Problems occurring during continuous positive airway pressure (CPAP) titration in a child

Polysomnographic tracing from a 30-second fragment of a CPAP titration in a 6-year-old child wearing a nasal mask. The CPAP pressure has been progressively increased from 6 to 15 cm H₂O pressure, but the child continues to show signs of airway obstruction, with snoring (SNORE tracing, green) and an air leak at 73 L/minute (CLeak tracing, vertical line at 73.7), and paradoxical breathing (ABD tracing deviates in opposite direction from CHEST tracing during obstructive event). Thus, the CPAP is not effective, likely because of a poorly fitting mask or nasal obstruction and/or open-mouth breathing. Note that there is no activity in the tracings for end-tidal CO₂ (EtCO2) and waveform (ETCO2WAV), indicating either a severe nasal obstruction or nonfunctional sensor. The transcutaneous CO₂ sensor (TcCO2) demonstrates normal systemic CO₂ levels. This child had a nasal tumor obstructing airflow. CPAP was ineffective.