Medical hypnosis as a tool to acclimatize children to non-invasive positive pressure ventilation

Patient cooperation is crucial for success of non-invasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce the anticipatory anxiety and the acclimatization time in children candidates for long-term NPPV. METHODS Medical hypnosis was performed by a trained nurse. The acclimatization time and long-term compliance with NPPV were evaluated. RESULTS Hypnosis was performed in 9 children, aged 2 to 15 years old; 7 children with a high level of anticipatory anxiety because of a tracheotomy since birth (2 patients), a history of maxillofacial surgery (2 patients), severe dyspnea due to lung disease (2 patients), morbid obesity and depression (1 patient), and 2 children with obstructive sleep apnea who failed standard NPPV initiation. The hypnosis techniques were based on distraction in the youngest patient and indirect or direct hypnotic suggestions in the older children, in order to obtain a progressive psycho-corporal relaxation. All the patients accepted the interface and the NPPV after the first hypnosis session. A median of three sessions was needed for overnight (> 6 hours) NPPV acceptance. The 6-months compliance with NPPV was excellent with a median use of 7.5 hours/night. CONCLUSION Medical hypnosis is a very effective, safe, non-invasive, and cheap tool for reducing the anticipatory distress and acclimatizing time for NPPV. This therapy is particularly useful in children with traumatic experiences such as a tracheotomy or facial surgical procedures.

Chest. 2013 Feb 7. doi: 10.1378/chest.12-2259. Delord V, Khirani S, Ramirez A, Joseph EL, Gambier C, Belson M, Gajan F, Fauroux B.