventilation.
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Affiliation(s)
- Vishal Saddi
- Department of Sleep MedicineSydney Children's HospitalSydneyNew South WalesAustralia
- School of Women and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Antonia O'Connor
- Department of Sleep MedicineSydney Children's HospitalSydneyNew South WalesAustralia
- School of Women and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Ganesh Thambipillay
- Department of Sleep MedicineSydney Children's HospitalSydneyNew South WalesAustralia
- School of Women and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Arthur Teng
- Department of Sleep MedicineSydney Children's HospitalSydneyNew South WalesAustralia
- School of Women and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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3
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Kaslow JA. Use of average volume-assured pressure support (AVAPS) in invasive pediatric chronic mechanical ventilation. Pediatr Pulmonol 2023; 58:1250-1252. [PMID: 36655825 DOI: 10.1002/ppul.26321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/22/2022] [Accepted: 01/15/2023] [Indexed: 01/20/2023]
Affiliation(s)
- Jacob A Kaslow
- Department of Pediatrics, Division of Allergy, Immunology and Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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4
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Saddi V, Thambipillay G, Pimenta M, Martin B, Blecher G, Teng A. Three generations of a family diagnosed with congenital central hypoventilation syndrome: A case series. Respirol Case Rep 2022; 10:e0999. [PMID: 35795478 PMCID: PMC9250650 DOI: 10.1002/rcr2.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/10/2022] [Indexed: 11/07/2022] Open
Abstract
Congenital central hypoventilation syndrome (CCHS) is an autosomal dominant disorder characterized by alveolar hypoventilation and autonomic dysregulation secondary to mutations of the PHOX2B genes. We present five cases from three generations within the same family with varying degrees of phenotypic expression of the PHOX2B gene mutation. The cases were diagnosed following identification of CCHS in index case at birth. This case series underscores the importance of screening first-degree relatives of individuals with confirmed CCHS and alerts the clinicians to maintain a high degree of suspicion in asymptomatic family members given the high degree of phenotypic variability of CCHS.
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Affiliation(s)
- Vishal Saddi
- Department of Sleep MedicineSydney Children's HospitalRandwickNew South WalesAustralia
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Ganesh Thambipillay
- Department of Sleep MedicineSydney Children's HospitalRandwickNew South WalesAustralia
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Marina Pimenta
- Department of Sleep MedicineSydney Children's HospitalRandwickNew South WalesAustralia
| | - Bradley Martin
- Department of Sleep MedicineSydney Children's HospitalRandwickNew South WalesAustralia
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Gregory Blecher
- Department of Sleep MedicineSydney Children's HospitalRandwickNew South WalesAustralia
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Arthur Teng
- Department of Sleep MedicineSydney Children's HospitalRandwickNew South WalesAustralia
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
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5
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Saddi V, Thambipillay G, Martin B, Blecher G, Teng A. Pediatric Average Volume Assured Pressure Support. Front Pediatr 2022; 10:868625. [PMID: 35601414 PMCID: PMC9114489 DOI: 10.3389/fped.2022.868625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Average volume assured pressure support (AVAPS) is a modality of non-invasive ventilation that enables the machine to deliver a pre-set tidal volume by adjusting the inspiratory pressure support within a set range. Data on its use in the pediatric population are limited to case reports and single centre case series. This article reviews paediatric data on use of AVAPS and highlights the need for validation to help develop specific guidelines on use of AVAPS in children.
