Noninvasive Ventilation in Pediatrics with Dr. Phoebe Yager

Published

The winter peak in respiratory tract infections adds considerable pressure to pediatric emergency departments and intensive care units across the country. In this episode of Curbside Consults, Dr. Phoebe Yager, pediatric intensivist and Chief of the Division of Pediatric Critical Care at MassGeneral for Children, discusses the use of noninvasive ventilation methods to support the respiratory function in pediatric patients.

 

0:00 – Introduction
1:03 – Respiratory illness in children
2:18 – Different methods of noninvasive ventilation in pediatrics
4:28 – Physiology and mechanics of respiratory support provided by CPAP and high-flow nasal cannula oxygen
6:30 – Differences in lung physiology between pediatric patients and adult patients
10:30 – Physiological effects of bronchiolitis
12:08 – Discussion of NEJM publication: Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis
15:20 – When to avoid using high-flow nasal cannula oxygen
16:50 – Discussion of NEJM publication: Nasal High-Flow Therapy for Newborn Infants in Special Care Nurseries
19:06 – Different effects of noninvasive ventilation in preterm infants and neonates compared with infants
20:10 – Indicators of treatment failure in patients on noninvasive ventilation methods leading to escalation of care
21:39 – The future of noninvasive ventilation in pediatrics
22:30 – Conclusion and wrap-up for the year

Resources and articles discussed in this episode:

1. Franklin D et al. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med 2018.
2. Manley B et al. Nasal High-Flow Therapy for Newborn Infants in Special Care Nurseries. N Engl J Med 2019.
3. Lavizzari A et al. Respiratory mechanics during NCPAP and HHHFNC at equal distending pressures. Archives of Disease in Childhood – Fetal and Neonatal Edition 2014.
4. Ejiofor BD et al. PEEP Generated by High-Flow Nasal Cannula in a Pediatric Model. Respiratory Care 2019.

The Curbside Consults series complements the foundational information in Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.

 Dr. Phoebe Yager, pediatric intensivist and Chief of the Division of Pediatric Critical Care at MassGeneral for Children.

 

 

 Ken Wu is a 2019-2020 NEJM Editorial Fellow and a paediatrician working in the National Health Service of the United Kingdom. He graduated from Imperial College School of Medicine and is training in general paediatrics in London.