PMC8421850_01
In-house developed NIV interface adaptor. An in-house 3D printed adaptor [left panel, biocompatible polycarbonate (PC), compliant with ISO 10993 and USP Class VI, white three-lead adaptor in different sizes] to connect a simple anesthetic mask to a five-point head gear for NIV application in children [right panel, 1. ventilator tubing and swivel; 2. 3D printed PC-ISO quick-release clips; 3. 3D printed PC-ISO adaptor; 4. simple anesthetic mask; 5. five-point head gear (Respireo SOFT child, VitalAire)].
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F1
During the stay at our PICU, NIV was provided with the need to rotate (1-3 times per day) two different face masks: a total face mask covering the mouth, nose and eyes (Respironics PerforMax  full face mask size small, Phillips, the Netherlands) and a simple anesthetic mask (Ambu King Mask, size 4, Denmark) connected to a five-point head gear by our in-house 3D printed reusable adaptor (Figures 1, 2).
NIV interface application in the child. NIV provided by a total face mask (left panel) and by a simple anesthetic mask using an in-house 3D printed adaptor for connection to a five-point head gear (right panel). Photographs taken and printed with permission granted by the parents.
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F2
During the stay at our PICU, NIV was provided with the need to rotate (1-3 times per day) two different face masks: a total face mask covering the mouth, nose and eyes (Respironics PerforMax  full face mask size small, Phillips, the Netherlands) and a simple anesthetic mask (Ambu King Mask, size 4, Denmark) connected to a five-point head gear by our in-house 3D printed reusable adaptor (Figures 1, 2).
Timeline of switches between NIV interfaces. Timeline for the relatively stable four-day period (relating to Table 1) showing the frequency of switches between the total face mask and simple anesthetic mask, as per decision of the attending nurse and/or physician (approximate time in hours spend on each mask as indicated in the figure). Switches between masks was timed with moments of patient (airway) care and sleep/awake cycles as much as possible. In addition, decision to switch masks was based on clinical judgement (e.g., increased respiratory distress, anxiety). To determine patient ventilation, pCO2 values were measured in capillary blood gases, which were taken daily, as per decision of the attending physician and in timing with normal patient care and sleep/awake cycles.
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F3
Table 1 shows the air leaks, and levels of hypercapnia/hypoxemia during the treatment with the total face- and simple anesthetic mask as measured on 15 random timepoints and daily capillary blood gas analysis during a relatively stable 4-day period in the acute phase of hypoxic ARF (first week of admission) (see Figure 3 for timeline of switches between the masks during this 4-day period).