1
|
Cousin VL, Corbisier T, Rimensberger PC, Polito A, Bordessoule A. Total face mask with neurally adjusted ventilatory assist as a rescue therapy in infants with severe bronchiolitis. Eur J Pediatr 2024; 183:2813-2817. [PMID: 38581463 PMCID: PMC11192665 DOI: 10.1007/s00431-024-05543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
Severe bronchiolitis patients are often supported with non-invasive ventilation (NIV). In case of NIV failure, we recently started to use non-invasive neurally adjusted ventilatory assist ventilation (NIV-NAVA) with a total face mask interface (TFM) and report now our experience with this modality of respiratory support. Retrospective study was made from October 2022 to May 2023 at the Geneva University Hospital Paediatric Intensive Care Unit. Inclusion criteria were children, aged from 0 to 6 months, with severe bronchiolitis with initial NIV failure and switch to NIV-NAVA-TFM. From 49 children with respiratory syncytial virus (RSV)-induced bronchiolitis requiring any form of respiratory support, 10 (median age 61 days (IQR 44-73) failing CPAP or NIV underwent rescue treatment with NIV-NAVA using a TFM. Patients were switched to TFM-NIV-NAVA 8 h (IQR 3-22) after admission for 24.5 h (IQR 13-60). After initiation of TFM-NIV-NAVA, oxygenation improved significantly as early as 1 h after initiation, whereas transcutaneous CO2 values remained stable. None of the patients needed to be intubated and there was no episode of TFM discontinuation due to interface discomfort or other unwanted side effects. Sedation was used in all patients with high proportion of intravenous dexmedetomidine. Median ventilatory assistance duration was 2.5 days (IQR 2-4) and median PICU stay was 4.5 (IQR 3-6). Conclusion: In infants with severe RSV-induced bronchiolitis, respiratory support with TFM-NIV-NAVA seems to be feasible as a rescue therapy and might be considered in selected patients. What is Known: • Bronchiolitic patients with NIV support failure may require invasive mechanical ventilation. • Interface related complications, especially facial sores, can be a cause of NIV failure. What is New: • Total face mask with non-invasive neurally adjusted ventilatory assist (TFM-NIV-NAVA) seems feasible as a rescue therapy in deteriorating patients with CPAP or NIV failure. • TFM-NIV-NAVA can improve oxygenation rapidly in patients with aggravating hypoxemia and seems to be well tolerated.
Collapse
Affiliation(s)
- Vladimir L Cousin
- Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1206, Geneva, Switzerland.
| | - Tiphaine Corbisier
- Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1206, Geneva, Switzerland
| | - Peter C Rimensberger
- Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1206, Geneva, Switzerland
| | - Angelo Polito
- Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1206, Geneva, Switzerland
| | - Alice Bordessoule
- Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Gynecology and Obstetrics, University Hospital of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1206, Geneva, Switzerland
| |
Collapse
|
2
|
McKinney RL, Wallström L, Courtney SE, Sindelar R. Novel forms of ventilation in neonates: Neurally adjusted ventilatory assist and proportional assist ventilation. Semin Perinatol 2024; 48:151889. [PMID: 38565434 DOI: 10.1016/j.semperi.2024.151889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Patient-triggered modes of ventilation are currently the standard of practice in the care of term and preterm infants. Maintaining spontaneous breathing during mechanical ventilation promotes earlier weaning and possibly reduces ventilator-induced diaphragmatic dysfunction. A further development of assisted ventilation provides support in proportion to the respiratory effort and enables the patient to have full control of their ventilatory cycle. In this paper we will review the literature on two of these modes of ventilation: neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV), propose future studies and suggest clinical applications of these modes.
Collapse
Affiliation(s)
- R L McKinney
- Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02906, United States.