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Affiliation(s)
- Vishal Saddi
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
| | - Ganesh Thambipillay
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
| | - Bradley Martin
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
| | - Gregory Blecher
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
| | - Arthur Teng
- Sydney Children's Hospital, Department of Sleep Medicine, Sydney, NSW, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, NSW, Australia
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6
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Saddi V, Thambipillay G, Pithers S, Moody M, Martin B, Blecher G, Teng A. Average volume-assured pressure support vs conventional bilevel pressure support in pediatric nocturnal hypoventilation: a case series. J Clin Sleep Med 2021; 17:925-930. [PMID: 33393900 DOI: 10.5664/jcsm.9084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Average volume-assured pressure support (AVAPS) is a modality of noninvasive ventilation that provides a targeted tidal volume by automatically adjusting the inspiratory pressure support within a set range. Pediatric studies evaluating the efficacy of AVAPS in treating nocturnal hypoventilation are confined to case reports. The aim of this study was to compare AVAPS to conventional bilevel positive airway pressure (BPAP) support in improving hypercarbia in a cohort of pediatric patients with nocturnal hypoventilation. METHODS Retrospective review of patient records at an established tertiary pediatric sleep laboratory over a 6-year period. Ventilatory and sleep study parameters from AVAPS and conventional BPAP titration studies were compared. AVAPS was used only if hypoventilation was not controlled using conventional BPAP. Inspiratory pressures, tidal volumes, and adherence were downloaded on final titrated ventilatory settings. Comparisons were made using paired t test. RESULTS A total of 19 patients (11 boys, 8 girls; median age 10.5 years, range 1 to 20 years) were identified. Diagnoses included neuromuscular disease (n = 9), obstructive hypoventilation (n = 5), parenchymal lung disease (n = 4), and congenital central hypoventilation syndrome (n = 2). AVAPS demonstrated significant improvement in peak (P = .009) and mean (P = .001). Transcutaneous CO₂ parameters compared to conventional bilevel. Oxygenation on AVAPS showed positive trend but did not reach statistical significance. AVAPS delivered higher tidal volumes (P = .04) using similar pressures. There was no statistically significant difference in obstructive apnea-hypopnea index, respiratory arousal index, sleep efficiency, and adherence between AVAPS and conventional BPAP. CONCLUSIONS AVAPS was an effective alternative to conventional BPAP in improving hypercarbia in our selective cohort of pediatric patients. Prospective, longitudinal studies are needed to evaluate the benefits of AVAPS feature in the pediatric population.
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Affiliation(s)
- Vishal Saddi
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ganesh Thambipillay
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sonia Pithers
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Miles Moody
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Bradley Martin
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gregory Blecher
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Arthur Teng
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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7
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Kasi AS, Anand N, Harford KL, Landry AM, Alfonso KP, Taylor M, Keens TG, Leu RM. Tracheostomy decannulation to noninvasive positive pressure ventilation in congenital central hypoventilation syndrome. Sleep Breath 2021; 26:133-139. [PMID: 33852109 DOI: 10.1007/s11325-021-02368-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/13/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Noninvasive positive pressure ventilation (NPPV) may permit tracheostomy decannulation (TD) in patients with congenital central hypoventilation syndrome (CCHS) requiring nocturnal positive pressure ventilation via tracheostomy (PPV-T). There is limited evidence on optimal strategies for transitioning patients from PPV-T to NPPV. This study aimed to describe the clinical course and outcome of children with CCHS who underwent TD and transitioned from PPV-T to NPPV. METHODS Retrospective review was conducted on patients with CCHS using nocturnal PPV-T who underwent TD to NPPV. The results of clinical evaluations, airway endoscopy, polysomnography, and clinical course leading to TD were analyzed. RESULTS We identified 3 patients with CCHS aged 8-17 years who required PPV-T only during sleep. Patients underwent systematic multidisciplinary evaluations with a pediatric psychologist, pulmonologist, sleep physician, and otolaryngologist utilizing a TD algorithm. These included evaluation in the sleep clinic, NPPV mask fitting and desensitization, endoscopic airway evaluation, daytime tracheostomy capping, acclimatization to low-pressure NPPV, polysomnography with capped tracheostomy and NPPV titration, and if successful, TD. All patients underwent successful TD following optimal titration of NPPV during polysomnography. The duration to TD from decision to pursue NPPV was between 2.4 and 10.6 months, and the duration of hospitalization for TD was between 4 and 5 days. There were no NPPV-related complications; however, all patients required surgical closure of tracheocutaneous fistula. CONCLUSION NPPV may be an effective and feasible option for patients with CCHS requiring PPV-T during sleep and permits TD. In patients with CCHS, a systematic multidisciplinary algorithm may optimize successful transition to NPPV and TD.
