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Invasive And Non Invasive Respiratory Support

Invasive And Non Invasive Respiratory Support in Bhubaneshwar

Paediatric patients with respiratory failure or impaired lung function require assisted ventilation for adequate breathing. There are two methods of providing respiratory support, and whether to use an invasive or noninvasive method depends on the severity and condition of the child. Invasive respiratory support uses mechanical ventilation that assists or modifies spontaneous breathing. This is often important for children who cannot do adequate ventilation themselves or have severe respiratory problems. However, they are also exposed to certain risks associated with these invasive procedures, such as pneumonia associated with ventilation, barotrauma, and ventilation-induced lung injury.

Non-invasive respiratory support includes providing continuous positive airway pressure (CPAP) to maintain a constant flow of air or oxygen, which helps to keep the airways open and maintains the proper oxygen delivery. The use of CPAP requires regular monitoring to ensure successful treatment outcomes for conditions such as obstructive sleep apnoea (OSA), acute respiratory failure, and others. Manipal Hospitals in Bhubaneswar have an advanced paediatric facility with experienced doctors skilled in providing all types of respiratory support to children, making their lives easier and better.

FAQ's

Invasive respiratory support is necessary for your child with severe respiratory failure who is unable to maintain adequate oxygenation or ventilation on their own. This includes conditions such as,

  • Acute respiratory distress syndrome (ARDS)
  • Severe pneumonia
  • Sudden worsening of airways in chronic obstructive pulmonary disease (COPD)
  • Postoperative respiratory failure

Invasive respiratory support is initiated by inserting an endotracheal tube (ETT) or tracheostomy tube into the patient's airway. This is typically done under sedation and neuromuscular blocking agents that facilitate intubation and minimise the discomfort to your child.

The choice of ventilation mode depends on the patient's clinical condition, respiratory mechanics, and therapeutic goals. There are various modes to deliver mechanical ventilation, which include:

  • Pressure Control Ventilation (PCV)
  • Assist-Control Ventilation (ACV)
  • Pressure Support Ventilation (PSV)
  • Synchronised Intermittent Mandatory Ventilation (SIMV)

Complications caused by invasive respiratory support include ventilator-associated pneumonia, barotrauma such as pneumothorax or pneumomediastinum, ventilator-induced lung injury, ventilator-induced diaphragmatic dysfunction, and sedation-related complications. To minimise these risks, our medical team will provide close monitoring and appropriate management.

Non-invasive respiratory support is used to provide breathing assistance to children without using invasive procedures. This assistance is usually provided by devices such as masks or nasal tubes without placing a breathing tube in the patient’s airway.

Non-invasive respiratory support is used for paediatric patients with respiratory distress or failure who can still maintain their airway and protective reflexes. It's commonly employed in conditions such as acute exacerbations of chronic obstructive pulmonary disease (COPD), asthma exacerbations, pulmonary oedema, sleep-related breathing disorders like obstructive sleep apnoea (OSA), and in some cases acute respiratory failure.

The main types of non-invasive respiratory support include:

  • Continuous Positive Airway Pressure (CPAP)

  • High-Flow Nasal Cannula (HFNC)

  • Bilevel Positive Airway Pressure (BiPAP)

These methods help keep the airways open, improve oxygenation, and assist with breathing efforts.

While non-invasive respiratory support is generally safe, potential complications may include skin breakdown or irritation from the mask interface, nasal congestion or dryness, gastric distension, and mask intolerance leading to mask leaks or discomfort. Close monitoring by a trained medical professional and adjustment of settings are essential to minimise these risks.

Non-invasive respiratory support is generally more comfortable for paediatric patients, as it preserves the ability to speak and eat, reduces the risk of complications associated with invasive procedures, and may allow for earlier mobilisation and discharge from the hospital. It is also associated with lower rates of ventilator-associated pneumonia and ventilator-induced lung injury.

Criteria for liberating a child include improvement in the underlying respiratory condition, stable haemodynamics, adequate gas exchange on minimal ventilatory support, resolution of sedation effects, and the child's ability to protect their airway and maintain adequate ventilation. After a careful assessment of the child’s clinical status and readiness for liberation from mechanical ventilation, the decision to extubate will be taken by a multidisciplinary team.

The fitting process for masks or nasal prongs used in non-invasive respiratory support is typically performed by a respiratory therapist or nurse. Before fitting the mask or nasal prongs, the healthcare provider will assess your child’s facial anatomy to determine the appropriate size and type of interface. This assessment may include measurements of the nose, mouth, and facial structure. Healthcare providers can provide guidance on techniques to enhance comfort, such as adjusting the fit, using cushioning pads, or applying skin barrier creams to reduce irritation.

Eating and drinking while using non-invasive ventilation can be challenging, especially if your child is wearing a mask that covers the nose and mouth or a full-face mask. In these cases, the mask may need to be temporarily removed by the patient to eat or drink. Talking while using non-invasive ventilation is generally possible, although the clarity of speech may be affected depending on the type of interface and the pressure settings used. Some children may experience difficulty articulating words or speaking clearly while wearing a mask or nasal prongs.

To ensure prompt medical attention and appropriate management, it's crucial to recognise the signs indicating that non-invasive ventilation may not be working effectively. These include:

  • Increased respiratory rate
  • Persistent or worsening respiratory distress
  • Persistent hypoxaemia
  • Leak or discomfort related to mask

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