| | - L Wallström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - S E Courtney
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - R Sindelar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
3
|
Lepage-Farrell A, Tabone L, Plante V, Kawaguchi A, Feder J, Al Omar S, Emeriaud G. Noninvasive Neurally Adjusted Ventilatory Assist in Infants With Bronchiolitis: Respiratory Outcomes in a Single-Center, Retrospective Cohort, 2016-2018. Pediatr Crit Care Med 2024; 25:201-211. [PMID: 38019615 DOI: 10.1097/pcc.0000000000003407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To describe our experience of using noninvasive neurally adjusted ventilatory assist (NIV-NAVA) in infants with bronchiolitis, its association with the evolution of respiratory effort, and PICU outcomes. DESIGN Retrospective analysis of a prospectively curated, high-frequency electronic database. SETTING A PICU in a university-affiliated maternal-child health center in Canada. PATIENTS Patients younger than 2 years old who were admitted with a diagnosis of acute bronchiolitis and treated with NIV-NAVA from October 2016 to June 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patient characteristics, as well as respiratory and physiologic parameters, including electrical diaphragmatic activity (Edi), were extracted from the electronic database. Respiratory effort was estimated using the modified Wood Clinical Asthma Score (mWCAS) and the inspiratory Edi. A comparison in the respiratory effort data was made between the 2 hours before and 2 hours after starting NIV-NAVA. In the two seasons, 64 of 205 bronchiolitis patients were supported with NIV-NAVA. These 64 patients had a median (interquartile range [IQR]) age of 52 days (32-92 d), and there were 36 of 64 males. Treatment with NIV-NAVA was used after failure of first-tier noninvasive respiratory support; 25 of 64 patients (39%) had at least one medical comorbidity. NIV-NAVA initiation was associated with a moderate decrease in mWCAS from 3.0 (IQR, 2.5-3.5) to 2.5 (IQR, 2.0-3.0; p < 0.001). NIV-NAVA initiation was also associated with a statistically significant decrease in Edi ( p < 0.01). However, this decrease was only clinically relevant in infants with a 2-hour baseline Edi greater than 20 μV; here, the before and after Edi was 44 μV (IQR, 33-54 μV) compared with 27 μV (IQR, 21-36 μV), respectively ( p < 0.001). Overall, six of 64 patients (9%) required endotracheal intubation. CONCLUSIONS In this single-center retrospective cohort, in infants with bronchiolitis who were considered to have failed first-tier noninvasive respiratory support, the use of NIV-NAVA was associated with a rapid decrease in respiratory effort and a 9% intubation rate.
Collapse
Affiliation(s)
- Alex Lepage-Farrell
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Department of Pediatrics, London Children's Hospital, Western University, London, ON, Canada
| | - Laurence Tabone
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Pediatric Intensive Care and Pediatric Emergency Department, CHU Clocheville, Tours, France
| | - Virginie Plante
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Atsushi Kawaguchi
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Department of Pediatrics, Pediatric Critical Care, St Marianna University, Kawasaki, Japan
| | - Joshua Feder
- Department of Pediatrics, Pediatric Intensive Care Unit, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Sally Al Omar
- CHU Sainte Justine Research Center, Université de Montréal, Montreal, QC, Canada
| | - Guillaume Emeriaud
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- CHU Sainte Justine Research Center, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
4
|
Wu M, Zhang X, Jiang Y, Guo Y, Zhang W, He H, Yin Y. Comparison of clinical outcomes in critical patients undergoing different mechanical ventilation modes: a systematic review and network meta-analysis. Front Med (Lausanne) 2023; 10:1159567. [PMID: 37675139 PMCID: PMC10477667 DOI: 10.3389/fmed.2023.1159567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose To evaluate the effects of different mechanical ventilation modes on critical patients. Methods PubMed, Embase, Web of science, and Cochrane Library databases were searched from their inception to November 15, 2022 for randomized controlled trials on the application of different mechanical ventilation modes in critical patients. Two researchers independently screened the literature, extracted data, and assessed the risk of bias in the included studies. R4.2.1 was used for this network meta-analysis. Results Twenty-eight RCTs involving 3,189 patients were included. The interventions in these RCTs included NAVA (neurally adjusted ventilatory assist), PAV (proportional assist ventilation), ASV (adaptive support ventilation), Smartcare/PS (Smartcare/pressure support), PSV (pressure support ventilation), PSV_ATC (pressure support ventilation_automatic tube compensation), and SIMV (synchronized intermittent mandatory ventilation). The network meta-analysis showed that, compared with the PSV group, there was no significant difference in duration of mechanical ventilation, duration of ICU stay, and hospital stay between NAVA, SIMV, AVS, PAV, Smartcare/PS, and PSV_ATC groups. Compared with PSV, PAV improved the success rate of withdrawal of ventilator [OR = 3.07, 95%CI (1.21, 8.52)]. Compared with PSV and PAV, NAVA reduced mortality in the ICU [OR = 0.63, 95%CI (0.43, 0.93); OR = 0.45, 95%CI (0.21, 0.97)]. Conclusion NAVA can reduce mortality in ICU, and PAV may increase the risk of withdrawal of the ventilator. There was no significant difference between PSV and other mechanical ventilation modes (NAVA, SIMV, AVS, PAV, Smartcare/PS, and PSV_ATC) in the duration of mechanical ventilation, duration of ICU stay, or hospital stay. Due to the limitations, more high-quality studies are needed to verify these findings.
