Noninvasive positive pressure ventilation in infants with upper airway obstruction:: comparison of continuous and bilevel positive pressure

Objective: This study evaluated the efficacy of noninvasive continuous positive pressure (CPAP) ventilation in infants with severe upper airway obstruction and compared CPAP to bilevel positive airway pressure (BIPAP) ventilation. Design and setting: Prospective, randomized, controlled study in the pulmonary pediatric department of a university hospital. Patients: Ten infants (median age 9.5 months, range 3-18) with laryngomalacia (n = 5), tracheomalacia (n = 3), tracheal hypoplasia (n = 1), and Pierre Robin syndrome (n = 1) Interventions: Breathing pattern and respiratory effort were measured by esophageal and transdiaphragmatic pressure monitoring during spontaneous breathing, with or without CPAP and BIPAP ventilation. Measurements and results: Median respiratory rate decreased from 45 breaths/ min (range 24-84) during spontaneous breathing to 29 (range 18-60) during CPAP ventilation. All indices of respiratory effort decreased significantly during CPAP ventilation compared to unassisted spontaneous breathing ( median, range): esophageal pressure swing from 28 to 10 cmH(2)O (13-76 to 7-28), esophageal pressure time product from 695 to 143 cmH(2)O/s per minute (264-1417 to 98-469), diaphragmatic pressure time product from 845 to 195 cmH(2)O/s per minute (264-1417 to 159-1183) During BIPAP ventilation a similar decrease in respiratory effort was observed but with patient-ventilator asynchrony in all patients. Conclusions: This short-term study shows that noninvasive CPAP and BIPAP ventilation are associated with a significant and comparable decrease in respiratory effort in infants with upper airway obstruction. However, BIPAP ventilation was associated with patient-ventilator asynchrony.