Abstract
The aim of this paper is to assess the clinical efficacy of non-invasive ventilation (NIV) in avoiding endotracheal intubation (ETI), to demonstrate clinical and gasometric improvement and to identify predictive risk factors associated with NIV failure. An observational prospective clinical study was carried out. Included Patients with acute respiratory disease (ARD) treated with NIV, from November 2006 to January 2010 in a Pediatric Intensive Care Unit (PICU). NIV was used in 151 patients with acute respiratory failure (ARF). Patients were divided in two groups: NIV success and NIV failure, if ETI was required. Mean age was 7.2±20.3 months (median: 1 min: 0,3 max.: 156). Main diagnoses were bronchiolitis in 102 (67.5%), and pneumonia in 44 (29%) patients. There was a significant improvement in respiratory rate (RR), heart rate (HR), pH, and pCO2 at 2, 6, 12 and 24 hours after NIV onset (P<0.05) in both groups. Improvement in pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) was verified at 2, 4, 6, 12 and 24 hours after NIV onset in the success group (P<0.001). In the failure group, significant SpO2/FiO2 improvement was only observed in the first 4 hours. NIV failure occurred in 34 patients (22.5%). Risk factors for NIV failure were apnea, prematurity, pneumonia, and bacterial co-infection (P<0.05). Independent risk factors for NIV failure were apneia (P<0.001; odds ratio 15.8; 95% confidence interval: 3.42–71.4) and pneumonia (P<0.001, odds ratio 31.25; 95% confidence interval: 8.33–111.11). There were no major complications related with NIV. In conclusion this study demonstrates the efficacy of NIV as a form of respiratory support for children and infants with ARF, preventing clinical deterioration and avoiding ETI in most of the patients. Risk factors for failure were related with immaturity and severe infection.
Highlights
We report our experience with the use ure were apneia (P
There were 149 children subjected to NIV in a total of 151 NIV episodes, with each advance/SiPAP® was used in 35 (23.2%), Respironics BiPAP Vision® in 35 (23.2%) and Respironics BiPAP Harmony® in 10 (6.6%)
This study brings additional data to literatiring. It appears that early use of This study shows the relevance of the use of ture on NIV used on acute respiratory setting
Summary
NIV was documented by clinical and laboratory parameters such as respiratory rate Materials and Methods. (RR) and cardiac rate (HR) and improvement. Ventilatory support strategies zolam boluses (0.1 mg/kg), in order to avoid. NIV was used as a primary ventilatory sup- The ventilatory strategy was based on the patient-ventilator asynchrony, or in cases of port in patients with acute respiratory dis- guidelines mentioned above.[23] severe agitation. Tress/failure, with the objective of clinical NIV was delivered by continuous (CPAP) or improvement and avoidance of endotracheal intubation. We used a written standardized protocol, based on the guidelines published by Respiratory Group of the Spanish Society of Pediatric Intensive Care.[23] bi-level (BiPAP) positive airway pressure. The interface to the patient was chosen between the following four (according to patient age, comfort and availability): nasal or mouth-nose mask, binasal short prosthesis
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