Collapse
Affiliation(s)
- Mengyu Wu
- Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xiaohong Zhang
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yu Jiang
- Department of Nursing, School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Yun Guo
- Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Wenjing Zhang
- Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Hong He
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yanhua Yin
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| |
Collapse
|
5
|
Chen IL, Chen HL. New developments in neonatal respiratory management. Pediatr Neonatol 2022; 63:341-347. [PMID: 35382987 DOI: 10.1016/j.pedneo.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 11/19/2022] Open
Abstract
Respiratory distress syndrome (RDS) is the major cause of respiratory failure in preterm infants due to immature lung development and surfactant deficiency. Although the concepts and methods of managing respiratory problems in neonates have changed continuously, determining appropriate respiratory treatment with minimal ventilation-induced lung injury and complications is crucially important. This review summarizes neonatal respiratory therapy's advances and available strategies (i.e., exogenous surfactant therapy, noninvasive ventilation, and different ventilation modes), focusing on RDS management.
Collapse
Affiliation(s)
- I-Ling Chen
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung, Taiwan
| | - Hsiu-Lin Chen
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung, Taiwan; Department of Pediatrics, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, San Ming District, Kaohsiung, Taiwan.
| |
Collapse
|
6
|
Leboucher J, Milési C, Fumagalli A, Wroblewski I, Debillon T, Mortamet G. Prevalence and risk factors of discomfort in infants with severe bronchiolitis. Acta Paediatr 2022; 111:1238-1244. [PMID: 35181910 DOI: 10.1111/apa.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to assess the prevalence of discomfort in infants with severe bronchiolitis supported by noninvasive ventilation and to identify its potential risk factors. METHODS A single-centre retrospective observational study. Discomfort was assessed using the EDIN (Echelle de Douleur et d'Inconfort du Nouveau-né) scale. RESULTS Ninety-one infants (median age 34 days [Interquartile IQR 19-55], 52 (57%) boys) were included in our study. Overall, no patient had a mean EDIN score higher than 8 on Days 1, 2 and 3. On Days 1 and 2, patients supported by bilevel positive airway pressure (BiPAP) had a higher EDIN score compared with other patients (3.3 [SD 2.5] versus 2.6 [SD 2.2] on Day 1 and 2.9 (SD 2.1) versus 2.3 (SD 2.2) on Day 2, both p < 0.001). CONCLUSION Patients with severe bronchiolitis and supported by any type of noninvasive ventilation had a low degree of discomfort during the first 3 days of ICU stay. Patients requiring bilevel noninvasive ventilation appeared to have a higher degree of discomfort, while we found no correlation between the level of discomfort and the degree of respiratory distress.
Collapse
Affiliation(s)
- Justine Leboucher
- Pediatric Intensive Care Unit Grenoble‐Alpes University Hospital Grenoble France
| | - Christophe Milési
- Pediatric Intensive Care Unit Montpellier University Hospital Montpellier France
| | - Alice Fumagalli
- Pediatric Intensive Care Unit Grenoble‐Alpes University Hospital Grenoble France
| | - Isabelle Wroblewski
- Pediatric Intensive Care Unit Grenoble‐Alpes University Hospital Grenoble France
| | - Thierry Debillon
- Neonatal Intensive Care Unit Grenoble‐Alpes University Hospital Grenoble France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit Grenoble‐Alpes University Hospital Grenoble France
- Univ. Grenoble‐Alpes Grenoble France
| |
Collapse
|
7
|
Abstract
Patient-ventilator asynchrony is very common in newborns. Achieving synchrony is quite challenging because of small tidal volumes, high respiratory rates, and the presence of leaks. Leaks also cause unreliable monitoring of respiratory metrics. In addition, ventilator adjustment must take into account that infants have strong vagal reflexes and demonstrate central apnea and periodic breathing, with a high variability in breathing pattern. Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation whereby the timing and amount of ventilatory assist is controlled by the patient's own neural respiratory drive. As NAVA uses the diaphragm electrical activity (Edi) as the controller signal, it is possible to deliver synchronized assist, both invasively and noninvasively (NIV-NAVA), to follow the variability in breathing pattern, and to monitor patient respiratory drive, independent of leaks. This article provides an updated review of the physiology and the scientific literature pertaining to the use of NAVA in children (neonatal and pediatric age groups). Both the invasive NAVA and NIV-NAVA publications since 2016 are summarized, as well as the use of Edi monitoring. Overall, the use of NAVA and Edi monitoring is feasible and safe. Compared with conventional ventilation, NAVA improves patient-ventilator interaction, provides lower peak inspiratory pressure, and lowers oxygen requirements. Evidence from several studies suggests improved comfort, less sedation requirements, less apnea, and some trends toward reduced length of stay and more successful extubation.
