O037 / #606: NON-INVASIVE VENTILATION PRACTICE FOR PRIMARY RESPIRATORY MANAGEMENT IN THE PEDIATRIC INTENSIVE CARE UNITS: AN INTERNATIONAL STUDY

Abstract

Aims & Objectives: To describe current practices and outcomes of Non-Invasive Ventilation (NIV) in PICUs internationally. Methods: IRB approved point prevalence study over 10 study weeks at 52 PICUs in 12 countries. Children were included if NIV was newly initiated on screening days, including high flow nasal cannula [HFNC: > 3LPM (Term / <1 year), > 4LPM (1-3 years), or >5LPM (>3 years)], continuous (CPAP) or bilevel positive airway pressure (BiPAP), or other NIV mode. We excluded post-operative cardiac surgery, post-extubation, and home NIV. The risk factor analysis used mixed effects logistic regression with stepwise addition/deletion (retention cutoff: p=0.15) Results: Of 15,310 patients screened, 695 met inclusion criteria, including 472 (68%) HFNC, 158 (23%) BiPAP, 62 (9%) CPAP, and 3 other modes. Median age was 15.4 months (IQR: 5.1-63.3). Main NIV indications were acute hypoxemia (51%) and respiratory distress (27%). NIV interface was nasal cannula 399 (58%), nasal mask/prongs 111 (16%), bucco-nasal mask 18 (3%), full-face mask 154 (22%), or other 3 (0.4%). NIV duration was 2.1 days (1-4). NIV failure (endotracheal intubation) occurred in 18.6% cases, 69.8% of them before 48h of NIV (Figure). After adjustment for severity of illness, risk factors for NIV failure included meeting at-risk criteria for Pediatric Acute Respiratory Distress Syndrome (p=0.02) and exposure to parenteral nutrition (p=<0.001). Factors predictive of NIV success were respiratory admission category (p=0.001) and exposure to enteral nutrition (p=0.001).Conclusions: NIV is frequently used in PICUs, with heterogenous practice. NIV failure occurs in 18.6% cases, most frequently within the first 48hrs