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Affiliation(s)
- Ajay S Kasi
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA, 30329, USA.
| | - Neesha Anand
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA, 30329, USA
| | - Kelli-Lee Harford
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA, 30329, USA
| | - April M Landry
- Division of Pediatric Otorhinolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristan P Alfonso
- Division of Pediatric Otorhinolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Melissa Taylor
- Pediatric Sleep Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Thomas G Keens
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Roberta M Leu
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA, 30329, USA
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8
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Mei M, Yang L, Lu Y, Wang L, Cheng G, Cao Y, Chen C, Qian L, Zhou W. Congenital central hypoventilation syndrome in neonates: report of fourteen new cases and a review of the literature. Transl Pediatr 2021; 10:733-745. [PMID: 34012823 PMCID: PMC8107878 DOI: 10.21037/tp-20-303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Congenital central hypoventilation syndrome (CCHS) is a rare autosomal dominant disorder caused by pathogenic variants in paired-like homeobox 2B (PHOX2B) gene. Characteristics of neonatal-onset CCHS cases have not been well assessed. The aim of this study is to expand current knowledge of clinical and genetic features of neonates with CCHS and provide data on the genotype-phenotype correlation. METHODS We made a retrospective analysis of 14 neonates carrying PHOX2B pathogenic variants from 2014 to 2019 and we reviewed previously published neonatal-onset cases. Clinical and genetic data were analyzed. Moreover, genotype-phenotype correlation analysis was performed. RESULTS We identified a total of 60 neonatal-onset CCHS cases (35 males and 25 females) including 14 novel cases from our local cohort. Nearly 20% (18.2%) of the patients were born prematurely. Nearly half (46.2%) of the patients had abnormal family history. Polyhydramnios was observed in 21.3% (10/47) of the patients. About 90% of the patients manifested symptoms of hypoventilation in the first week of life. Fourteen patients (23.3%) were classified as mild-CCHS and the rest were severe-CCHS. Gastrointestinal manifestations were observed in 71.7% of the patients. Approximately twofold more males than females were affected by Hirschprung disease (HSCR)/variant HSCR (75.8% vs. 35%, P=0.003). Neural crest tumor occurred in 9.1% (4/44) patients. Half patients had polyalanine repeat expansion mutations (PARMs) in PHOX2B (seven with 25 PARM, nine with 26 PARM, twelve with 27 PARM, one with 28 PARM and one with 31 PARM) and the other half patients had 23 distinct non-polyalanine repeat expansion mutations (NPARMs) with one novel pathogenic variant (c.684dup). The prevalence of HSCR and mild-CCHS among patients with NPARMs was significantly greater than that of the patients with PARMs. CONCLUSIONS This report provides a large cohort of neonatal-onset CCHS cases. The results indicate that severe hypoventilation and HSCR are frequently observed in this group. NPARMs accounted for half of the cohort with some genotypes tend to be associated with mild phenotype. Molecular testing in neonates with suspicion of CCHS and genetic counseling for CCHS families are highly recommended.
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Affiliation(s)
- Mei Mei
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Yang
- Clinical Genetic Center, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Yulan Lu
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Laishuan Wang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Guoqiang Cheng
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Liling Qian
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Wenhao Zhou
- Clinical Genetic Center, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China.,Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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9
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Saddi V, Thambipillay G, Teng A. Non-invasive home ventilation using the average volume assured pressure support feature in an infant with severe bronchopulmonary dysplasia and chronic respiratory failure. Pediatr Investig 2020; 4:222-224. [PMID: 33150318 PMCID: PMC7520108 DOI: 10.1002/ped4.12221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction While majority of infants with bronchopulmonary dysplasia (BPD) can be discharged home without low flow oxygen or on supplemental low flow oxygen, some require long term home mechanical ventilation. Case presentation We present a case of an extremely premature infant with severe bronchopulmonary dysplasia who was successfully managed at home on a new feature of non-invasive ventilation called average volume assured pressure support (AVAPS) without the need for tracheostomy. The AVAPS feature enables the machine to deliver a consistent tidal volume by automatically adjusting the inspiratory pressure within a set range. Conclusion The use of AVAPS feature in our case improved ventilation as indicated by a more stable gas exchange profile, making home non-invasive ventilation a more practicable method of managing severe BPD in this infant.
