Upper airway obstructive events on noninvasive ventilation in NMD adolescents

Home noninvasive ventilation (NIV) is expanding worldwide for pediatrics and is mainly indicated to treat nocturnal alveolar hypoventilation. Nasal mask is the most common interface used in children, but oronasal mask may be indicated in case of excessive mouth leaks or facial weakness. Obstructive events caused by the oronasal mask have been reported in a few studies on adult patients, but never in pediatrics. Some strategies to prevent their occurrence have been proposed, such as the increase of expiratory positive airway pressure (EPAP), the use of automatic adjusted EPAP or the switch to a nasal mask. We report here the cases of 2 adolescents with neuromuscular diseases, who experienced upper airway obstructive events by an oronasal mask. The management of these patients to improve NIV efficacy is described and discussed in line with the adult literature.