Paeds Vivas · respiratory-sleep-and-airway
Non-invasive ventilation and home respiratory support — branching viva
Branching viva from the definition and modalities of non-invasive ventilation, through choosing CPAP versus bilevel, the neuromuscular child with a weak cough, the infant with bronchiolitis on high-flow, the child with central hypoventilation, and planning a safe discharge home on ventilation.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar on a respiratory and long-term ventilation service. The consultant asks you to talk through several children: a boy with Duchenne muscular dystrophy and morning headaches, an infant with bronchiolitis and rising work of breathing, a newborn who hypoventilates whenever asleep, and a child with a neuromuscular disorder being prepared for discharge home on nocturnal ventilation.
Station opening
Examiner: "Define non-invasive ventilation and tell me how CPAP differs from bilevel." [2]
Strong candidate (must-hit)
- Defines non-invasive ventilation as positive-pressure support through a mask or nasal interface without an artificial airway; explains that CPAP applies one constant pressure that splints the airway and recruits the lung but does not augment the breath, whereas bilevel cycles between a higher inspiratory and a lower expiratory pressure, and that difference is the pressure support that increases tidal volume and unloads the muscles; adds that a back-up rate is needed when the child's drive is weak or absent. [2]
Weak candidate
- "It is just a breathing mask; CPAP and BiPAP are the same thing." [2]
References6ShowHide
- [1]Sterni LM; Collaco JM; Baker CD; Carroll JL; Sharma GD; Brozek JL; et al An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation. Am J Respir Crit Care Med, 2016.PMID 27082538
- [2]Fauroux B; Abel F; Amaddeo A; Bignamini E; Chan E; Corel L; et al ERS statement on paediatric long-term noninvasive respiratory support. Eur Respir J, 2022.PMID 34916265
- [3]Hull J; Aniapravan R; Chan E; Chatwin M; Forton J; Gallagher J; et al British Thoracic Society guideline for respiratory management of children with neuromuscular weakness. Thorax, 2012.PMID 22730428
- [4]Weese-Mayer DE; Berry-Kravis EM; Ceccherini I; Keens TG; Loghmanee DA; Trang H An official ATS clinical policy statement: Congenital central hypoventilation syndrome: genetic basis, diagnosis, and management. Am J Respir Crit Care Med, 2010.PMID 20208042
- [7]Chatwin M; Ross E; Hart N; Nickol AH; Polkey MI; Simonds AK Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J, 2003.PMID 12662009
- [10]Franklin D; Babl FE; Schlapbach LJ; Oakley E; Craig S; Neutze J; et al A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med, 2018.PMID 29562151