What is non-invasive positive pressure ventilation therapy? Non-invasive positive pressure ventilation is an assisted mechanical ventilation method that connects the patient to a positive pressure ventilator through a nasal plug, nasal mask, or nasal mask in a non-invasive manner. The principle of invasive positive pressure ventilation for acute and chronic diseases in infants and children is to stabilize lung volumes to improve lung ventilation and air exchange, as well as to improve conditions such as apnea, upper airway obstruction and labored breathing. The main purpose is to increase lung ventilation, reduce respiratory effort and reduce respiratory muscle fatigue by providing a positive pressure support during inspiration, which helps the child to blow air into the lungs, and a lower pressure during expiration, which prevents alveolar atrophy, increases functional residual air volume and improves blood oxygenation. What kind of children need home noninvasive positive pressure ventilation? Most children with obstructive sleep apnea can be treated with tonsil and/or adenoidectomy. However, in some children, chronic hypoxia can cause a series of pathophysiological changes in the body, which can lead to severe pulmonary hypertension and even cardiac insufficiency. These changes in the cardiovascular system are very dangerous to perform surgery if not corrected before surgery. Therefore, for these children who are temporarily unsuitable for surgery, they need to be treated with non-invasive positive pressure ventilation at home before surgery to correct the long-term hypoxia and secondary cardiac impairment, in order to reduce the occurrence of various complications during the perioperative period, as well as to reduce the occurrence of anesthesia accidents during surgery and difficulties in postoperative extubation, so that they can safely pass through the perioperative period. In addition, there are many children who are not completely cured after tonsil and/or adenoidectomy surgery, especially those with a very high preoperative sleep monitoring sleep disorder index or those with moderate to severe obesity or cardiac impairment (one study showed that 47% of children, and even up to 75% of children with postoperative sleep monitoring, still had an abnormal index related to obstructive sleep disordered breathing). Although the index of sleep disordered breathing and quality of life of this group of children can be significantly improved after surgery, such as the parents reported that the child’s snoring and open-mouth breathing are basically improved, but the obstructive sleep disorder of the child is not completely lifted, and the child still has apnea and hypoxia during sleep, and should continue home non-invasive positive pressure ventilation treatment. Generally, after three months to six months of home treatment, the child has good growth and development, the symptoms improve, and the sleep monitoring is normal again, then the child may not need to continue to use. It should be noted that as the treatment continues, the pressure required by the child varies, so the doctor needs to adjust the pressure of the ventilator according to the changes in the child’s condition during the treatment process in order to make the child more comfortable and improve the efficiency of treatment. What is a remote monitoring system? The TELETREK remote monitoring system is a new high-tech instrument that transmits data on the condition and compliance of the child’s ventilator at home (including the duration of use and the effect of use) to a network server remotely via a fixed telephone line, so that medical personnel and patients can observe the information on the child’s ventilator use at home every day by logging on to the relevant website, thus linking the patient, the doctor and the home medical equipment better. This allows the patient, the physician and the home medical equipment to be better linked together and improves the effectiveness of home treatment. The purpose of the application: 1. To identify the problems that occur during the treatment of children using ventilators at home, and to contact the parents of the children in a timely manner to correct the problems through guidance. 2.The doctor can obtain perfect and accurate medical data during the treatment of the child, and make a systematic and correct assessment of the child’s use and changes in condition. 3.Reduces the time and money needed for hospitalization of the child and for parents to bring the child back to the hospital for follow-up. Technology used: A combination of clinical medicine and high technology is used. The hospital provides the clinical aspects of the technology, such as diagnosis of the patient, setting the appropriate ventilator pressure, training the child and parents on the use of the ventilator, etc. The medical equipment company provides computer network technology, such as the establishment of a network platform, real-time monitoring of the patient’s home ventilator operating status and related technical problems, and long-term ventilator use tracking service and follow-up work. Monitoring items: Monitoring items include: blood oxygen, use pressure, mask leakage rate, heart rate, use time, etc., and according to the monitoring value, blood oxygen analysis, use compliance analysis, etc. Access and processing of monitoring information for children by medical personnel: Monitoring of the status of home medical devices through data transmitters (teleTREK) and remote home healthcare system monitoring web pages, etc. With the medical telemonitoring system, the usage data can be seen by authorized medical staff and patients and their families, as well as by the customer service staff of the medical telemonitoring system via the monitoring web page. When a malfunction of a medical device is detected during the monitoring process, the customer service staff can send a technician to the patient’s home. Through the observation of this data information, the medical staff can grasp complete and accurate medical data, make a scientific assessment of the development of the child’s condition, and guide the child to adjust the required treatment pressure and the next step of treatment. We have successfully applied the remote monitoring system to several cases of children with obstructive sleep apnea syndrome with high-risk factors (e.g. pulmonary hypertension, liver function abnormalities, Pi-Ro syndrome and psychomotor retardation) who are temporarily unsuitable for surgery or still need a period of treatment after surgery, and therefore need to be treated at home with non-invasive ventilation (i.e., what we call ventilator therapy). During the hospitalization period, parents are trained to use the ventilator for 2-3 days, and are taught to properly fit the ventilator at home, and to adjust the ventilator pressure to the most appropriate state for the child in the hospital and after the child is able to adapt, the child can be discharged. At home, the ventilator is used every night while the child sleeps, without interfering with the child’s daily life, learning, eating, etc. The remote monitoring system allows the doctor to observe the child’s daily use. In the early treatment, we can often find a variety of problems in the use of children, such as poor mask wear resulting in a high rate of air leakage and therefore poor oxygen saturation (and oxygen saturation is the main observation indicator, most of the children with obstructive sleep apnea hypoventilation syndrome is due to long-term hypoxia, low oxygen saturation has a great impact on their growth and development), tell the parents and give guidance A significant improvement in use was seen the next day (significant reduction in mask leakage and maintenance of oxygen saturation above the normal level of 95% throughout the night). In one of the children with severe obstructive sleep apnea hypoventilation syndrome with pulmonary hypertension, after nearly 3 months of remote monitoring, it was observed through the monitoring data that the treatment pressure of the child gradually decreased and became stable, and the oxygen saturation of the child could be maintained at a high level steadily, at which time the child was notified to return to the hospital for follow-up examination, which showed that the pulmonary hypertension of the child had been completely corrected, and the child was admitted to the hospital for surgery and continued home treatment and After admission to the hospital, home treatment and remote monitoring were continued for 2 months, and sleep monitoring was repeated 2 months later, showing that the child had fully recovered. During the course of treatment, the child and his family only had to return to the hospital for a total of two follow-up visits, significantly reducing the time and money required. It has also been shown that remote support and guidance can partially replace hospital visits. In the cases we have used, many of the parents had concerns of one kind or another before going home, worrying that their child would not cooperate or wondering if the ventilator was effective. At present, there are still several cases in our hospital where children are treated with ventilators at home through the remote monitoring system. Through communication and feedback with parents, parents have reflected that by putting a mask on their children at night, the children can cooperate well and even take the initiative to ask to wear it, and snoring, breath-holding and open-mouth breathing at night are significantly improved. The children can sleep peacefully and have a better concentration during the day. According to our preliminary research data, the number of people using the remote monitoring system for various diseases in Hong Kong has exceeded 350, and the follow-up services have enabled the patients to achieve very good treatment results at home.