Table 5.

PAP complications and corresponding strategies.

Complications	Strategies
Skin erythema and breakdown	Ensure proper fit Alternate interfaces Alternate interface compositions (e.g., gel, air) Use of protective dressing and gel pads
Midface hypoplasia	Titrate pressure to minimum effective pressure Maximize time off PAP Routine evaluation of maxillomandibular growth
Gastric insufflations and aspiration	Avoid PAP if ongoing emesis Vent Gastrostomy tube Optimize GERD management Monitor closely when PAP first introduced with concurrent feeds
Nasal congestion and epistaxis	Use supplemental humidification Consider nasal steroids for congestion Consider change from nasal to oronasal mask with intercurrent illness
Eye irritation	Ensure proper mask fit Use artificial tears
Rebreathing carbon dioxide	Ensure smallest and best fitting mask used Clinically assess oronasal and total face mask before discharge
Pulmonary air leak	Admit patient to hospital: decision to hold PAP or decrease pressure should be made on a case by case basis Titrate pressure to minimum effective pressure
Cardiovascular complications	Caution in children with single ventricles or hypovolemic states

GERD: Gastroesophageal Reflux Disease; Adapted from [65].