NON-INVASIVE VENTILATION IN LIMITED RESOURCES AREA:
Does it so simple as well?
Ririe Fachrina Malisie
Child Health Department, Emergency and Intensive Care Pediatric Division
Faculty of Medicine Sumatera Utara University
Sumatera Utara University Hospital
Respiratory infections and sepsis are the leading causes of respiratory failure in children
under five years of age developing country. Respiratory support is essential in the
management of these critically ill children. Mortality and morbidity in these children could be
decreased with adequate respiratory support in the emergency and intensive care setting.
Providing mechanical ventilation to all sick children with respiratory distress may not be
feasible in the resource limited setting where the burden of referral is huge. Non-invasive
ventilation (NIV) could be considered in this condition, as it is cheap, safe and reduced almost
> 75% the need of invasive ventilation. NIV is ventilated patient with the techniques that do
not require an endotracheal airway. Although there are limited non-invasive support options
for children, the use of NIV in children is expanding worldwide. Continuous positive airway
pressure (CPAP) is widely used for children with moderate or severe respiratory distress in
intensive care unit in developed countries. CPAP can be delivered using a conventional
ventilator, bubble circuit or a CPAP driver with various types of interfaces like face mask,
nasopharyngeal tube or nasal prongs, which is not available in most health care center in low
middle income countries. Bubble CPAP could be beneficial in hospitals where the only
respiratory support for treating children with respiratory distress and hypoxemia is the
standard flow oxygen. High flow nasal cannula (HFNC) oxygen delivery is a relatively new NIV
that might be well tolerated in infants with hypoxemic respiratory failure. The evidence for
safety or effectiveness of HFNC as a respiratory support in children is relatively lacking.
Debate is still ongoing as to whether HFNC may reduce the use of less tolerated and more
invasive ventilator supports, such as CPAP and mechanical ventilation.
Keywords: non-invasive ventilation in children, limited resources area
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