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Affiliation(s)
- Vishal Saddi
- Department of Sleep Medicine Sydney Children's Hospital Sydney New South Wales Australia.,School of Women and Children's Health Faculty of Medicine University of New South Wales Sydney New South Wales Australia
| | - Ganesh Thambipillay
- Department of Sleep Medicine Sydney Children's Hospital Sydney New South Wales Australia.,School of Women and Children's Health Faculty of Medicine University of New South Wales Sydney New South Wales Australia
| | - Arthur Teng
- Department of Sleep Medicine Sydney Children's Hospital Sydney New South Wales Australia.,School of Women and Children's Health Faculty of Medicine University of New South Wales Sydney New South Wales Australia
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10
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Trang H, Samuels M, Ceccherini I, Frerick M, Garcia-Teresa MA, Peters J, Schoeber J, Migdal M, Markstrom A, Ottonello G, Piumelli R, Estevao MH, Senecic-Cala I, Gnidovec-Strazisar B, Pfleger A, Porto-Abal R, Katz-Salamon M. Guidelines for diagnosis and management of congenital central hypoventilation syndrome. Orphanet J Rare Dis 2020; 15:252. [PMID: 32958024 PMCID: PMC7503443 DOI: 10.1186/s13023-020-01460-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/03/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Congenital Central Hypoventilation Syndrome (CCHS) is a rare condition characterized by an alveolar hypoventilation due to a deficient autonomic central control of ventilation and a global autonomic dysfunction. Paired-like homeobox 2B (PHOX2B) mutations are found in most of the patients with CCHS. In recent years, the condition has evolved from a life-threatening neonatal onset disorder to include broader and milder clinical presentations, affecting children, adults and families. Genes other than PHOX2B have been found responsible for CCHS in rare cases and there are as yet other unknown genes that may account for the disease. At present, management relies on lifelong ventilatory support and close follow up of dysautonomic progression. BODY: This paper provides a state-of-the-art comprehensive description of CCHS and of the components of diagnostic evaluation and multi-disciplinary management, as well as considerations for future research. CONCLUSION Awareness and knowledge of the diagnosis and management of this rare disease should be brought to a large health community including adult physicians and health carers.
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Affiliation(s)
- Ha Trang
- Hôpital Universitaire Robert Debré, Centre de référence des maladies respiratoires rares, and Université de Paris, Paris, France
| | - Martin Samuels
- Staffordshire Children’s Hospital, Stoke-on-Trent, Staffs and Great Ormond Street Hospital, London, UK
| | - Isabella Ceccherini
- Istituto Giannina Gaslini, UOSD Laboratory of Genetics and Genomics of Rare Diseases, Genoa, Italy
| | - Matthias Frerick
- Department of Pediatrics, Klinikum Dritter Orden, Munich, Germany
| | | | - Jochen Peters
- Department of Pediatrics, Klinikum Dritter Orden, Munich, Germany
| | | | - Marek Migdal
- Department of Anaesthesiology and Intensive care, Children’s Memorial Health Institute, Warsaw, Poland
| | | | | | - Raffaele Piumelli
- Sleep Disordered Breathing and SIDS Center, Meyer Children’s Hospital, Florence, Italy
| | | | - Irena Senecic-Cala
- University Hospital Centre, Department of Pediatrics, Zagreb and School of Medicine, Zagreb, Croatia
| | - Barbara Gnidovec-Strazisar
- University Children’s Hospital, Department of child, adolescent & developmental neurology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Andreas Pfleger
- Medical University of Graz, Paediatric Pulmonology and Allergology, Graz, Austria
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11
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Pavone M, Verrillo E, Onofri A, Caggiano S, Cutrera R. Ventilators and Ventilatory Modalities. Front Pediatr 2020; 8:500. [PMID: 32984212 PMCID: PMC7492667 DOI: 10.3389/fped.2020.00500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/15/2020] [Indexed: 11/13/2022] Open
Abstract
Non-invasive ventilation is increasingly used in children for acute and chronic respiratory failure. Ventilators available for clinical use have different levels of complexity, and clinicians need to know in detail their characteristics, setting variables, and performances. A wide range of ventilators are currently used in non-invasive ventilation including bi-level ventilators, intermediate ventilators, and critical care ventilators. Simple or advanced continuous positive airway pressure devices are also available. Differences between ventilators may have implications on the development of asynchronies and air leaks and may be associated with discomfort and poor patient tolerance. Although pressure-targeted (controlled) mode is preferable in children because of barotrauma concerns, volume-targeted (controlled) ventilators are also available. Pressure support ventilation represents the most used non-invasive ventilation mode, as it is more physiological. The newest ventilators allow the clinicians to use the hybrid modes that combine the advantages of volume- and pressure-targeted (controlled) ventilation while limiting their drawbacks. The use of in-built software may help clinicians to optimize the ventilator setting as well as to objectively monitor patient adherence to the treatment. The present review aims to help the clinician with the choice of the ventilator and its ventilation modalities to ensure a successful non-invasive ventilation program.
