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• W2023877099 abstract "To the Editor: The ACCP should be congratulated on its recent Consensus Report on “Mechanical Ventilation Beyond the Intensive Care Unit.”1Make BJ Hill NS Goldberg AI et al.Mechanical ventilation beyond the intensive care unit.Chest. 1998; 113: 2895-3445Google Scholar This thorough report describes the current state-of-the-art technology for home ventilation. However, we take exception to the comments regarding nasal mask ventilation in children. The report states that infants and young children may not tolerate nasal masks, that nasal mask ventilation is not usually recommended for use outside the ICU, and that nasal mask ventilation in young children must be considered an investigational technique. Although adaptation to nasal masks is generally more labor-intensive in children and may require behavioral therapy,2Rains JC Treatment of obstructive sleep apnea in pediatric patients.Clin Pediatr. 1995; 34: 535-541Crossref PubMed Scopus (74) Google Scholar children do tolerate nasal masks well. This was demonstrated by three recent articles describing the successful long-term use of nasal masks for home continuous positive airway pressure in a total of 248 infants and children,3Marcus CL Ward SL Mallory GB et al.Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea.J Pediatr. 1995; 127: 88-94Abstract Full Text Full Text PDF PubMed Scopus (229) Google Scholar, 4Waters KA Everett FM Bruderer JW et al.Obstructive sleep apnea: the use of nasal CPAP in 80 children.Am J Respir Crit Care Med. 1995; 152: 780-785Crossref PubMed Scopus (211) Google Scholar, 5Guilleminault C Pelayo R Clerk A et al.Home nasal continuous positive airway pressure in infants with sleep-disordered breathing.J Pediatr. 1995; 127: 905-912Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar 147 of whom were <6 years of age. The literature documents the successful and safe use of home nasal mask ventilation in young children with neuromuscular disease,6Khan Y Heckmatt JZ Dubowitz V Sleep studies and supportive ventilatory treatment in patients with congenital muscle disorders.Archives of Disease in Childhood. 1996; 74: 195-200Crossref PubMed Scopus (59) Google Scholar as well as children with congenital central hypoventilation syndrome.7Kerbl R Litscher H Grubbauer HM et al.Congenital central hypoventilation syndrome (Ondine's curse syndrome) in two siblings: delayed diagnosis and successful noninvasive treatment.Eur J Pediatr. 1996; 155: 977-980Crossref PubMed Scopus (42) Google Scholar, 8Villa MP Dotta A Castello D et al.Bi-level positive airway pressure (BiPAP) ventilation in an infant with central hypoventilation syndrome.Pediatr Pulmonol. 1997; 24: 66-69Crossref PubMed Scopus (54) Google Scholar, 9Ellis ER McCauley VB Mellis C et al.Treatment of alveolar hypoventilation in a six year old girl with intermittent positive pressure ventilation through a nose mask.Am Rev Respir Dis. 1987; 136: 188-191Crossref PubMed Scopus (69) Google Scholar, 10Nielson DW Black PG Mask ventilation in congenital central alveolar hypoventilation syndrome.Pediatr Pulmonol. 1990; 9: 44-46Crossref PubMed Scopus (34) Google Scholar In addition, many studies have shown its efficacy in adolescents with neuromuscular disease or cystic fibrosis, as well as in pediatric patients with acute respiratory failure or in the hospital environment.11Padman R Nadkarni VN Von Nessen S et al.Noninvasive positive pressure ventilation in end-stage cystic fibrosis: a report of seven cases.Respir Care. 1994; 39: 736-739Google Scholar, 12Padman R Lawless S Von Nessen S Use of BiPAP by nasal mask in the treatment of respiratory insufficiency in pediatric patients: preliminary investigation.Pediatr Pulmonol. 1994; 17: 119-123Crossref PubMed Scopus (108) Google Scholar, 13Akingbola OA Servant GM Custer JR et al.Noninvasive bi-level positive pressure ventilation: management of two pediatric patients.Respir Care. 1993; 38: 1092-1098Google Scholar, 14Akingbola O Palmisano J Servant G et al.Bi-PAP mask ventilation in pediatric patients with acute respiratory failure.Crit Care Med. 1994; 22: A144Crossref Google Scholar, 15Brown RW Grady EA Van Laanen CJ et al.Home use of bi-level positive airway pressure (BLPAP) ventilation for chronic respiratory failure in children.Am J Respir Crit Care Med. 1994; 149: A376Crossref PubMed Scopus (44) Google Scholar, 16Fanfulla F Zoia MC Ottolini A et al.BiPAP in Duchenne muscular patients with sleep disorders breathing (SDB): a two years follow-up.Am J Respir Crit Care Med. 1994; 149: A645Google Scholar, 17Fortenberry JD Del Toro J Jefferson LS et al.Management of pediatric acute hypoxemic respiratory insufficiency with bilevel positive pressure (BiPAP) nasal mask ventilation.Chest. 1995; 108: 1059-1064Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar, 18Teague WG Fortenberry JD Noninvasive ventilatory support in pediatric respiratory failure.Respir Care. 1995; 40: 86-96Google Scholar, 19Piper AJ Parker S Torzillo PJ et al.Nocturnal nasal IPPV stabilizes patients with cystic fibrosis and hypercapnic respiratory failure.Chest. 1992; 102: 846-850Abstract Full Text Full Text PDF PubMed Scopus (144) Google Scholar, 20Teague WG Pediatric application of noninvasive ventilation.Respir Care. 1997; 42: 414-423Google Scholar, 21Pope JF Birnkrant DJ Martin JE et al.Noninvasive ventilation during percutaneous gastrostomy placement in Duchenne muscular dystrophy.Pediatr Pulmonol. 1997; 23: 468-471Crossref PubMed Scopus (24) Google Scholar, 22Gozal D Nocturnal ventilatory support in patients with cystic fibrosis: comparison with supplemental oxygen.Eur Respir J. 1997; 10: 1999-2003Crossref PubMed Scopus (128) Google Scholar Although there are relatively few published series of nasal mask ventilation in pediatrics, clinically it is being used widely in children throughout the United States and Europe. We have successfully used home nasal mask ventilation in a total of 76 pediatric patients with chronic hypoventilation at our institutions; the youngest was 3 months of age. As summarized in the ACCP report, other techniques for noninvasive ventilation in children are fraught with technical problems (eg, negative pressure ventilators are cumbersome and may result in obstructive apnea), have limited efficacy (eg, rocking beds), or are appropriate for only a small segment of the population (diaphragm pacers). Tracheostomies have high rates of physical and social morbidity, and even death23Zeitouni A Manoukian J Tracheotomy in the first year of life.J Otolaryngol. 1993; 22: 431-434PubMed Google Scholar in young children. Certainly, young children with chronic respiratory failure should be managed by experienced centers. We strongly agree with the conference recommendations that more research is needed in this area. However, we think nasal mask ventilation shows great promise as an alternative to positive pressure ventilation via tracheostomy in children with chronic hypoventilation. To dismiss nasal mask ventilation as a purely investigational technique is a mistake, considering that it is being used increasingly in pediatric patients in the United States, Australia, and Europe, with much success." @default.
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