Noninvasive ventilation in pediatric acute respiratory failure by means of a conventional volumetric ventilator

Abstract

Acute respiratory failure (ARF) is one of the main causes for admission to pediatric intensive care unit (PICU). This study aimed to evaluate the feasibility and outcome of noninvasive ventilation (NIV) by a volumetric ventilator with a specific mode in pediatric acute respiratory failure. A three-year prospective non-controlled study was undertaken in children with ARF who had received NIV delivered by Evita 2 Dura with NIV mode through a nonvented oronasal mask. Thirty-two episodes of ARF were observed in 26 patients. Pneumonia was observed in most of the children (46.8%). Pediatric logistic organ dysfunction (PELOD) score was 12.4% ± 24% (range 0-84%). Peak inspiratory pressure was 18.5 ± 2.7 cmH₂O, positive end-expiratory pressure 5.7 ± 1.1 cmH₂O, pressure support 10.5 ± 2.7 cmH₂O, and mean pressure 9.2 ± 2 cmH₂O. The clinical score was improved progressively within the first 6 hours. Before the initiation of NIV, respiratory rate was 41.7 ± 16.3, heart rate 131.6 ± 25.8, systolic arterial pressure 108 ± 19.5, diastolic arterial pressure 58.2 ± 13.9, pH 7.33 ± 0.12, pCO₂ 55.1 ± 20.2, SatO₂ 87.8 ± 9.9 and FiO₂ 0.55 ± 0.25. There was a significant improvement in the respiratory rate, heart rate, pH, pCO₂ and SatO₂ at 2-4 hours. This improvement was kept throughout the first 24 hours. The level of FiO₂ was significantly lower at 24 hours. Radiological improvement was observed after 24 hours in 17 out of 26 patients. The duration of NIV was 85.4 ± 62.8 hours. Complications were defined as minor. Only 4 patients required intubation. All patients survived. NIV can be successfully applied to infants and children with ARF using this volumetric ventilator with specific NIV mode. It should be considered particularly in children whose underlying condition warrants avoidance of intubation.