Timing of Mask Fitting as a Predictor of Adherence in Children Requiring Non-Invasive Ventilation Therapy
Creators: Lu, Ling
Publisher: name: University of Alberta Library
Year: 2024

<p>Introduction: The utilization of non-invasive ventilation (NIV) in the pediatric population is becoming increasingly prevalent. NIV is a form of breathing support that employs a mask interface outside the airway. It provides necessary respiratory support that improves patients’ quality of life by maintaining airway patency and preventing inadequate ventilation during sleep. While appropriate mask fitting and headgear adaptation enhance NIV adherence, the impact of timing on these interventions is underexplored. This study examined the timing of mask fitting and headgear adaptation on NIV initiation, adherence, and discontinuation within six months post-initiation.<br>
Methods: This retrospective, case-control study used secondary data analysis to examine pediatric patients aged 0-17 in the Stollery Children&#39;s Hospital NIV program who received mask fitting and headgear adaptation (if needed) between 2012 and 2015. Participants were divided into case and control groups based on the timing of mask fitting and headgear adaptation, either prior to initiating NIV (cases) or following initiation (controls). Demographic and clinical data were collected from the NIV program&#39;s clinical database, and adherence data were downloaded from patients’ machines into a database provided by the sleep vendors. Outcomes of interest included NIV initiation rates, NIV usage at 1, 3, and 6 months, as well as NIV discontinuation rates at six months. <br>
Results: One hundred and ten patients (29% female) were included, resulting in 146 mask-fitting entries (69% cases, 31% controls). The median NIV initiation age was 8 years, and upper airway conditions were the most common primary indication (64%). NIV was predominantly initiated in outpatient settings (72%), with CPAP (63%) and nasal masks (91%) being most commonly used. 76% of patients initiated within six months after NIV was recommended based on clinical documentation. Based on available adherence reports, at one month, 54% of cases and 44% of controls initiated NIV (p = 0.341; OR: 1.48, 95% CI: 0.66–3.35), increasing to 57% and 50% by three months (p = 0.522; OR: 1.30, 95% CI: 0.58–2.93), and 61% and 53% by six months (p = 0.456; OR: 1.36, 95% CI: 0.60–3.08). When examining NIV usage over a 30-day period, at one month, cases used NIV for 4.6 hours per night (vs. 4.1 hours in controls; p=0.4), 5.7 hours (vs. 4.3 hours; p=0.13) at three months, and 6.3 hours (vs. 5.1 hours; p=0.51) at six months. The percentage of days with NIV use &gt;4 hours was 56% in cases (vs. 45% in controls; p=0.29) at one month, 60% (vs. 46%; p=0.22) at three months, and 88% (vs. 61%; p=0.18) at six months. Dropout rates within the first 6 months were 15% in the case group and 22% in the control group, with no significant difference (p = 0.504; OR: 0.63, 95% CI: 0.16–2.48).<br>
Conclusion: This study did not reveal a significant impact with respect to the timing of mask fitting on NIV initiation and therapy adherence at six months. This is not surprising since many other known factors can impact NIV adherence, including patient comfort, severity of medical conditions, and family involvement. This study, however, showed adherence rates in both cases and controls higher than previously reported in the literature, suggesting mask fitting and headgear adaptation are key interventions in successful NIV initiation, either before or shortly after NIV initiation. Since these interventions have become the standard of care, collecting further information on the control group for further comparisons will be challenging.</p>