Non invasive mechanical ventilation in Pediatric Intensive Care, four years of clinical practice

Abstract

In the last years, different studies have shown the effectiveness of noninvasive ventilation (NIV) in reducing rate of intubation in chronic and acute respiratory failure, with the direct consequence of lower morbidity and mortality associated with artificial airway, and reduction of days of hospitalization in ICU. To describe our clinical experience in the use of NIV in the pediatric intensive care unit (PICU) and to analyze the characteristics associated with the success of this technique. Retrospective, descriptive and observational study. We reviewed the medical records of all patients treated with NIV between 2006 and 2010. We divided the patients in three groups, according to the clinical setting of application: elective NIV (group 1), rescue NIV (group 2) and preventive NIV (group 3). For each group we collected age, severity (score PIM 2), day of NIV and evolution. We considered failure of NIV if the patient needed intubation (group 1) or reintubation (groups 2 and 3) in the first 72 hours after the application of NIV. During the period of study, 313 children used NIV, some of them in more than one occasion (332 total events): 154 in group 1, 60 in group 2 and 118 in group 3. NIV was applied successfully in 52%, 63% and 77% of the patients in each group, respectively. In group 1, the success of NIV was related with less severity and in all the cases, patients who failed NIV had more days of admission in ICU and worse evolution. There is an increase in the use of NIV and this technique avoided invasive mechanical ventilation in a high rate of children. The preventive use of NIV demands more studies to define the clinical applications in this setting.