Abstract P-581: NON-INVASIVE VENTILATION WITH NASAL-PHARYNGEAL TUBE IN LIMITED RESOURCE: CASE SERIES

Abstract

Aims & Objectives: Use of non-invasive ventilation (NIV) has increased in past years. Successful NIV requires compatible interface, however, NIV masks have not been widely available in our country so we tried alternative interface, albeit less effective because of potential leakage. Methods Case series Results Case 1. A 3-months-old baby, 3.6kg, was admitted with respiratory failure, pneumonia, and large PDA. She was intubated for 8 days then switched to NIV–pressure control (PC) mode (Servo-i) with ET tube 3.0 inserted 8 cm from nostril, respiratory rate (RR) 30x/minute, FiO2 40%, PIP 15/PEEP 6. Minute volume (MV) 0.6–0.9 L, PaO2 108.8, and PaCO2 32.7 were achieved without increased work of breathing. Case 2. A 4-months-old boy, 7.6kg, was admitted with pneumonia and respiratory failure. He had diaphoresis, chest indrawing, SaO2 90%, PaO2 33.2, and PaCO2 59.7, with 6 lpm oxygen (PaO2/FiO2 ratio 83). NIV–PC mode was started with ET tube 3.5 inserted 9 cm from nostril, RR 20x/minute, FiO2 65%, PIP 15/PEEP 5. His work of breathing was reduced significantly after NIV, RR was decreased from 60 to 30x/minute, and SaO2 was improved. Case 3. A 3.5-years-old boy, 15kg, admitted with dilated cardiomyopathy, cardiogenic shock, and increased work of breathing on 1 lpm nasal oxygen. NIV–PC was administered using ET tube 4.0, 12 cm depth, RR 30x/minute, FiO2 40%, PIP 15/PEEP 5. Chest wall retraction was diminished after NIV. Conclusions Despite of our limited resource, NIV showed promising results in respiratory failure and prevention of reintubation. Shortened ET tube might be used as alternative interface in pediatric NIV.