EFFECT OF NONINVASIVE VENTILATION ON OUTCOME OF PEDIATRIC PATIENTS WHO DEVELOP ACUTE RESPIRATORY FAILURE

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: The utilization of noninvasive ventilation (NIV) has become popular as a supportive therapy in the treatment of acute respiratory failure in children. It has been proven to be effective in selected patients, and has decreased the incidence of endotracheal intubation, and the risk of acquiring ventilator-associated pneumonia, barotrauma, laryngeal swelling, and post-extubation vocal cord dysfunction. In the local setting, there is paucity of literature regarding the use of non -invasive ventilation in pediatrics, hence this study aims to determine its outcome and predictors of success, to fill gap in knowledge. METHODS: The study is a retrospective cross-sectional study that examined the outcomes and predictors of success of use of non- invasive ventilation in pediatric patients with acute respiratory failure. RESULTS: There were a total of 75 patients included in the study. Seventy three percent (n= 55) of patients had NIV success as an outcome while twenty seven percent (n= 20) of patient has NIV failure as an outcome. The average age of the participants 0.33 or 3.9 months. Seventy six percent (n= 57) were male, while twenty four percent (n=18) were female. Most of the patient had a normal nutritional status with an incidence of 50.6% (n= 38). The most common cardiac diagnosis of patients who were instituted with NIV are dextro transposition of the great arteries (46%) and ventricular septal defect (40.91%). The most common cause of respiratory failure of patients who were instituted with non- invasive ventilation are post extubation failure (64%); pulmonary congestion (54%) and pneumonia (53%).On multivariate analysis, the following factors namely 1) Presence of Pneumonia (p = 0.008); 2.) Presence of sepsis (p= 0.10); 3.) Having a severe respiratory distress prior to NIV ( p = 0.044) 4.) and using CPAP as the NIV mode (p= 0.003) were found to be significantly associated with NIV outcome. Specifically, it was found that patients with pneumonia were 97.72% less likely to have successful NIV and patients with presence of sepsis were 94.95% less likely to have successful NIV. In addition, patients with severe level of distress prior to NIV were 99.97% less likely to have successful NIV. Lastly, patients with CPAP NIV mode were 63.5 times more likely to have successful NIV compared to patients with BIPAP NIV mode. CONCLUSIONS: The use of non- invasive ventilation in patients with acute respiratory failure can be effective and can ultimately decrease the need for endotracheal intubation. However, caution with its use should be applied in patients with pneumonia, sepsis and severe level of respiratory distress, Knowledge regarding the efficacy and possible predictors of outcome of NIV use, can help in the prevention of pulmonary morbidity as well as in the improvement of management approach to children presenting with respiratory distress. CLINICAL IMPLICATIONS: This study evaluated the clinical indication, predictors and outcomes of non -invasive ventilation. The information gathered in this study will contribute to the existing pool of knowledge and will help the pediatricians to decide whether to initiate NIV or not. This study will also serve as a stepping stone to the pursuit of further studies about non- invasive ventilation. DISCLOSURES: No relevant relationships by JENNEYFER REZZA RUCKENBROD, source=Web Response