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Racca F. 1, Cutrera R. 2, Robba C. 1, Caldarelli V. 2, Paglietti M. G. 2, De Angelis M. C. 2, Sekhon M. S. 3, Gualino J. 1, Bella C. 1, Passoni N. 4, Ranieri V. M. 4
1 Anesthesiology and Intensive Care Unit, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy;
2 Pneumology Unit, Department of Pediatric Medicine, Bambino Gesù Children’s Hospital, ICCS, Rome, Italy;
3 Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada;
4 Department of Anesthesiology and Intensive Care, University of Turin, S. Giovanni Battista-Molinette Hospital, Turin, Italy
Upper airway obstruction (UAO) can cause severe respiratory distress in young children by increasing inspiratory muscle load and decreasing alveolar ventilation, ultimately resulting in hypercapnia and hypoxemia which have long term negative cardiovascular effects. Although non-invasive continuous positive airway pressure (CPAP) improves gas exchange in these patients, use of conventional interfaces (nasal mask, nasal pillow and facial mask) may cause significant discomfort and lead to CPAP intolerance. We report five cases of children affected by UAO who experienced CPAP intolerance via application of conventional interfaces. Alternatively, we acutely applied helmet-CPAP which resulted in improved breathing pattern and gas exchange. Thereafter, patients received training with respect to a nasal CPAP interface, allowing successful long term treatment. In conclusion, these five clinical cases demonstrate that helmet-CPAP can be used acutely in children with UAO if compliance to conventional modalities is problematic, allowing for sufficient time to achieve compliance to nasal-CPAP.