Collapse
Affiliation(s)
- Jennifer Beck
- Department of Critical Care, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B1W8, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada; Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael's Hospital, Toronto, Canada.
| | - Christer Sinderby
- Department of Critical Care, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B1W8, Canada; Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael's Hospital, Toronto, Canada; Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Bobillo-Perez S, Sorribes C, Gebellí P, Lledó N, Castilla M, Ramon M, Rodriguez-Fanjul J. Lung ultrasound to predict pediatric intensive care admission in infants with bronchiolitis (LUSBRO study). Eur J Pediatr 2021; 180:2065-2072. [PMID: 33585977 DOI: 10.1007/s00431-021-03978-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 01/01/2023]
Abstract
It is extremely difficult to stratify bronchiolitis and predict the need for admission to the pediatric intensive care unit (PICU). We aimed to evaluate the capacity of a new lung ultrasound score (LUSBRO) to predict the need for admission to the PICU compared to a clinical score. This was a prospective observational single-center study that includes infants < 6 month of age admitted to a hospital due to acute bronchiolitis. Both scores were calculated at admission. The main outcome was PICU admission. Second endpoints were the need for mechanical ventilation, respiratory support duration, and the length of stay in the hospital. Eighty patients were included, with a median age of 53 days (IQR 29-115). Forty-four patients (55%) required PICU admission. LUSBRO score showed a better AUC compared to the clinical score to predict PICU admission: 0.932 (95% CI 0.873-0.990) vs. 0.675 (95% CI 0.556-0.794) and a positive correlation with the hospital length of stay. The best cut-off point for predicting the need for PICU admission for LUSBRO score was 6, showing a sensitivity of 90.91% and a specificity of 88.89%.Conclusions: The LUSBRO score is a useful tool to predict the need for admission to the PICU. What is Known • It is extremely difficult to stratify which patients affected by bronchiolitis should be precociously transferred to a third level hospital and will require pediatric intensive care unit (PICU) admission. • Clinical scores have been created but neither of them is accurate. What is New • The LUSBRO score is a useful tool to predict the need for admission to the PICU of patients with bronchiolitis and, consequently, to predict the patients who should be transferred to a tertiary hospital to optimize respiratory support.
Collapse
Affiliation(s)
- Sara Bobillo-Perez
- Disorders of Immunity and Respiration of the Paediatric Critical Patient Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Clara Sorribes
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Paula Gebellí
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Nuria Lledó
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Marta Castilla
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Miquel Ramon
- Pediatric Intensive Care Unit, Paediatric Department, Hospital Joan XXIII, Tarragona, Spain
| | - Javier Rodriguez-Fanjul
- Neonatology Unit, Paediatric Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain.
| |
Collapse
|
9
|
Christophe M, Julien B, Gilles C. Improving synchrony in young infants supported by noninvasive ventilation for severe bronchiolitis: Yes, we can… so we should! Pediatr Pulmonol 2021; 56:319-322. [PMID: 33270991 DOI: 10.1002/ppul.25184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Milési Christophe
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Baleine Julien
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Cambonie Gilles
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| |
Collapse
|
10
|
Abstract
OBJECTIVES This review discusses the different techniques used at the bedside to assess respiratory muscle function in critically ill children and their clinical applications. DATA SOURCES A scoping review of the medical literature on respiratory muscle function assessment in critically ill children was conducted using the PubMed search engine. STUDY SELECTION We included all scientific, peer-reviewed studies about respiratory muscle function assessment in critically ill children, as well as some key adult studies. DATA EXTRACTION Data extracted included findings or comments about techniques used to assess respiratory muscle function. DATA SYNTHESIS Various promising physiologic techniques are available to assess respiratory muscle function at the bedside of critically ill children throughout the disease process. During the acute phase, this assessment allows a better understanding of the pathophysiological mechanisms of the disease and an optimization of the ventilatory support to increase its effectiveness and limit its potential complications. During the weaning process, these physiologic techniques may help predict extubation success and therefore optimize ventilator weaning. CONCLUSIONS Physiologic techniques are useful to precisely assess respiratory muscle function and to individualize and optimize the management of mechanical ventilation in children. Among all the available techniques, the measurements of esophageal pressure and electrical activity of the diaphragm appear particularly helpful in the era of individualized ventilatory management.
Collapse
|