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Affiliation(s)
- Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù Research Institute, Rome, Italy
| | - Elisabetta Verrillo
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù Research Institute, Rome, Italy
| | - Alessandro Onofri
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù Research Institute, Rome, Italy
| | - Serena Caggiano
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù Research Institute, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù Research Institute, Rome, Italy
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12
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Paglietti MG, Esposito I, Goia M, Rizza E, Cutrera R, Bignamini E. Long Term Non-invasive Ventilation in Children With Central Hypoventilation. Front Pediatr 2020; 8:288. [PMID: 32637385 PMCID: PMC7316889 DOI: 10.3389/fped.2020.00288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
Central hypoventilation (CH) is a quite rare disorder caused by some congenital or acquired conditions. It is featured by increased arterial concentration of serum carbon dioxide related to an impairment of respiratory drive. Patients affected by CH need to be treated by mechanical ventilation in order to achieve appropriate ventilation and oxygenation both in sleep and wakefulness. In fact, in severe form of Congenital Central Hypoventilation Syndrome (CCHS) hypercarbia can be present even during the day. Positive pressure ventilation via tracheostomy is the first therapeutic option in this clinical condition, especially in congenital forms. Non-Invasive ventilation is a an option that must be reserved for more stable clinical situations and that requires careful monitoring over time.
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Affiliation(s)
- Maria Giovanna Paglietti
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Irene Esposito
- Pediatric Pulmonology & Regional Reference Centre for Pediatric Respiratory Failure and Cystic Fibrosis, Regina Margherita's Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Manuela Goia
- Pediatric Pulmonology & Regional Reference Centre for Pediatric Respiratory Failure and Cystic Fibrosis, Regina Margherita's Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elvira Rizza
- Pediatric Pulmonology & Regional Reference Centre for Pediatric Respiratory Failure and Cystic Fibrosis, Regina Margherita's Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elisabetta Bignamini
- Pediatric Pulmonology & Regional Reference Centre for Pediatric Respiratory Failure and Cystic Fibrosis, Regina Margherita's Hospital, AOU Città della Salute e della Scienza, Turin, Italy
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Xu Z, Wu Y, Li B, Zheng L, Liu J, Shen K. Noninvasive ventilation in a young infant with congenital central hypoventilation and 7-year follow-up. Pediatr Investig 2019; 3:261-264. [PMID: 32851333 PMCID: PMC7331288 DOI: 10.1002/ped4.12167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/20/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by alveolar hypoventilation and autonomic system dysregulation secondary to mutations of the PHOX2B gene. Treatment consists of assisted ventilation using positive-pressure ventilators via tracheostomy, bi-level positive airway pressure (BPAP) via a noninvasive interface, negative-pressure ventilators, or diaphragm pacing. The long-term use of BPAP in younger children at home has been less frequently reported. CASE PRESENTATION We present a case of a 2-month-old infant with CCHS who was successfully managed by BPAP without the need for tracheostomy and followed up for 7 years. CONCLUSION CCHS is a rare disease that manifests as nocturnal desaturation and carbon dioxide retention in early life. Noninvasive ventilation can be successfully used in young infants via an appropriate mask.
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Affiliation(s)
- Zhifei Xu
- Department of Respiratory MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yunxiao Wu
- Beijing Key Laboratory of Pediatric Otolaryngology, Head and Neck SurgeryBeijing Pediatric Research InstituteBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Bei Li
- Department of Otolaryngology, Head and Neck SurgeryBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Li Zheng
- Department of Otolaryngology, Head and Neck SurgeryBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jingyuan Liu
- Department of Pediatric Critical Care MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Kunling Shen
- Department of Respiratory MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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