Long-term non-invasive positive airway pressure ventilation in infants

Aim: To evaluate the clinical application of long‐term non‐invasive ventilation (NIV) in infants with life‐threatening ventilatory failure with regard to: diagnosis, age at initiation, indication for and duration of treatment, clinical outcome and mortality and adverse effects. Patients and methods: The medical records of 18 infants treated in a home setting during a 7‐year period were reviewed. The criteria for ventilatory support were: (a) transcutaneous partial pressures of carbon dioxide (TcPCO₂) >6.5 kPa and oxygen (TcPO₂) < 8.5 kPa and (b) decreased cough ability and/or recurrent chest infections. Results: The median age at initiation was 4 months (range 1–12). NIV was initiated because of hypoventilation in 12 infants and because of reduced cough ability and/or recurrent infections in six infants. Tracheotomy was eventually needed in two infants. The median duration of treatment was 24 months (range 1–84). NIV produced significant improvements, with median TcPCO₂ falling from 9.9 to 6.1 kPa, and median TcPO₂ rising from 9.8 to 11.1 kPa. Conclusion: NIV can be successfully and safely used in infants with prolonged life‐threatening ventilatory failure, potentially avoiding intubation and tracheotomy.