Special considerations for paediatric patients
Because the child’s efforts are sometimes very slight, ventilators need to be sensitive enough to detect their inspiratory trigger.
- ResMed ventilators offer adjustable trigger sensitivities, allowing clinicians to choose a high or very high sensitivity to make triggering easier.
- The Stellar™ range of ventilators allows oxygen to be connected directly to the ventilator, reducing the likelihood of triggering being compromised.
To achieve adequate minute ventilation, some clinicians advocate setting a fairly high back-up rate.
- Stellar ventilators offer a settable back-up breath rate of up to 60 bpm.
- Stellar ventilators also offer the Pressure Assist Control (PAC) mode, allowing clinicians to set both a back-up rate and a fixed inspiratory time.
Unintentional leaks are inevitable, especially for paediatric patients who may be moving about, or who don’t yet understand the need to keep the mask on.
- ResMed ventilators allow clinicians to set a ‘tight’ Ti Max for paediatric patients to ensure that each breath terminates, even if there is large leak.
NIV can be used in acute respiratory failure.
- Stellar and Lumis™ ventilators are approved for paediatric patients (13 kg and above) in the hospital and the home.
- The Stellar range offers a comprehensive menu of alarm options, as well as integrated oximetry, making it ideal for paediatric NIV use.
- In addition, Stellar ventilators allow up to 30L/min of oxygen to be connected directly to the device (as opposed to being ‘bled into’ the circuit), and also offer an FiO2 monitoring option, suitable for hospital use.
For paediatric patients, it is important to ensure that the ventilator has appropriate alarms.
- Most ResMed ventilators include alarms such as power failure or device failure.
- Stellar ventilators offer a comprehensive menu of alarm options, including a non-vented mask alarm.
Skin breakdown can occur from over-tightening the mask straps. To avoid skin breakdown and facial flattening, some clinicians suggest offering all chronic paediatric patients at least two different styles of masks to vary the pressure points.
- ResMed offers a range of paediatric masks including the Pixi™ and Mirage Kidsta™ nasal masks.
Mouthpiece ventilation can be tried in children at least four years old if they have good oro-motor control. Each patient must be evaluated to ensure appropriate alarms in case of circuit disconnection or loss of mouthpiece from the lips.
Heated humidification often helps patients to be more comfortable and avoid increasing airway resistance.
- Compatible with most ResMed ventilators, the H4i™ is a simple-to-use, integrated heated humidifier.
- Most ResMed ventilators are compatible with external humidifiers. Please review the device clinical guide for details.
Many children on NIV also require nebuliser therapy. Because breathing for these children is typically very shallow, it is helpful for them to take their nebuliser treatment while on NIV, to ensure deeper inhalation and better medication deposition.
- Stellar ventilators allow clinicians to use the PAC mode, which ensures a specified breath rate and inspiratory time.
- Alternatively, Stellar (in the Lumis™ series) allow clinicians to set the Ti Min, which will ensure a minimum inspiratory time in S and ST modes.
Paediatric patients are often prescribed an oximeter.
- Stellar ventilators offer an integrated oximeter with alarms. The integrated oximeter simplifies the carer’s routine because there are fewer devices to carry around and learn how to operate.
It is important for families of children on NIV to participate in normal activities and excursions that promote bonding and quality of life.
- Stellar ventilators are equipped with an internal battery for extra mobility.
- Additionally, many ResMed ventilators can accommodate the ResMed Power Station II (RPS II), which can provide from eight to sixteen hours* of battery duration (based on whether one or two batteries are used).
- The batteries facilitate continuity of therapy for the paediatric patient.
*8 hours per battery in PAC mode at EPAP 5 cm H2O, IPAP 15 cm H2O and 20 bpm (two batteries can be connected simultaneously)